Patient motivators and preferences regarding diabetic retinopathy screening methods at a rural eye clinic

Abstract

Purpose : Barriers and facilitators to patients receiving tele-ophthalmology for diabetic retinopathy are not well-understood. We sought to ascertain what motivates rural patients to undergo diabetic eye screening and to determine their preferred method of screening: a clinical dilated eye exam versus tele-ophthalmology using non-mydriatic fundus photography.

Methods : 33 adults with diabetes at a rural eye clinic previously scheduled for a clinical dilated eye exam were enrolled. All participants underwent non-mydriatic fundus photography just prior to dilation. Participants completed a written survey that asked for reasons motivating their eye clinic visit, their beliefs regarding diabetic eye disease, their preferences regarding diabetic eye screening methods, and whether they would be willing to participate in tele-ophthalmology screening in the future.

Results : Participants were predominantly male (67%) with a mean age of 71 years. Each endorsed multiple reasons for obtaining a diabetic eye exam. The most common (75%) were beliefs that diabetes could “cause eye problems” and that the exam would “prevent [the patient] from losing vision.” 50% reported that a recommendation from their primary diabetes doctor was also a motivating factor. However, none endorsed having insurance coverage or enjoying eye exams as motivating factors. The majority preferred non-mydriatic photography to a clinical dilated exam. The primary reasons cited were all related to avoidance of pupil dilation, which was described as time-consuming, required the assistance of a driver to get home, and caused sufficient difficulty with vision afterwards that it limited the ability to “get on with life.” All participants were willing to have tele-ophthalmology screening in the future. When asked to describe non-mydriatic fundus photography, the most common responses (75%) were “quick,” “easy,” and “painless.” In addition, many reported that they would recommend this method of screening to their friends and family.

Conclusions : The primary motivator for obtaining screening was the concern that diabetic eye disease could lead to vision loss. Tele-ophthalmology screening was acceptable to all and was preferred by most participants because it did not require dilation. Emphasis on the lack of pupil dilation may increase patient use of tele-ophthalmology in rural settings.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.