• Patient Adherence to Follow-up Care After DR Screening in a Public Health Setting

    By Lynda Seminara and edited by Neil M. Bressler, MD

    Journal Highlights

    JAMA Ophthalmology, November 2016

    Download PDF


    The success of public health screening programs for diabetic retinopathy (DR) depends on patients’ adherence to the recommended follow-up schedules. Keenum et al. determined the adher­ence rate for patients screened at a pub­lic county-funded clinic and examined factors associated with attaining follow-up eye care. The majority of their large­ly African American study population did not observe the recommended follow-up schedules. Those most likely to adhere were older and aware of their glycated hemoglobin level.

    This prospective study included 949 adults (aged 21-95 years) who had been diagnosed with diabetes type 1 or 2. The mean duration of diabetes at DR screening was 9.6 years. Most partici­pants were African American (85%), and many lacked health insurance (72%). However, county residents have access to the clinic’s services regardless of their ability to pay or their insurance status.

    Although all enrollees had been cautioned that the screening program is not a substitute for comprehensive examination by an ophthalmologist, only 30% observed their recommended schedule for follow-up eye care. Within 2 years of the screening, 51% had not received a subsequent eye exam. Factors associated with adherence were advanced age (odds ratio [OR], 1.02; 95% CI, 1.01-1.04) and knowing one’s glycated hemoglobin level (OR, 2.00; 95% CI, 1.34-2.97). However, agreeing to assistance in making follow-up ap­pointments was associated with nonad­herence (OR, 0.67; 95% CI, 0.45-0.99). Younger adults, who were more likely to be employed than older adults, were less likely to adhere to the recommend­ed follow-up regimens, perhaps due to inconvenience or concerns about lost wages on days of follow-up care.

    The authors concluded that even when cost and accessibility barriers are minimized, DR screening programs are unlikely to meet their goals without the incorporation of eye health education initiatives that promote adherence to the comprehensive care required to prevent vision loss. Combining such efforts is especially important in light of the soaring prevalence of diabetes.

    The original article can be found here.