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P. S. Silva, J. K. Sun, M. M. Al-Latayfeh, C. R. Sanchez, S. Walia, K. Hock, A. M. Tolson, J. D. Cavallerano, L. M. Aiello, L. P. Aiello; Unawareness of Vision Threatening Diabetic Retinopathy and Appropriate Followup in a Tertiary Telemedicine Eye Care Program. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5059.
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To assess timeliness of eye care provider scheduled followup and extent of retinopathy awareness among diabetic patients with vision threatening diabetic retinopathy (vtDR) evaluated by the Joslin Vision Network (JVN) telemedicine eye care program.
Retrospective structured query review of electronic medical records (EMR) of all JVN patients (1/1/06-10/31/08).
7,358 records were reviewed and 705 (10%) patients had vtDR (moderate NPDR or worse, or any DME). Compared to the entire cohort, patients with vtDR were older (median age 57 vs 54y; p<0.0001), male (58 vs 55%; p<0.0001), longer median diabetes (DM) duration (16 vs 8y; p<0.0001) and higher mean HbA1c (8.2 vs 8.0; p<0.0001). 565 (80%) patients reported dilated eye exam within the past year and 425 (60%) reported eye followup plans. By JVN evaluation, 58% had DR severity requiring earlier followup than suggested by their eye care provider. Of those with vtDR, 78% reported on DR awareness with 56% being unaware they had DR. Current HbA1c did not differ significantly. Adjusting for age, DM duration and DR severity, patients were more likely aware of DR if their provider was a retinal physician (66%) than with a nonretina ophthalmologist (58%) or optometrist (33%) [trend p=0.006]. Patients were more likely aware than unaware of their DR if they were previously examined by a retinal physician (1.9-fold; p=0.005) or ophthalmologist (1.1-fold; p=0.002), but less likely aware with an optometrist (0.5-fold; p=0.40). Patients unaware of DR had worse mean VA (20/20 vs 20/15; p=0.002).
Although 80% of persons with vision threatening DR at initial evaluation in a diabetes-dedicated academic medical center reported a dilated exam in the past year, 56% were unaware of their DR. More than half required earlier follow-up than recommended by their eye care provider. In this population, patient awareness of retinopathy was strongly associated with both type of eye care provider and with better VA outcome. These data emphasize the need for patient awareness of diabetic eye disease and access to qualified eye care.
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