Knowledge and perceived barriers about Diabetic retinopathy and Dilated eye exam among patients with diabetes in an urban academic environment

Diabetic retinopathy (DR) is the leading cause of blindness among the working age population in the US. Studies have shown that a significant proportion of diabetics do not get their dilated fundus examinations (DFE) as per the recommended clinical guidelines. The present study was undertaken to assess the knowledge of DR and DFE in diabetic patients of an academic urban primary care practice. 200 patients were randomly selected within the age range of 18-64 years. A mailed survey based on the health belief model was used to assess the awareness level of DR and DFE, and the barriers/and facilitating factors to getting a DFE. 28% of the patients returned the survey. 68% of the responders stated they received a DFE within 1 year, 12.5% between 1-2 years, and 19.5% did not get a DFE within two years of diagnosis. Barriers identified were cost, transportation, lack of symptoms, and fear of the exam. Facilitating factors were awareness of the importance of the DFE, existing eye problems, and receiving information from their doctors. Patient's knowledge of the importance of the DFE was positively associated with obtaining the DFE within two years of diagnosis (p=0.01).There was a significant difference in eye exams by insurance coverage with a smaller percentage of Medicaid recipients (60%) meeting the guidelines compared to private (94% and 80%) (p=0.01). Results suggest that type of insurance can affect the behavior; and improved provider education efforts that address patient barriers may increase adherence to the recommendations for getting a DFE.