Adherence to eye examination guidelines among individuals with diabetes: An analysis of linked health data.

IMPORTANCE

Screening for diabetic retinopathy for early detection and treatment can prevent vision loss.

BACKGROUND

We aimed to assess rates of eye examination of people with diabetes, adherence with national guidelines and investigate characteristics of those who do not adhere.

DESIGN

We used data from the 45 and Up Study, a cohort study of 267 153 randomly selected residents aged ≥45 years from New South Wales, Australia. Individual survey data collected in 2006 to 2009 were linked to corresponding national Medicare Benefits Schedule claims data for 2006 to 2016.

PARTICIPANTS

The study sample included 24 832 participants who reported having diabetes and at least 5 years of observation.

METHODS

Claims for visits to optometrists or ophthalmologists were assessed to estimate rates of eye examination. Poisson regression models were used to investigate factors associated with non-adherence.

MAIN OUTCOME MEASURE: Participants were classified as adherent if the average time between eye care claims was consistent with national guideline of having an eye exam every 2 years.

RESULTS

Of 50% to 75% people with diabetes met the biennial eye examination guidelines and only 21% to 28% with diabetes duration ≥10 years were adherent to the annual eye examination guideline. Characteristics associated with greatest (~1.3-fold) risk of non-adherence were smoking, age <60 years and higher income.

CONCLUSIONS AND RELEVANCE: There is a clear need to improve rates of adherence to eye examination guidelines among people with diabetes to reduce the personal and societal burden of diabetic retinopathy.