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Characteristics Associated with Adherence to Annual Dilated Eye Examinations among US Patients with Diagnosed Diabetes.
Ophthalmology. 2019 11; 126(11):1492-1499.O

Abstract

PURPOSE

To identify the characteristics that are associated with adherence to annual diabetic eye exams and patient awareness of retinopathy using a nationally representative sample from the United States.

DESIGN

Cross-sectional, secondary analysis.

PARTICIPANTS

National Health and Nutrition Examination Survey (NHANES) participants from 2005 to 2016 aged 20 years and older with diabetes mellitus.

METHODS

The NHANES collected surveys every 2 years from 2005 to 2016, which contained demographic information, clinical information, and time to last dilated eye exam. From 2005 to 2008, retinal photographs were taken of all participants older than 40 years of age. We used univariate and multivariable logistic regression to determine the demographic and clinical factors associated with adherence to annual diabetic eye examinations and those associated with correctly reporting their retinopathy status.

MAIN OUTCOME MEASURE

Factors associated with adherence defined as having an eye exam within the preceding 12 or 24 months.

RESULTS

From 2005 to 2016, NHANES surveyed 4072 individuals who represent 20 million Americans aged 20 years and older with self-report of diabetes. By using the adherence definitions of 12 and 24 months, 63.4% and 78.7%, respectively, were adherent to diabetic eye examinations. The nonadherence rates of 36.6% and 21.3% for this national estimate did not change from 2005 to 2016 (P = 0.7, logistic regression). Insurance status, age, education, income, cholesterol levels, duration of diabetes, and self-reported retinopathy were all significantly associated with adherence with both definitions (all P < 0.05, logistic regression). Insurance status had the highest predictive value, with 76% of Americans on combination private-public insurance adherent compared with 36% of uninsured. Most Americans with retinopathy incorrectly denied having the diagnosis (2 727 144/3 896 093 or 70%).

CONCLUSIONS

Multiple variables were associated with nonadherence to eye exams, with insurance status having the strongest association. Adherence with annual eye exams has not improved over the past decade. The majority of patients with retinopathy are unaware of this diagnosis, including the majority of those with a dilated funduscopic examination in the past year. Further improvements in education and adherence may reduce the visual morbidity caused by diabetes.

Authors+Show Affiliations

School of Medicine, University of California, San Francisco, California.Devers Eye Institute, Legacy Health System, Portland, Oregon.Department of Ophthalmology, University of California, San Francisco, California.Devers Eye Institute, Legacy Health System, Portland, Oregon; Casey Eye Institute, Oregon Health and Sciences University, Portland, Oregon. Electronic address: eugenelowry@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31281055

Citation

Eppley, Sarah E., et al. "Characteristics Associated With Adherence to Annual Dilated Eye Examinations Among US Patients With Diagnosed Diabetes." Ophthalmology, vol. 126, no. 11, 2019, pp. 1492-1499.
Eppley SE, Mansberger SL, Ramanathan S, et al. Characteristics Associated with Adherence to Annual Dilated Eye Examinations among US Patients with Diagnosed Diabetes. Ophthalmology. 2019;126(11):1492-1499.
Eppley, S. E., Mansberger, S. L., Ramanathan, S., & Lowry, E. A. (2019). Characteristics Associated with Adherence to Annual Dilated Eye Examinations among US Patients with Diagnosed Diabetes. Ophthalmology, 126(11), 1492-1499. https://doi.org/10.1016/j.ophtha.2019.05.033
Eppley SE, et al. Characteristics Associated With Adherence to Annual Dilated Eye Examinations Among US Patients With Diagnosed Diabetes. Ophthalmology. 2019;126(11):1492-1499. PubMed PMID: 31281055.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics Associated with Adherence to Annual Dilated Eye Examinations among US Patients with Diagnosed Diabetes. AU - Eppley,Sarah E, AU - Mansberger,Steven L, AU - Ramanathan,Saras, AU - Lowry,Eugene A, Y1 - 2019/06/15/ PY - 2019/01/31/received PY - 2019/05/03/revised PY - 2019/05/31/accepted PY - 2019/7/10/pubmed PY - 2020/3/14/medline PY - 2019/7/9/entrez SP - 1492 EP - 1499 JF - Ophthalmology JO - Ophthalmology VL - 126 IS - 11 N2 - PURPOSE: To identify the characteristics that are associated with adherence to annual diabetic eye exams and patient awareness of retinopathy using a nationally representative sample from the United States. DESIGN: Cross-sectional, secondary analysis. PARTICIPANTS: National Health and Nutrition Examination Survey (NHANES) participants from 2005 to 2016 aged 20 years and older with diabetes mellitus. METHODS: The NHANES collected surveys every 2 years from 2005 to 2016, which contained demographic information, clinical information, and time to last dilated eye exam. From 2005 to 2008, retinal photographs were taken of all participants older than 40 years of age. We used univariate and multivariable logistic regression to determine the demographic and clinical factors associated with adherence to annual diabetic eye examinations and those associated with correctly reporting their retinopathy status. MAIN OUTCOME MEASURE: Factors associated with adherence defined as having an eye exam within the preceding 12 or 24 months. RESULTS: From 2005 to 2016, NHANES surveyed 4072 individuals who represent 20 million Americans aged 20 years and older with self-report of diabetes. By using the adherence definitions of 12 and 24 months, 63.4% and 78.7%, respectively, were adherent to diabetic eye examinations. The nonadherence rates of 36.6% and 21.3% for this national estimate did not change from 2005 to 2016 (P = 0.7, logistic regression). Insurance status, age, education, income, cholesterol levels, duration of diabetes, and self-reported retinopathy were all significantly associated with adherence with both definitions (all P < 0.05, logistic regression). Insurance status had the highest predictive value, with 76% of Americans on combination private-public insurance adherent compared with 36% of uninsured. Most Americans with retinopathy incorrectly denied having the diagnosis (2 727 144/3 896 093 or 70%). CONCLUSIONS: Multiple variables were associated with nonadherence to eye exams, with insurance status having the strongest association. Adherence with annual eye exams has not improved over the past decade. The majority of patients with retinopathy are unaware of this diagnosis, including the majority of those with a dilated funduscopic examination in the past year. Further improvements in education and adherence may reduce the visual morbidity caused by diabetes. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/31281055/Characteristics_Associated_with_Adherence_to_Annual_Dilated_Eye_Examinations_among_US_Patients_with_Diagnosed_Diabetes_ DB - PRIME DP - Unbound Medicine ER -