Factors associated with follow-up eye examinations among persons with diabetes

Objective: The authors investigated the process of diabetes eye care by assessing follow-up eye examinations in patients with diagnosed diabetes in a managed care organization. Methods: The authors randomly identified 5000 diabetic patients from the Kaiser Permanente Southern California diabetes case identification database. A total of 2412 patients received an eye examination during the enrollment period. The medical records of these patients then were reviewed to determine the interval of the next eye examination. The authors investigated characteristics of patients who had a follow-up examination within 1 year and > 1 year. Results: Although every diabetic patient is sent an annual reminder to get an eye examination, only 27.6% of patients were re-examined within 1 year. One third of patients with diabetes did not see an ophthalmologist or optometrist in the next 2 years even though a substantial number had already been diagnosed with retinopathy. Patients who were older, had a longer duration of diabetes, and used insulin were more likely to have a follow-up examination within 1 year. Neither levels of glycosylated hemoglobin or serum cholesterol nor race/ethnicity were associated with likelihood of getting a repeat examination. Patients who had slightly worse visual acuity and retinopathy level were more likely to have an examination within 1 year. Conclusion: The current report assesses the process of eye care by investigating the frequency of follow-up examination in patients with diabetes mellitus. Patients who were older, with longer duration of diabetes, with poorer vision and more severe retinopathy were more likely to have a follow-up examination within 1 year. Glycemic control and race/ethnicity were not associated with follow-up within 1 year. Additional studies are needed to further understand the barriers to receiving a follow-up eye examination among people with diabetes.