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Benjamin Leiby, David Weiss, Ann P Murchison, Robin J Casten, Lisa A Hark, Julia A Haller; Ocular Disease Incidence and Factors that Influence DFE Adherence in African Americans with Diabetes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5341.
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African Americans have high rates of diabetes and diabetic retinopathy and prevalence is increasing. This study aimed to document incidence of ocular diseases and identify factors that impact annual eye exam adherence in older, African Americans with diabetes who did not have a dilated fundus exam (DFE).
In a prospective clinical trial, 206 African Americans with diabetes were randomized into a home-based behavioral intervention group or an attention control group after an initial baseline assessment. In the control group, a trained interventionist encouraged participants to talk about how diabetes affects their daily life in four individual sessions. Active intervention components, such as eye care education and goal setting to obtain a DFE, were not included in the control group. The Visual Function Questionnaire-25 (NEI-VFQ), a verbal memory test, and depression and diabetes management questionnaires were administered at the baseline visit. Control group demographic and baseline characteristics were analyzed to identify factors that may influence DFE adherence. DFE results were examined to determine incidence of eye disease.
The majority of the 103 control group participants were female (66.1%) with a mean age of 73.1 years. Of the 79 control patients who completed study participation, 32.9% obtained a DFE. There were no differences between control subjects who obtained a DFE and those who did not in age, education, hemoglobin A1C, verbal memory, self-report of diabetes management or depression, or NEI-VFQ subscales including on Near and Distance Activities, Social Functioning, and Mental Health. However, control group participants who obtained a DFE were significantly more likely to report ocular pain (M=75.54, SD=24.85) on the NEI-VFQ compared to participants who did not obtain a DFE (M=87.75, SD=19.12, t(72)= 2.31 p=0.024). For control participants who received an eye exam, 73% were diagnosed with cataracts and 11.5% were diagnosed with diabetic retinopathy.
In an older African-American sample with diabetes who are not adherent to DFE recommendations, individuals who reported more ocular pain prior were more likely to obtain a DFE. Older African-Americans with diabetes who are visually asymptomatic remain at-risk for ocular disease and should be targeted in future ophthalmic trials to improve DFE adherence.
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