Skip to main content
Top
Published in: Current Diabetes Reports 10/2017

01-10-2017 | Microvascular Complications—Retinopathy (JK Sun and PS Silva, Section Editors)

Diabetic Eye Screening: Knowledge and Perspectives from Providers and Patients

Authors: Yao Liu, Rebecca Swearingen

Published in: Current Diabetes Reports | Issue 10/2017

Login to get access

Abstract

Purpose of Review

Diabetic retinopathy remains the leading cause of blindness among working-age US adults even though timely screening and treatment prevent 90% of blindness. We summarize current knowledge and perspectives to better understand why diabetic eye screening rates remain low and future directions towards preventing blindness from diabetes.

Recent Findings

Significant advancements in the past 10 years include primary care and patient-oriented interventions as well as the use of teleophthalmology. In England, diabetic eye disease is no longer the leading cause of certifiable blindness following the implementation of a national teleophthalmology program for diabetic retinopathy.

Summary

Multiple workflow and systems-level barriers affect providers. Patient barriers include a limited understanding of screening and lack of access to care. Interventions have been developed, but new barriers exist towards sustaining their impact. More research is needed to identify and implement the best practices to increase diabetic eye screening rates long-term.
Literature
4.
go back to reference •• Scanlon PH. The English National Screening Programme for diabetic retinopathy 2003-2016. Acta Diabetol. 2017; doi:10.1007/s00592-017-0974-1. Summary of the national teleophthalmology program for diabetic eye screening in England •• Scanlon PH. The English National Screening Programme for diabetic retinopathy 2003-2016. Acta Diabetol. 2017; doi:10.​1007/​s00592-017-0974-1. Summary of the national teleophthalmology program for diabetic eye screening in England
7.
10.
go back to reference • Hipwell AE, Sturt J, Lindenmeyer A, Stratton I, Gadsby R, O'Hare P, et al. Attitudes, access and anguish: a qualitative interview study of staff and patients' experiences of diabetic retinopathy screening. BMJ Open. 2014;4(12):e005498. doi:10.1136/bmjopen-2014-005498. Semi-structured interviews were conducted to better understand patient perspectives in the English teleophthalmology program for diabetic eye screening. Knowledge of diabetic retinopathy and screening were patient facilitators, while work commitments, the use of dilating drops, and travel concerns were identified as barriers to patient participation CrossRefPubMedPubMedCentral • Hipwell AE, Sturt J, Lindenmeyer A, Stratton I, Gadsby R, O'Hare P, et al. Attitudes, access and anguish: a qualitative interview study of staff and patients' experiences of diabetic retinopathy screening. BMJ Open. 2014;4(12):e005498. doi:10.​1136/​bmjopen-2014-005498. Semi-structured interviews were conducted to better understand patient perspectives in the English teleophthalmology program for diabetic eye screening. Knowledge of diabetic retinopathy and screening were patient facilitators, while work commitments, the use of dilating drops, and travel concerns were identified as barriers to patient participation CrossRefPubMedPubMedCentral
11.
go back to reference Willard-Grace R, Chen EH, Hessler D, DeVore D, Prado C, Bodenheimer T, et al. Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: a randomized controlled trial. Ann Fam Med. 2015;13(2):130–8. doi:10.1370/afm.1768.CrossRefPubMedPubMedCentral Willard-Grace R, Chen EH, Hessler D, DeVore D, Prado C, Bodenheimer T, et al. Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: a randomized controlled trial. Ann Fam Med. 2015;13(2):130–8. doi:10.​1370/​afm.​1768.CrossRefPubMedPubMedCentral
12.
14.
go back to reference •• Silva PS, Aiello LP. Telemedicine and eye examinations for diabetic retinopathy: a time to maximize real-world outcomes. JAMA Ophthalmol. 2015; doi:10.1001/jamaophthalmol.2015.0333. Overview of current challenges in teleophthalmology for diabetic eye screening •• Silva PS, Aiello LP. Telemedicine and eye examinations for diabetic retinopathy: a time to maximize real-world outcomes. JAMA Ophthalmol. 2015; doi:10.​1001/​jamaophthalmol.​2015.​0333. Overview of current challenges in teleophthalmology for diabetic eye screening
16.
go back to reference Conlin PR, Fisch BM, Cavallerano AA, Cavallerano JD, Bursell SE, Aiello LM. Nonmydriatic teleretinal imaging improves adherence to annual eye examinations in patients with diabetes. J Rehabil Res Dev. 2006;43(6):733–40.CrossRefPubMed Conlin PR, Fisch BM, Cavallerano AA, Cavallerano JD, Bursell SE, Aiello LM. Nonmydriatic teleretinal imaging improves adherence to annual eye examinations in patients with diabetes. J Rehabil Res Dev. 2006;43(6):733–40.CrossRefPubMed
17.
go back to reference Whited JD, Datta SK, Aiello LM, Aiello LP, Cavallerano JD, Conlin PR, et al. A modeled economic analysis of a digital tele-ophthalmology system as used by three federal health care agencies for detecting proliferative diabetic retinopathy. Telemed J E-Health. 2005;11(6):641–51. doi:10.1089/tmj.2005.11.641.CrossRefPubMed Whited JD, Datta SK, Aiello LM, Aiello LP, Cavallerano JD, Conlin PR, et al. A modeled economic analysis of a digital tele-ophthalmology system as used by three federal health care agencies for detecting proliferative diabetic retinopathy. Telemed J E-Health. 2005;11(6):641–51. doi:10.​1089/​tmj.​2005.​11.​641.CrossRefPubMed
19.
go back to reference • Sheppler CR, Lambert WE, Gardiner SK, Becker TM, Mansberger SL. Predicting adherence to diabetic eye examinations: development of the compliance with annual diabetic eye exams survey. Ophthalmology. 2014;121(6):1212–9. doi:10.1016/j.ophtha.2013.12.016. A survey instrument was developed to assess predictors of adherence with diabetic eye screening. Factors associated with obtaining screening included insurance coverage, consideration of screening as a priority, the belief that eye disease could be detected, lower hemoglobin A1c levels, and longer duration of diabetes CrossRefPubMed • Sheppler CR, Lambert WE, Gardiner SK, Becker TM, Mansberger SL. Predicting adherence to diabetic eye examinations: development of the compliance with annual diabetic eye exams survey. Ophthalmology. 2014;121(6):1212–9. doi:10.​1016/​j.​ophtha.​2013.​12.​016. A survey instrument was developed to assess predictors of adherence with diabetic eye screening. Factors associated with obtaining screening included insurance coverage, consideration of screening as a priority, the belief that eye disease could be detected, lower hemoglobin A1c levels, and longer duration of diabetes CrossRefPubMed
20.
go back to reference • Zangalli CS, Murchison AP, Hale N, Hark LA, Pizzi LT, Dai Y, et al. An education- and telephone-based intervention to improve follow-up to vision care in patients with diabetes: a prospective, single-blinded, randomized trial. Am J Med Qual. 2016;31(2):156–61. doi:10.1177/1062860614552670. This prospective study evaluated the effectiveness of a multipronged intervention to improve adherence with diabetic eye exams. The intervention group had significantly increased rates of scheduling and obtaining diabetic eye exams CrossRefPubMed • Zangalli CS, Murchison AP, Hale N, Hark LA, Pizzi LT, Dai Y, et al. An education- and telephone-based intervention to improve follow-up to vision care in patients with diabetes: a prospective, single-blinded, randomized trial. Am J Med Qual. 2016;31(2):156–61. doi:10.​1177/​1062860614552670​. This prospective study evaluated the effectiveness of a multipronged intervention to improve adherence with diabetic eye exams. The intervention group had significantly increased rates of scheduling and obtaining diabetic eye exams CrossRefPubMed
21.
22.
go back to reference Fong DS, Aiello LP, Ferris FL 3rd, Klein R. Diabetic retinopathy. Diabetes Care. 2004;27(10):2540–53.CrossRefPubMed Fong DS, Aiello LP, Ferris FL 3rd, Klein R. Diabetic retinopathy. Diabetes Care. 2004;27(10):2540–53.CrossRefPubMed
23.
go back to reference National Diabetes Statistics Report. Estimates of diabetes and its burden in the United States, 2014. In: prevention. CfDCa, editor. U.S. Department of Health and Human Services: Atlanta; 2014. National Diabetes Statistics Report. Estimates of diabetes and its burden in the United States, 2014. In: prevention. CfDCa, editor. U.S. Department of Health and Human Services: Atlanta; 2014.
24.
go back to reference Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy: ETDRS report number 9. Ophthalmology. 1991;98(5):766–785. doi: 10.1016/S0161-6420(13)38011-7 Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy: ETDRS report number 9. Ophthalmology. 1991;98(5):766–785. doi: 10.​1016/​S0161-6420(13)38011-7
25.
go back to reference Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States A. GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States A. GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.
27.
go back to reference Hatef E, Vanderver BG, Fagan P, Albert M, Alexander M. Annual diabetic eye examinations in a managed care Medicaid population. Am J Manag Care. 2015;21(5):e297–302.PubMed Hatef E, Vanderver BG, Fagan P, Albert M, Alexander M. Annual diabetic eye examinations in a managed care Medicaid population. Am J Manag Care. 2015;21(5):e297–302.PubMed
37.
go back to reference Delorme C, Boisjoly HM, Baillargeon L, Turcotte P, Bernard PM. Screening for diabetic retinopathy. Do family physicians know the Canadian guidelines? Can Fam Physician. 1998;44:1473–9.PubMedPubMedCentral Delorme C, Boisjoly HM, Baillargeon L, Turcotte P, Bernard PM. Screening for diabetic retinopathy. Do family physicians know the Canadian guidelines? Can Fam Physician. 1998;44:1473–9.PubMedPubMedCentral
39.
go back to reference American Academy of Ophthalmology Retina/Vitreous Panel. Preferred Practice Pattern Guidelines. Diabetic Retinopathy. San Francisco, CA: American Academy of Ophthalmology. 2016. Available at: www.aao.org/ppp. American Academy of Ophthalmology Retina/Vitreous Panel. Preferred Practice Pattern Guidelines. Diabetic Retinopathy. San Francisco, CA: American Academy of Ophthalmology. 2016. Available at: www.​aao.​org/​ppp.
41.
go back to reference Dansky KH, Dirani R. The use of health care services by people with diabetes in rural areas. J Rural Health. 1998;14(2):129–37.CrossRefPubMed Dansky KH, Dirani R. The use of health care services by people with diabetes in rural areas. J Rural Health. 1998;14(2):129–37.CrossRefPubMed
42.
go back to reference Sloan FA, Yashkin AP, Chen Y. Gaps in receipt of regular eye examinations among Medicare beneficiaries diagnosed with diabetes or chronic eye diseases. Ophthalmology. 2014;121(12):2452–60. doi:10.1016/j.ophtha.2014.07.020 Sloan FA, Yashkin AP, Chen Y. Gaps in receipt of regular eye examinations among Medicare beneficiaries diagnosed with diabetes or chronic eye diseases. Ophthalmology. 2014;121(12):2452–60. doi:10.​1016/​j.​ophtha.​2014.​07.​020
44.
45.
go back to reference Odom JV. Vision, visual needs, and quality of life of older people in rural environments: a report and synthesis of a meeting. J Rural Health. 2001;17(4):360–3.CrossRefPubMed Odom JV. Vision, visual needs, and quality of life of older people in rural environments: a report and synthesis of a meeting. J Rural Health. 2001;17(4):360–3.CrossRefPubMed
46.
go back to reference Halbert RJ, Leung KM, Nichol JM, Legorreta AP. Effect of multiple patient reminders in improving diabetic retinopathy screening: a randomized trial. Diabetes Care. 1999;22(5):752–5.CrossRefPubMed Halbert RJ, Leung KM, Nichol JM, Legorreta AP. Effect of multiple patient reminders in improving diabetic retinopathy screening: a randomized trial. Diabetes Care. 1999;22(5):752–5.CrossRefPubMed
49.
go back to reference Cavallerano AA, Cavallerano JD, Katalinic P, Blake B, Rynne M, Conlin PR, et al. A telemedicine program for diabetic retinopathy in a Veterans Affairs Medical Center—the Joslin Vision Network eye health care model. Am J Ophthalmol. 2005;139(4):597–604. doi:10.1016/j.ajo.2004.10.064.CrossRefPubMed Cavallerano AA, Cavallerano JD, Katalinic P, Blake B, Rynne M, Conlin PR, et al. A telemedicine program for diabetic retinopathy in a Veterans Affairs Medical Center—the Joslin Vision Network eye health care model. Am J Ophthalmol. 2005;139(4):597–604. doi:10.​1016/​j.​ajo.​2004.​10.​064.CrossRefPubMed
50.
go back to reference Garg S, Zimmer-Galler I. Telemedicine and remote imaging for diabetic retinopathy evaluation: an update. Retin Physician. 2013:49–51. Garg S, Zimmer-Galler I. Telemedicine and remote imaging for diabetic retinopathy evaluation: an update. Retin Physician. 2013:49–51.
51.
go back to reference Mansberger SL, Sheppler C, Barker G, Gardiner SK, Demirel S, Wooten K, et al. Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations: a randomized clinical trial. JAMA Ophthalmol. 2015;133(5):518–25. doi:10.1001/jamaophthalmol.2015.1 Mansberger SL, Sheppler C, Barker G, Gardiner SK, Demirel S, Wooten K, et al. Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations: a randomized clinical trial. JAMA Ophthalmol. 2015;133(5):518–25. doi:10.​1001/​jamaophthalmol.​2015.​1
53.
go back to reference Silva PS, Cavallerano JD, Tolson AM, Rodriguez J, Rodriguez S, Ajlan R, et al. Real-time ultrawide field image evaluation of retinopathy in a diabetes telemedicine program. Diabetes Care. 2015;38(9):1643–9. doi:10.2337/dc15-0161.CrossRefPubMed Silva PS, Cavallerano JD, Tolson AM, Rodriguez J, Rodriguez S, Ajlan R, et al. Real-time ultrawide field image evaluation of retinopathy in a diabetes telemedicine program. Diabetes Care. 2015;38(9):1643–9. doi:10.​2337/​dc15-0161.CrossRefPubMed
54.
go back to reference Aiello LP, Ayala AR, Antoszyk AN, Arnold-Bush B, Baker C, Bressler NM, et al. Assessing the effect of personalized diabetes risk assessments during ophthalmologic visits on glycemic control: a randomized clinical trial. JAMA Ophthalmol. 2015;133(8):888–96. doi:10.1001/jamaophthalmol.2015.1312.CrossRefPubMed Aiello LP, Ayala AR, Antoszyk AN, Arnold-Bush B, Baker C, Bressler NM, et al. Assessing the effect of personalized diabetes risk assessments during ophthalmologic visits on glycemic control: a randomized clinical trial. JAMA Ophthalmol. 2015;133(8):888–96. doi:10.​1001/​jamaophthalmol.​2015.​1312.CrossRefPubMed
59.
go back to reference DCCT/EDIC Research Group, Nathan DM, Bebu I, Hainsworth D, Klein R, Tamborlane W, et al. Frequency of evidence-based screening for retinopathy in type 1 diabetes. N Engl J Med. 2017;376(16):1507–16. doi:10.1056/NEJMoa1612836. DCCT/EDIC Research Group, Nathan DM, Bebu I, Hainsworth D, Klein R, Tamborlane W, et al. Frequency of evidence-based screening for retinopathy in type 1 diabetes. N Engl J Med. 2017;376(16):1507–16. doi:10.​1056/​NEJMoa1612836.
63.
go back to reference Li HK, Horton M, Bursell SE, Cavallerano J, Zimmer-Galler I, Tennant M, et al. American Telemedicine Association Diabetic Retinopathy Telehealth Practice Recommendations Working Group. Telehealth practice recommendations for diabetic retinopathy, second edition. Telemed J E Health. 2011;17:814–837 . doi:10.1089/tmj.2011.0075.pmid:21970573. Li HK, Horton M, Bursell SE, Cavallerano J, Zimmer-Galler I, Tennant M, et al. American Telemedicine Association Diabetic Retinopathy Telehealth Practice Recommendations Working Group. Telehealth practice recommendations for diabetic retinopathy, second edition. Telemed J E Health. 2011;17:814–837 . doi:10.​1089/​tmj.​2011.​0075.​pmid:​21970573.
64.
go back to reference Daskivich LP, Vasquez C, Martinez C Jr, Tseng CH, Mangione CM. 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; doi:10.1001/jamainternmed.2017.0204. Daskivich LP, Vasquez C, Martinez C Jr, Tseng CH, Mangione CM. 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; doi:10.​1001/​jamainternmed.​2017.​0204.
66.
go back to reference Keenum Z, McGwin G Jr, Witherspoon CD, Haller JA, Clark ME, Owsley C. Patients’ adherence to recommended follow-up eye care after diabetic retinopathy screening in a publicly funded county clinic and factors associated with follow-up eye care use. JAMA Ophthalmol. 2016;134(11):1221–8. doi:10.1001/jamaophthalmol.2016.3081.CrossRefPubMed Keenum Z, McGwin G Jr, Witherspoon CD, Haller JA, Clark ME, Owsley C. Patients’ adherence to recommended follow-up eye care after diabetic retinopathy screening in a publicly funded county clinic and factors associated with follow-up eye care use. JAMA Ophthalmol. 2016;134(11):1221–8. doi:10.​1001/​jamaophthalmol.​2016.​3081.CrossRefPubMed
70.
go back to reference Zhang W, Nicholas P, Schuman SG, Allingham MJ, Faridi A, Suthar T, et al. Screening for diabetic retinopathy using a portable, noncontact, nonmydriatic handheld retinal camera. J Diabetes Sci Technol. 2017;11(1):128–34. doi:10.1177/1932296816658902.CrossRefPubMed Zhang W, Nicholas P, Schuman SG, Allingham MJ, Faridi A, Suthar T, et al. Screening for diabetic retinopathy using a portable, noncontact, nonmydriatic handheld retinal camera. J Diabetes Sci Technol. 2017;11(1):128–34. doi:10.​1177/​1932296816658902​.CrossRefPubMed
Metadata
Title
Diabetic Eye Screening: Knowledge and Perspectives from Providers and Patients
Authors
Yao Liu
Rebecca Swearingen
Publication date
01-10-2017
Publisher
Springer US
Published in
Current Diabetes Reports / Issue 10/2017
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-017-0911-2

Other articles of this Issue 10/2017

Current Diabetes Reports 10/2017 Go to the issue

Microvascular Complications—Retinopathy (JK Sun and PS Silva, Section Editors)

Screening Intervals for Diabetic Retinopathy and Implications for Care

Pathogenesis of Type 1 Diabetes (A Pugliese, Section Editor)

Tolerogenic Nanoparticles to Treat Islet Autoimmunity

Immunology, Transplantation, and Regenerative Medicine (L Piemonti and V Sordi, Section Editors)

Heterogeneity in the Beta-Cell Population: a Guided Search Into Its Significance in Pancreas and in Implants

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.