Prevalence and Predictors for Being Unscreened for Diabetic Retinopathy

Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults aged between 20 and 74 years in the US. DR affects >5.3 million Americans aged ≥18 years.¹ Over time, more than half of the population with diabetes will develop diabetic retinopathy.² This retrospective study used several databases to assess the prevalence and population-level predictors for people with diabetes who were not screened for DR.

This study, one the largest of its type, included approximately 14 million individuals in Ontario enrolled in the single-payer Canadian healthcare system. It found that approximately 1.2 to 1.3 million people had diabetes from 2011 to 2013 and from 2017 to 2019. Approximately 35% of people with diabetes were not screened for DR. The predictors for not being screened were: young adults, low income, immigrants, residents in large cities, history of mental illness, and no primary care access. Surprisingly about 55% of those not screened for DR did not have a primary care provider.

Screening for DR is important as it may prevent vision loss and blindness. Individuals with type 2 diabetes are recommended to complete their first eye examination at the time of diagnosis of diabetes, irrespective of age. Those with type 1 diabetes aged between 10 and 15 years or older should have their first eye examination within 5 years of diagnosis.³

The results that 35% of people with diabetes were not screened suggest that a community-wide approach is needed to ensure that all people with diabetes are screened for DR. To maximize success, everyone who interacts with these unscreened people should help them be screened. This would include primary care providers, specialists, pharmacists, employers, government agencies overseeing income supplementation and immigration status, public health agencies, media (public service advertisements), and clinics in non-traditional settings such as retail and drug stores. To minimize cost and maximize participation, current teleretinal screening programs in the US could be expanded to include private practices.^4-6

References

1. Common Eye Disorders and Diseases. Centers for Disease Control and Prevention. Accessed May 31, 2022. https://www.cdc.gov/visionhealth/basics/ced/index.html
2. Diabetic Retinopathy. National Eye Institute. Accessed May 31, 2022. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy
3. Flaxel CJ, Adelman RA, Bailey ST, et al. Diabetic retinopathy preferred practice pattern. Ophthalmology. 2020;127(1):66–145. https://www.aaojournal.org/article/S0161-6420(19)32092-5/fulltext
4. Daskivich LP, Vasquez C, Martinez C, et al. Implementation and Evaluation of a Large-Scale Teleretinal Diabetic Retinopathy Screening Program in the Los Angeles County Department of Health Services. JAMA Intern Med. 2017;177(5):642–649. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2612116
5. Chasan JE, Delaune B, Maa AY, et al. Effect of a teleretinal screening program on eye care use and resources. JAMA Ophthalmol. 2014;132(9):1045–1051. https://jamanetwork.com/journals/jamaophthalmology/article-abstract/1874720
6. Zimbalist RJ, Scharnweber AR. Teleretinal Imaging for Diabetic Retinopathy. Think remote screening doesn’t apply to your practice? Think again. Rev Optom Published December 15, 2016. Accessed May 31, 2022. https://www.reviewofoptometry.com/article/teleretinal-imaging-for-diabetic-retinopathy