Referral Rates Are Hurting People at Risk for Vision-Threatening Diabetic Retinopathy

Despite established criteria for patients at risk for vision-threatening diabetic retinopathy from the United Kingdom Prospective Diabetes Study (UKPDS), referral rates don’t reflect the number of people who should visit optometrists, ophthalmologists, and retina specialists.

In a poster presentation at the 34^th Annual Scientific Meeting of the American Society of Retina Specialists (ASRS 2016) in San Francisco, California, GD Lee, MD, and colleagues from the University of Kentucky, examined current referral patterns of primary care practitioners in the United States.

The analysis included data from 30 primary care physicians from June 2014 to May 2015. An electronic medical record system assessed documentation of visual symptoms, communication regarding eye examination importance, and documentation of referral to an optometrist, ophthalmologist, or retina specialist. A total of 180 patients were found to have had type 2 diabetes for more than three years and have HbA1c greater than 7% within the past year. The 149 patients with complete chart information were included in the study.

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The patients — 54% male, 87% Caucasian, average age of 63, and mean HbA1c of 8.4% - also had other conditions including, hypertension (84%), obesity (52%), coronary artery disease (21%), nephropathy (15%), congestive heart failure (10%), and angina (6%).

The results revealed that out of the 149 patients, only 43 of them (29%) had a documented eye exam with dilated fundus exam — 12 of which (28% of those who got an eye exam) were diagnosed with diabetic retinopathy.

The primary care physicians had referred 42.7% of the patients to optometrists or general ophthalmologists and 2.9% were referred to retina specialists.

“Patients who had visual complaints, HbA1c>9%, or other end-organ diabetic complications (nephropathy, coronary artery disease, peripheral vascular disease, neuropathy) were more often found to have diabetic retinopathy,” the researchers confirmed.

The findings indicate that many patients at risk for vision-threatening diabetic retinopathy are not getting the referrals that they should be — especially to retina specialists. Lee and his team said that outreach and education initiatives should be implemented.

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