Awareness of Retinopathy and Timeliness of Follow-up Among Patients Presenting to a Diabetes Teleophthalmology Program

Abstract

Purpose: : To evaluate patient awareness of their diabetic retinopathy (DR) and timeliness of previously scheduled followup as reported at the time of teleophthalmology (JVN: Joslin Vision Network) evaluation in a tertiary multispecialty academic diabetes center.

Methods: : Cross-sectional survey of first-time JVN patients from 12/15/2009-11/30/2010. Patient-reported DR history, time since last eye exam, and time to next scheduled eye exam were recorded prior to retinal imaging.

Results: : 2,795 sequential patients had median age of 56yrs (Q1,Q3:44,66), DM duration 9yrs (3,16), HbA1c 7.8% (7,9); 54% were male and 68% white. In the eye with more severe DR, 59% (1,636) had no DR, 15% (430) mild nonproliferative DR (NPDR) and 25% (698) moderate NPDR or worse; 1% (31) of images were ungradable. Diabetic macular edema (DME) was absent in 84% (371) and present in 7% (181); 9% (243) were ungradable for DME. Vision threatening DR (vtDR: moderate NPDR or worse, or DME) was present in 27% (743). 17% (195) of patients with DR and 22% (162) with vtDR were aware of their DR despite 72% (809) and 73% (539) reporting an eye exam within the past year, respectively. Nearly 50% (369) with vtDR reported followup interval longer than recommended for the severity of DR seen on imaging. Patients with vtDR who were aware of their DR were younger (p=0.003) and had longer DM duration (p<0.0001). Increased patient awareness of DR and timely followup were associated with eye care provider specialization. Nearly 60% of patients seen by retina specialists were aware of their DR, while 21% seen by comprehensive ophthalmologists and 16% seen by optometrists were aware of their DR (p<0.0001). Timely followup (based on severity of DR at imaging) was also dependent on provider with 67%, 59% & 49% of patients having a timely followup appointment scheduled when seen by a retina specialist, comprehensive ophthalmologist or optometrist, respectively (p<0.0001).

Conclusions: : A large percentage of patients with DR (>82%) and vtDR (>78%) remain unaware of their DR despite ongoing eye care. Although awareness is increased by more specialized eye care providers, 40% of patients under such care are not appropriately aware of their DR. These data suggest that efforts to increase patient education and enhance successful transfer of knowledge from providers to their patients are urgently needed.

Keywords: diabetic retinopathy • diabetes • retina