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Fang Ko, Susan Vitale, David Friedman; Potential Targets for Preventative Eye Care Among those with Diabetes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2170.
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The need for dilated eye exams is an important problem as the prevalence of diabetes increases. We analyzed data from a population-based study of US adults with diabetes to determine who had received a dilated eye exam (DFE) in the past year, and what risk factors are associated with not receiving an examination.
The National Health and Nutrition Examination Survey (NHANES) examines a representative sample of the US non-institutionalized population. In 2005-2008, 10,480 participants were surveyed, and 1,298 reported having diabetes. These participants received questionnaire, lab testing, physical examination, and visual acuity measurement including autorefraction.
38% (95% confidence interval (CI) 31.4-43.2) of people with diabetes living in the US reported not having a dilated fundus exam (DFE) in the past year. Multivariable regression showed those at greater risk for not receiving a dilated fundus exam in the past year were younger (64% of participants age 20-39 years did not receive DFE, odds ratio (OR) 2.66 [95% CI 1.36-5.20] as compared to age ≥65 years), lacked access to health care (80% did not receive DFE, OR 6.40 [95% CI 1.57-26.06]), had no insurance (64% did not receive DFE, OR 3.06 [95% CI 1.64-5.73]), and stated that a doctor had not told them that their eyes were affected by diabetes (59.6% did not receive DFE, OR 2.08 [95% CI 1.17-3.71]). Those with diabetes longer-duration diabetes were no more likely to receive a dilated eye exam than those with shorter duration (35% of those with diabetes ≥10 years duration, and 39% of those with diabetes <10 years, did not receive an eye exam, p=0.14). Ethnicity, gender, poverty, education less than high school, smoking, type of insurance, and visual acuity were not significantly associated with receiving a DFE.
Over a third of persons in the U.S. with diabetes, a group at higher risk for ophthalmic complications, did not have an eye exam in the past year. To increase screening rates, programs will need to focus on those at greatest risk of not receiving a DFE, including younger populations, those lacking access to eyecare providers, those without health insurance, and those who may not be aware of how diabetes affects their eyes.
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