Article Text


Dilated eye examination screening guideline compliance among patients with diabetes without a diabetic retinopathy diagnosis: the role of geographic access
  1. David J Lee1,
  2. Naresh Kumar1,
  3. William J Feuer2,
  4. Chiu-Fang Chou3,
  5. Potyra R Rosa2,
  6. Joyce C Schiffman2,
  7. Alexis Morante2,
  8. Adam Aldahan2,
  9. Patrick Staropoli2,
  10. Cristina A Fernandez1,
  11. Stacey L Tannenbaum1,
  12. Byron L Lam2
  1. 1Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
  2. 2Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
  3. 3Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA
  1. Correspondence to Dr David J Lee; DLee{at}


Objective To estimate the prevalence of, and factors associated with, dilated eye examination guideline compliance among patients with diabetes mellitus (DM), but without diabetic retinopathy.

Research design and methods Utilizing the computerized billing records database, we identified patients with International Classification of Diseases (ICD)-9 diagnoses of DM, but without any ocular diagnoses. The available medical records of patients in 2007–2008 were reviewed for demographic and ocular information, including visits through 2010 (n=200). Patients were considered guideline compliant if they returned at least every 15 months for screening. Participant street addresses were assigned latitude and longitude coordinates to assess their neighborhood socioeconomic status (using the 2000 US census data), distance to the screening facility, and public transportation access. Patients not compliant, based on the medical record review, were contacted by phone or mail and asked to complete a follow-up survey to determine if screening took place at other locations.

Results The overall screening compliance rate was 31%. Patient sociodemographic characteristics, insurance status, and neighborhood socioeconomic measures were not significantly associated with compliance. However, in separate multivariable logistic regression models, those living eight or more miles from the screening facility were significantly less likely to be compliant relative to those living within eight miles (OR=0.36 (95% CI 0.14 to 0.86)), while public transit access quality was positively associated with screening compliance (1.34 (1.07 to 1.68)).

Conclusions Less than one-third of patients returned for diabetic retinopathy screening at least every 15 months, with transportation challenges associated with noncompliance. Our results suggest that reducing transportation barriers or utilizing community-based screening strategies may improve compliance.

  • Retinopathy Diagnosis

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