Dilated diabetic eye examinations by optometrists.

Title
The frequency of dilated diabetic eye examinations by optometrists in the state of ohio.
Source
Optometry & Vision Science. 82(11):959-63, 2005 Nov.



PURPOSE:

Diabetes is a leading cause of blindness in the United States.Several landmark clinical trials have demonstrated the advantage for detecting and treating the ocular complications early in the natural history of the disease. It has been reported that up to 90% of severe vision loss resulting from diabetic eye disease is preventable. Preventative programs can reduce vision loss and the cost of treating late-stage complications. As part of the Healthy Vision 2010 initiative, the U.S. Department of Health and Human Services has stated a goal to increase the percentage of diabetic patients receiving annual dilated examinations from an estimated 47% in 1998 to 75% by 2010.

In an attempt to prevent vision loss, the American Optometric Association (AOA) recommends annual dilated eye examinations for diabetic patients. The use of mydriatic ophthalmic solutions is important because some forms of retinopathy are not as readily diagnosed through an undilated pupil. These guidelines are based on expert clinical opinions combined with available research data. Recent studies report that between 47% and 71% of diabetic patients receive yearly dilated examinations.

The AOA started a Diabetes Initiative program in the 1990s with a goal of improving diabetic patient care within optometric practices. This volunteer program included patient education materials, office posters, press and communication materials, and listing on a registry of optometrists desiring to provide a high level of diabetic patient care.

The quality of optometric care for diabetic patients has been debated. There have been several reports that have found high sensitivity and specificity in diabetic retinopathy detection by optometrists examining the retina through a dilated pupil. However, it has also been reported that diabetic patients last seen by optometrists were five times less likely than those seen by ophthalmologists to have been dilated at their last examination.

CONCLUSIONS:

In conclusion, this study provides an assessment of optometric adherence to diabetic standard of care recommendations in a subset of the general optometric population. The percentage of diabetic patients dilated by optometrists steadily increased between 1994 and 2003. Over 90% of patients examined at the end of this interval were dilated at their last comprehensive eye examination. Patient characteristics associated with higher rates of dilation were older patient age and the request for a diabetic eye examination. These results suggest that programs desiring to increase compliance to diabetic standard of care guidelines such as Health Vision 2010 may benefit by targeting both doctors and patients.