Screening for Diabetic Eye Disease Increases With Awareness, Access

Increasing patient and clinician awareness and improving access to health care can encourage people with diabetes to seek annual eye exams, which help prevent a serious complication called retinopathy, according to a new systematic review of studies.

However, the studies showed that these tactics are less successful when conducted among ethnic minorities or in rural areas, according to researchers led by Xuanping Zhang, Ph.D., of the Centers for Disease Control and Prevention.

Minorities have a higher prevalence of diabetes than whites do, according to the U.S. Agency for Healthcare Research and Quality. Some minority groups also have much higher rates of diabetes-related complications, in some instances by as much as 50 percent more than the total population.

Diabetic retinopathy occurs when chronically elevated blood-sugar levels damage small blood vessels in the eye. The disease might cause very few symptoms before vision loss begins, and it remains the leading cause of new-onset blindness among American adults.

Careful control of blood glucose and blood pressure can reduce the risk of these eye problems, and in more advanced cases, laser surgery can often preserve vision.

The American Diabetes Association recommends dilated eye exams at least once a year for most people with the disease. However, in 1998, only 47 percent of U.S. patients followed this advice. One of the nation’s health objectives is to increase this figure to 75 percent by 2010.

The new systematic review provides evidence on effective ways to promote annual screenings for diabetic retinopathy. It appears in the October issue of American Journal of Preventive Medicine.

The review includes 48 studies with more than 160,000 participants from the United States, Australia, the United Kingdom, Israel, Saudi Arabia and other developed countries. Twelve of the studies are randomized controlled trials, which many consider the most reliable.

“In all randomized controlled trials but one, interventions achieved statistically significant increases in retinal screening rates in the intervention group compared to the control group,” Zhang said. The other 36 studies also generally demonstrated positive effects.

The studies looked at a wide range of approaches to promoting eye exams — some emphasizing patients or populations, and others focusing on health care providers. Data showed that the following interventions are effective:
• Increasing patient and provider awareness of diabetic retinopathy
• Improving access to health care
• Introducing computer-based registration or reminder systems
• Collaboration among local organizations that provide retinal screening
• Developing a community-based health care system

Evidence also suggested that these approaches are more likely to succeed when the interventions are part of a multifaceted program.