Deficits in Retinopathy Self-Awareness and Timeliness of Eye Care Follow-up Over 6 Years among Diabetic Patients

Abstract

Purpose : To assess deficits in diabetic retinopathy (DR) self-awareness and timeliness of eye care follow-up (FU) over a 6-year period in a teleophthalmology program.

Methods : Prospective cross-sectional study of 12,058 consecutive diabetic patients who received retinal imaging but had not received previous eye care at the Joslin Diabetes Center from January 1, 2010 to July 15, 2016. Patient self-reported DR history, time since last eye exam, and timing of next scheduled eye exam were recorded and compared with DR severity and FU recommendations based on imaging.

Results : Age (mean±SD) was 51.2±16.8 yrs with 54.7% male. Based on retinal imaging, 60% (6,859) had no DR, 21.3% (2,399) had mild nonproliferative DR (NPDR) and 17.8% (2,800) had vision-threatening DR (vtDR: moderate NPDR or worse, or any macular edema). Awareness of any DR was reported in 3.0%, 9.6% and 47.8% of patients with no, mild and vtDR, respectively. Appropriately timed FU based on DR severity at imaging was reported in 57.5%, 54.9% and 12.2% of subjects with no, mild and vtDR, respectively. Overall, DR awareness was associated with longer diabetes duration (p<0.0001), vtDR (P<0.0001), eye examination within 1 yr (P<0.0001), prior dilation (P<0.003), scheduled appointment (p<0.0001) and greater provider specialization (P<0.0001). Among patients with vtDR, 56%, 23% and 13% reported DR awareness (p<0.0001) and 31%, 14% and 7% reported timely FU (P=<0.0001) when prior examination had been performed by a retina specialist, nonretina ophthalmologist or optometrist, respectively. Increasing awareness was seen over time (1/2010-6/2012: 9.3%, 7/2012-6/2014: 10.6%, 7/2014-7/2016: 11.5%, p=0.02) as well as increasingly timely FU (43.9%, 46.8%, 47.3%, p=0.01).

Conclusions : In over 12,000 diabetic patients evaluated over 6 years, both overall patient awareness of eye disease when DR is present and timeliness of FU improved. However, especially with vtDR, large discrepancies exist between patient-reported awareness (52% unaware) and timeliness of FU eye care (88% not timely). Although significantly related to provider specialization, this discrepancy exists across all provider types (44%-87% unaware, 69%-93% not timely), suggesting that modifications of current medical care models to enhance transfer and retention of eye care knowledge to diabetic patients are urgently needed.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.