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Jay B Lusk, Ailin Song, Karen A Scherr, Ryan P McNabb, Anthony N Kuo; Real-world practice patterns of diabetic retinopathy screening in primary care: direct ophthalmoscopy and screening exam documentation. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1144.
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Diabetic retinopathy (DR) screening is critical to prevent vision loss, but how screening is conducted and documented in the real-world primary care setting has not been reported. We performed a retrospective, observational study to determine the practice patterns for preventative eye care for patients with diabetes seen in a large single-institution primary care network.
All adult patients with diabetes mellitus who were seen at least once at one of the practices within a large primary care network in the year of 2019 were identified (n=7449). A subset of patients was randomly selected for chart review (n=171), and all primary care encounters for diabetes care or general wellness within the year were reviewed for each patient. Within each encounter, we examined whether the primary care provider (PCP) documented: 1) a direct ophthalmoscope examination; and 2) if the patient’s screening eye exam was up to date. The ophthalmology visit closest in date to each primary care encounter, if within 2 years of the encounter, was also reviewed for diagnoses and examination findings, and findings were compared to the PCP’s direct ophthalmoscopy results. Statistics were calculated in R.
414 primary care encounters from 171 patients were reviewed, 38% (159) for an annual physical examination and 62% (255) for diabetes care. PCPs documented a direct ophthalmoscope examination in 14% (24) of the patients; all results were documented as normal (Table 1). PCPs also documented whether the ophthalmology exam was up to date for 79% (165) of patients; 42% (71) were up to date, and 37% (64) were not up to date. There was no documentation of ophthalmology exam status for the remaining 21% (36) of patients. 50% (85) of patients had an ophthalmology visit within 2 years. For the encounters where both direct ophthalmoscopy results and ophthalmology clinical diagnosis were available (n=18), the rate of agreement was 33% (13%, 59%); sensitivity of direct ophthalmoscopy for detecting posterior eye pathology was 0% (0%, 27%).
This study is one of the first to document the real-world practice patterns for DR screening in primary care, demonstrating the challenges associated with DR screening in that setting. Systems-level approaches are needed to improve preventative eye care for patients with diabetes.
This is a 2021 ARVO Annual Meeting abstract.
Table 1: Characteristics of the patients in the study
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