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Benefits of Eye Care Provider Availability in Diabetes

Access to eye care professionals result in better outcome…. 

In a recent study assessing the impact of increased access to eye care professionals, researchers examined the effect of county-level eye doctor availability on ‘realized access to eye care’ – defined as the use of eye care services and visual health outcomes and patient satisfaction that results from such care. Study participants included patients with diabetes mellitus, diabetic retinopathy and age-related macular degeneration.

Using a cross-sectional sample, researchers evaluated data from the 2005 to 2008 National Health and Nutrition Examination Survey. A total of 1,098 individuals with diabetes – 40 years of age and older – were identified along with 345 individuals with diabetic retinopathy and 498 with age-related macular degeneration. Counties of residence were then stratified based on the number of ophthalmologists per 100,000 residents. Researchers examined whether diabetic individuals reported undergoing a dilated eye examination in the past year, awareness of diabetic individuals to diabetic retinopathy, presence of diabetic individuals having diabetic retinopathy and whether individuals were unaware of having age-related macular degeneration.

In counties with higher ophthalmologist availability, study participants were less likely to have diabetic retinopathy than those living in a county with low ophthalmologist availability (Predictive margin 1.4%; CI 90%, 0.9% to 1.9% vs. predictive margin 2.6%; CI 90%, 1.8% to 3.4%). They were also less likely to be unaware of having diabetic retinopathy (Predictive margin 66.1%; CI 90%, 48.8% to 83.4% vs. 84.1%; CI 90%, 78.7% to 89.6%). Further, individuals residing in counties within the lowest ophthalmologist availability quartile were more likely to be unaware of having age-related macular degeneration than individuals who lived a county in the higher 3 ophthalmologist availability quartiles. (Predictive margin 93.8%; CI 90%, 90.6% to 97.0% vs. predictive margin 88.3%; CI 90%, 84.7% to 91.9%)

Results from this study indicate that increasing access to eye-care professionals may improve outcomes related to diabetic retinopathy.

Practice Pearls:
  • Diabetic patients are at an increased risk of ophthalmologic complications
  • Diabetic patients may be unaware of their increased risk for vision complications
  • Access to ophthalmologists was associated with more favorable diabetes-related ophthalmologic outcomes
Gibson DM. Eye care availability and access among individuals with diabetes, diabetic retinopathy, or age-related macular degeneration. JAMA Ophthalmol. 2014;132(4):471-7.