Diabetic Retinopathy Screening Adherence.

Abstract

Objective: To evaluate the adherence rate of diabetic subjects to the retinopathy screening program and to identify the characteristics associated with non-compliance to regular screening.

Methods: A cross-sectional study involving 240 patients with diabetes who attended outpatient non-ophthalmology clinics at four tertiary university hospitals between March 2020 and March 2021 was conducted. A validated questionnaire collected data that included socio-demographic variables, characteristics of diabetes, diabetes-related complications and comorbidities, knowledge and attitudes toward DR and its screening, and barriers to DR screening. Univariate and multivariate logistic regression was employed to identify the factors associated with adherence to the annual diabetic eye examination. Adherence was defined as a history of the dilated ophthalmic exam in the past year and subsequent follow-ups recommended by the ophthalmologist.

Results: The participants had an average age of 59 ± 14.2 years, and 53% were females. The average duration of diabetes was 108 ± 89.62 months. Based on the last ophthalmic examination, 50.8% of patients were non-adherent to the suggested DR screening guidelines. A history of smoking (p-value=0.013, 95%CI for OR: 1.21-5.10), lower education levels (p-value=0.045, 95%CI for OR: 1.02-3.82), and not clarifying the necessity of ophthalmic examination by primary physicians (p-value < 0.001, 95%CI for OR: 2.19-12.35) were significantly associated with non-adherence. Among non-adherent subjects, 38% reported fear of the COVID-19 pandemic, 21.3% cited the lack of information regarding DR screening, 10.7% cited lack of access to the ophthalmologist, 5.7% cited financial problems, and 10.7% noted a lack of support from family and friends as the main reason for non-attendance to the annual eye care.

Discussions: This study revealed a non-compliance rate with DR screening guidelines that surpasses pre-pandemic figures. Although younger participants demonstrated a higher likelihood of recent eye care, this correlation lost significance in multivariate analysis, potentially reflecting education and technology utilization disparities. Despite uniform insurance coverage, socioeconomic factors, such as transportation challenges, may impede adherence. Furthermore, individuals informed by healthcare providers about the necessity of eye exams exhibited greater compliance; however, many newly diagnosed patients remained unaware of the risks associated with DR. The COVID-19 pandemic emerged as a prominent barrier, with numerous patients citing it as a reason for their non-compliance due to disruptions in clinical care.

Conclusions: Half of the diabetic subjects attending tertiary hospitals for non-ophthalmic complaints were non-adherent to recommended retinopathy screening. Lower education, smoking, and unawareness of the necessity of annual eye care had the strongest association with non-compliance. Fear of contracting COVID-19 was the most prevalent barrier to the eye examination. These findings underscore the necessity for targeted patient education initiatives, particularly among those with lower education levels and smokers.