Trends in eye care use in adults treated for diabetes between 2008 and 2017 in France: a nationwide study

Abstract

Purpose :
The objective of this study was to describe eye care use among adults treated for diabetes from 2008 to 2017, in the French population.

Methods : We used the Echantillon Généraliste de Bénéficiaires (EGB), a 1/97th random representative permanent sampling of the national health insurance system database, which covers now 98.8% of the French population (whether they have received reimbursement or not). EGB includes from 503 758 individuals in 2008 to 703 261 in 2017. The participants of this study were Individuals treated with anti-diabetic drugs, 18 years old and older, who lived in France and were covered by the national health insurance system. Treated diabetic individuals were defined as subjects receiving reimbursements of antidiabetic medications or insulin therapy on at least three different dates during a given year. Ophthalmological management was defined by: eye examination, defined by at least one visit to ophthalmologists or retina imaging procedure by year (annual eye examination) or every two years (biennial eye examinations); retina imaging procedures, defined by at least one optical coherence tomography (OCT) or fluorescein angiography in the year and medical treatment, defined by at least one laser photocoagulation in the posterior pole or intravitreal injection (IVI) in the year. Cross-sectional studies of ophthalmological management of the diabetic subjects were performed each year from 2008 to 2017.

Results : Between 2008 and 2017, less than 50% of treated diabetics underwent an annual eye examination (2008: 44.7%; 2017: 47.9%) and less than two-third a biennial eye examination (2008-2009: 62.6%; 2016-2017: 66.4%). From 2008 to 2017, the use of OCT examinations increased steadily from 2.7% to 16.2%, while use of fluorescein angiography decreased from 2.4% to 0.9%. In the same period, IVI increased from 0.3% to 1.5% and laser photocoagulation decreased progressively from 2008 to 2014 (1.3% vs 0.7%) but slightly increased from 2015 to 2017 (0.8% vs 1.0%).

Conclusions : Although eye care has strongly evolved in recent years, with an increasing use of OCT imaging and intravitreal injections, adherence to recommended eye examinations remains insufficient in French diabetics. Strategies to increase compliance are needed to improve early detection and timely treatment of diabetic eye disease.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.