Purpose:
To assess patients’ understanding and possible misconceptions regarding diabetic eye disease, in order to further identify areas in which patient education should be implemented or improved.
Methods:
A 25-item questionnaire was developed to address three main topics: demographics and glycemic control, diabetic effect on the eye, and the treatment of diabetic eye disease. The patient’s location (general versus retina clinic) and the retinopathy classification, based on ETDRS classification, were recorded. The study was performed at Texas Diabetic Institute, San Antonio, Texas. Patients meeting the inclusion criteria were invited to participate in the study. English and Spanish versions were available, and the survey was administered verbally to those who were unable to read. Data was entered in an Excel database and analyzed.
Results:
A total of 46 patients were surveyed. Over 85% of the participants were seen in the retina clinic and 69% were over age of 50. Greater than 90% of the patients were Hispanic, 67% had diabetes for longer than 10 years, and 80% of the patients had proliferative diabetic retinopathy. Over 70% of patients knew the recommended range for blood glucose level, but 60% of patients did not know their last hemoglobin A1c (HbA1c) and 63% did not know the recommended HbA1c goal. Four percent of patients felt their glycemic control was excellent, but none of them knew the recommended goals; on the contrary, 13% felt their glycemic control was poor and all of them knew the recommended range. Only 41% of patients understood the pathophysiology of diabetes, but when asked about the basic presentation of diabetic retinopathy (i.e. bleeding in the eye), 86% responded correctly. When asked about the goal of laser treatment for diabetic retinopathy 65% of patients responded correctly. Regarding barriers to care, nearly 90% of patients followed up with their ophthalmology appointments. Of those who didn’t follow up, 2% reported a negative experience with laser. Nearly half of the patients wished that their ophthalmologist took more time to explain diabetic eye disease.
Conclusions:
Despite duration of diabetes and advanced diabetic eye disease, the majority of the patients lack understanding of key concepts of blood glucose control, specifically HbA1c values. In addition, these patients struggle to identify basic mechanisms of their disease process and the goal of laser photocoagulation. In order to address these gaps in understanding, focused patient education should be integrated into the routine clinical care of these patients. Given patients’ desire to learn more about their disease, this is an important opportunity for the ophthalmologist to potentially improve patient care and outcomes.
Keywords: diabetes • diabetic retinopathy • clinical (human) or epidemiologic studies: health care delivery/economics/manpower