Abstract
Purpose :
To identify the demographic and clinical characteristics that predict adherence to recommended screening eye exams among American diabetic patients.
Methods :
A cross-sectional secondary analysis of Americans age 20 and older with diabetes mellitus using data from the National Health and Nutrition Examination Survey (NHANES), 2005-2016. NHANES performs nationally representative surveys every two years and collects demographic and clinical information, as well as time to last dilated eye exam, in all survey cycles. Univariate and multivariable logistic regression determined which factors predicted adherence to diabetic screening eye exams. Adherence was defined as an eye exam within the preceding 12 months, or 24 months in secondary analysis. From 2005-2008, retinal photographs were taken of participants over age 40. This sub-sample was further analyzed to determine predictors of patients correctly reporting retinopathy status.
Results :
From 2005-2016, NHANES surveyed 4,072 individuals age 20 and older with self-report of diabetes, representing 20 million diabetic Americans. Within the study population, 63.4% were adherent to the AAO recommendation for annual diabetic eye examinations and 78.7% were adherent to the ADA biennial recommendation. Insurance status, age, education, income, cholesterol levels, duration of diabetes and self-reported retinopathy were all significantly associated with adherence (all p<0.05, logistic regression). Lack of insurance was the single strongest predictor of failure to receive annual eye exams in this study. The overall nonadherence rate of 36.6% for annual eye exams for this national estimate did not change from 2005 to 2016 (p = 0.7, logistic regression). Most patients (71%) with retinopathy on exam denied having ever been given the diagnosis, and 61% of those who incorrectly denied having retinopathy endorsed receiving a dilated exam in the past year.
Conclusions :
Significant barriers persist in preventing adherence to recommended eye screenings among patients with diabetes, and rates of adherence to annual diabetic eye exams have not improved in the US over the past decade. Patients generally remain unaware of diabetic eye disease even when compliant with annual eye exams. Further improvements in diabetic retinopathy education and accessibility is needed to improve adherence and reduce the visual morbidity caused by diabetes.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.