• Written By:
    Comprehensive Ophthalmology, Retina/Vitreous

    This paper presents characteristics associated with adherence to annual diabetic eye exams in the United States.

    Study design

    This cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) included 4,072 participants aged 20 years and older with diabetes mellitus between 2005 to 2016. The main outcome measure was factors associated with adherence to annual dilated eye examination, which was defined as having an eye exam within the preceding 12 or 24 months.


    Approximately 63% of individual had a diabetic eye examination within the past 12 months, and 79% within the last 24 months. The nonadherence rates did not significantly change during the study period. Insurance status had the highest predictive value, with 76% of insured Americans adherent to annual exams compared with 36% of those who were uninsured. Age, education, income, cholesterol levels, duration of disease and self-reported retinopathy also correlated with adherence.


    Self-reporting of diabetic status and eye examination adherence may have biased the study findings.

    Clinical significance

    Adherence with annual diabetic eye exams has not significantly increased over the past decade. Patients at the highest risk for missing examinations tend to be younger, poorer, less educated and lack insurance. Further efforts to educate and encourage adherence are needed.