Br J Ophthalmol 1998;82:410-414 ( April )
Use of eye care services by people with diabetes: the Melbourne
Visual Impairment Project
Catherine A McCarty,a
Conrad W Lloyd-Smith,a
Sharon E Lee,b
Patricia M Livingston,a
Yury L Stanislavsky,a
Hugh R Taylora
a Department of Ophthalmology, University of Melbourne,
Melbourne, Australia, b Victorian WorkCover Authority, Melbourne, Australia
Correspondence to: Dr Cathy McCarty,
Epidemiology Research Unit, Department of Ophthalmology, University of
Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street,
East Melbourne, Victoria 3002, Australia.
Accepted for publication 10 October 1997
AIM The use of eye care services by people with
and without diabetes was investigated in the Melbourne Visual
Impairment Project (VIP), a population based study of eye disease in a
representative sample of Melbourne residents 40 years of age and older.
METHODSA comprehensive interview was employed to
elicit information on history of diabetes, medication use, most recent
visit to an ophthalmologist and optometrist, and basic demographic
details. Presence and extent of diabetic retinopathy was determined by dilated fundus examination.
RESULTSThe Melbourne VIP comprised 3271 people
who ranged in age from 40 to 98 years; 46.2% of them were male. Of
3189 people who had the fundus examination and knew their diabetes
status, 162 (5.1%) reported having been previously diagnosed with
diabetes and, of these, 37 (22.2%) were found to have diabetic
retinopathy. Seven people (4.3%) had developed diabetes before age 30. The mean duration of diabetes was 9.2 years. People with diabetes were
significantly more likely to have visited an ophthalmologist ever or in
the past 2 years than people without diabetes. However, 31.8% of
people with diabetes had never visited an ophthalmologist. The
proportion of people who had never seen an ophthalmologist was 47.1%
for people without diabetes, 34.2% for people with diabetes but
without diabetic retinopathy, and 25% for people with diabetic retinopathy. Sixty one per cent of people with diabetic retinopathy had
seen an ophthalmologist in the past year and a further 3% within the
past 2 years. People with diabetes were not significantly more likely
to have visited an optometrist than people without diabetes (p=0.51).
Overall, 37.7% of people with diabetes and 32.9% of people without
diabetes had visited an optometrist within the past year
( 2=2.25, 1 df, p=0.13). Information concerning retinal
examinations was available for 135 individuals (83.3% of people with
diabetes). Only 74 (54.8%) could recall ever having a dilated fundus
examination; 10 (14%) by an optometrist, 62 (86%) by an
ophthalmologist, and five (7%) by a general practitioner. Of those 68 people who had seen an ophthalmologist in the past 2 years, 48 (71%)
reported a dilated fundus examination during that time. This compares
with 28 (43%) reported dilated fundus examinations in the 65 people who had seen an optometrist in the past 2 years. This finding is
statistically significant (2=10.2, 1 df, p<0.005).
CONCLUSIONThese results indicate that nearly half
of people with diabetes in Melbourne are not receiving adequate
screening or follow up for diabetic retinopathy, despite universal
health care.
Keywords:
diabetes;
diabetic retinopathy;
screening
guidelines
© 1998 by British Journal of Ophthalmology
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