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Eye care availability and access among individuals with diabetes, diabetic retinopathy, or age-related macular degeneration.
JAMA Ophthalmol. 2014 Apr 01; 132(4):471-7.JO

Abstract

IMPORTANCE Understanding whether differences in the local availability of eye care professionals are related to differences in realized access to eye care is important for assessing whether and where public health efforts are needed to increase access to eye care professionals.

OBJECTIVE

To examine whether the county-level availability of ophthalmologists and optometrists is associated with measures of realized access to eye care for individuals with diabetes mellitus, diabetic retinopathy, or age-related macular degeneration (ARMD). DESIGN, SETTING, AND PARTICIPANTS We studied a cross-sectional sample of US adults 40 years and older (1098 individuals with diabetes, 345 with diabetic retinopathy, and 498 with ARMD) from the 2005-2008 National Health and Nutrition Examination Survey. MAIN OUTCOMES AND MEASURES Outcomes were whether diabetic individuals reported undergoing a dilated eye examination in the past year, whether individuals were unaware they had diabetic retinopathy, whether diabetic individuals had vision-threatening diabetic retinopathy, and whether individuals were unaware they had ARMD.

RESULTS

In logistic regression models that also included individual characteristics, individuals who lived in a county in the highest ophthalmologist availability quartile were less likely to be unaware they had diabetic retinopathy (predictive margin [PM], 66.1%; 90% CI, 48.8%-83.4%; vs PM, 84.1%; 90% CI, 78.7%-89.6%) and were less likely to have vision-threatening diabetic retinopathy (PM, 1.4%; 90% CI, 0.9%-1.9%; vs PM, 2.6%; 90% CI, 1.8%-3.4%) than individuals who lived in a county in the lower 3 ophthalmologist availability quartiles. Individuals who lived in a county in the lowest ophthalmologist availability quartile were more likely to be unaware they had ARMD (PM, 93.8%; 90% CI, 90.6%-97.0%; vs PM, 88.3%; 90% CI, 84.7%-91.9%) than individuals who lived a county in the higher 3 ophthalmologist availability quartiles. Optometrist availability quartiles were not significantly related to any of the outcomes.

CONCLUSIONS

AND RELEVANCE The results suggest that efforts to increase access to ophthalmologists to improve outcomes related to diabetic retinopathy or to increase awareness of ARMD should focus on improving access for diabetic individuals who live in counties in the lowest 3 quartiles of ophthalmologist availability and on individuals at risk of ARMD who live in counties in the lowest quartile of ophthalmologist availability.

Authors+Show Affiliations

School of Public Affairs, Baruch College-City University of New York, New York, New York.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24458097

Citation

Gibson, Diane M.. "Eye Care Availability and Access Among Individuals With Diabetes, Diabetic Retinopathy, or Age-related Macular Degeneration." JAMA Ophthalmology, vol. 132, no. 4, 2014, pp. 471-7.
Gibson DM. Eye care availability and access among individuals with diabetes, diabetic retinopathy, or age-related macular degeneration. JAMA Ophthalmol. 2014;132(4):471-7.
Gibson, D. M. (2014). Eye care availability and access among individuals with diabetes, diabetic retinopathy, or age-related macular degeneration. JAMA Ophthalmology, 132(4), 471-7. https://doi.org/10.1001/jamaophthalmol.2013.7682
Gibson DM. Eye Care Availability and Access Among Individuals With Diabetes, Diabetic Retinopathy, or Age-related Macular Degeneration. JAMA Ophthalmol. 2014 Apr 1;132(4):471-7. PubMed PMID: 24458097.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Eye care availability and access among individuals with diabetes, diabetic retinopathy, or age-related macular degeneration. A1 - Gibson,Diane M, PY - 2014/1/25/entrez PY - 2014/1/25/pubmed PY - 2014/6/15/medline SP - 471 EP - 7 JF - JAMA ophthalmology JO - JAMA Ophthalmol VL - 132 IS - 4 N2 - IMPORTANCE Understanding whether differences in the local availability of eye care professionals are related to differences in realized access to eye care is important for assessing whether and where public health efforts are needed to increase access to eye care professionals. OBJECTIVE To examine whether the county-level availability of ophthalmologists and optometrists is associated with measures of realized access to eye care for individuals with diabetes mellitus, diabetic retinopathy, or age-related macular degeneration (ARMD). DESIGN, SETTING, AND PARTICIPANTS We studied a cross-sectional sample of US adults 40 years and older (1098 individuals with diabetes, 345 with diabetic retinopathy, and 498 with ARMD) from the 2005-2008 National Health and Nutrition Examination Survey. MAIN OUTCOMES AND MEASURES Outcomes were whether diabetic individuals reported undergoing a dilated eye examination in the past year, whether individuals were unaware they had diabetic retinopathy, whether diabetic individuals had vision-threatening diabetic retinopathy, and whether individuals were unaware they had ARMD. RESULTS In logistic regression models that also included individual characteristics, individuals who lived in a county in the highest ophthalmologist availability quartile were less likely to be unaware they had diabetic retinopathy (predictive margin [PM], 66.1%; 90% CI, 48.8%-83.4%; vs PM, 84.1%; 90% CI, 78.7%-89.6%) and were less likely to have vision-threatening diabetic retinopathy (PM, 1.4%; 90% CI, 0.9%-1.9%; vs PM, 2.6%; 90% CI, 1.8%-3.4%) than individuals who lived in a county in the lower 3 ophthalmologist availability quartiles. Individuals who lived in a county in the lowest ophthalmologist availability quartile were more likely to be unaware they had ARMD (PM, 93.8%; 90% CI, 90.6%-97.0%; vs PM, 88.3%; 90% CI, 84.7%-91.9%) than individuals who lived a county in the higher 3 ophthalmologist availability quartiles. Optometrist availability quartiles were not significantly related to any of the outcomes. CONCLUSIONS AND RELEVANCE The results suggest that efforts to increase access to ophthalmologists to improve outcomes related to diabetic retinopathy or to increase awareness of ARMD should focus on improving access for diabetic individuals who live in counties in the lowest 3 quartiles of ophthalmologist availability and on individuals at risk of ARMD who live in counties in the lowest quartile of ophthalmologist availability. SN - 2168-6173 UR - https://www.unboundmedicine.com/medline/citation/24458097/Eye_care_availability_and_access_among_individuals_with_diabetes_diabetic_retinopathy_or_age_related_macular_degeneration_ L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2013.7682 DB - PRIME DP - Unbound Medicine ER -