The frequency of dilated diabetic eye examinations by optometrists in the state of ohio.

PURPOSE: The purpose of this study was to assess optometric care of diabetic patients. The American Optometric Association recommends dilated eye examinations at least once a year for people with diabetes. METHODS: Onsite chart reviews of 1497 diabetic patient charts were performed at a volunteer sample of Ohio-based optometric practices (n = 82). Four percent of all optometrists in the state of Ohio were surveyed. Data were collected from a 10-year period and included doctor age, membership in the Ohio Optometric Association (OOA) Diabetes Initiative, patient age, date of examinations, chief complaints, and dilation at examination. The primary outcome of the study was the frequency of dilated eye examination for diabetic patients by optometrists. RESULTS: Optometrists dilated 85.8% of diabetic patients at their last comprehensive examination. The percentage of diabetic patients dilated by optometrists increased from 40.0% in 1994 to 91.5% in 2003. The average time since last comprehensive eye examination for diabetic patients was 1.0 +/- 1.8 (mean +/- standard deviation) years. Diabetic patients who were dilated at a comprehensive eye examination returned to care on average 0.7 years sooner than those who were not dilated. Doctor-level factors related to a higher average percentage of dilations were younger doctor age (beta = -6.1%/10 years of doctor age; 95% confidence interval [CI], -10.1 to -2.1) and membership in the OOA Diabetes Initiative (beta = 11.6%; 95% CI, 2.3 to 20.8). CONCLUSIONS: There is variability in diabetic eye care by optometrists. However, the majority of optometrists surveyed in this study provided dilated eye examinations for their diabetic patients. Programs desiring to increase compliance to diabetic standard of care guidelines may benefit by targeting both doctors and patients.

Factors related to vision care in an older adult cohort.

PURPOSE: This study provides cross-sectional data on eye care utilization in a community-based adult population. METHODS: Data are from a questionnaire administered during the 7-year follow-up of the Epidemiology of Hearing Loss Study in 2000 to 2002. Participants in the population-based Beaver Dam Eye Study were eligible for the Epidemiology of Hearing Loss Study, which began in 1997. The primary outcome was self-reported vision testing within the past year. RESULTS: Subject ages ranged from 55 to 99 years (n = 2433), and 60.4% were female. Fifty-three percent of subjects reported they had their vision tested in the past year. Diabetes was self-reported by 11.5% of subjects, and 70.9% of diabetic participants had their vision tested in the past year. A current hospitalization or health insurance plan was reported by 98.6% of subjects. In multivariate analyses, self-reported factors significantly associated with having a vision test in the past year were female gender (odds ratio [OR] = 1.27; 95% confidence interval [CI] 1.06-1.52), current use of refractive correction for distance (OR = 1.98; 95% CI 1.56-2.52), glaucoma (OR = 3.52; 95% CI 2.37-5.24), cataract surgery (OR = 1.57; 95% CI 1.21-2.03), age-related macular degeneration (ARMD) (OR = 1.74; 95% CI 1.22-2.47), diabetes (OR = 2.46; 95% CI 1.83-3.31), visiting a primary care practitioner for any reason in the past year (OR = 1.72; 95% CI 1.32-2.25), having a hearing test in the past year (OR = 1.79; 95% CI 1.40-2.28), and the cessation of driving because of poor vision (OR = 1.64; 95% CI 1.16-2.52). In participants 65 years of age or older, having private insurance was associated with increased odds (OR = 3.39, 95% CI 1.82-6.31) of vision testing in the past year. CONCLUSION: This study suggests that chronic ocular conditions, diabetes, health insurance beyond government entitlements, and the use of other healthcare services are associated with increased eye care utilization.

Patients' perspectives on noncompliance with diabetic retinopathy standard of care guidelines.

BACKGROUND: Periodic dilated eye examinations are recommended by the American Optometric Association, American Academy of Ophthalmology, and American Diabetes Association to detect sight-threatening conditions in diabetic patients. However, many patients with diabetes do not receive this recommended eye care and there is limited research to explain why. The objective of this study was to determine reasons some diabetic patients do not receive a dilated eye examination at least every year. METHODS: A chart review identified patients at The Ohio State University College of Optometry who had not been examined for more than a year, but less than two years. A telephone interview was attempted for all subjects. RESULTS: Of 100 eligible subjects, 43 completed the telephone interview. The reasons patients with diabetes did not return for a recommended dilated eye examination included transfer of care to another eye doctor, limited personal mobility due to poor overall health, last examination at a homeless clinic, self-reported lack of insurance, and self-reported apathy. CONCLUSIONS: Strategies to improve compliance of patients with diabetes should include reaching patients of low socioeconomic status and those institutionalized for poor overall health. Improved compliance may also come by encouraging patients to use medical insurance for eye examinations and using patient recall systems.