Study Shows Gaps in Diabetes-Related Ocular Complication Knowledge

Photo Madical Retina Abnormal isolated on black background.Retina of diabetes diabates retinopathy.
Although most knew diabetes could lead to blindness, eye disease, or both, more detailed knowledge “appeared suboptimal,” researchers say.

While most people with diabetes have an awareness that their disease can threaten their vision, most know little about the specific risk factors or how to manage it, a report suggests. Only 13.6% of Australians with type 2 diabetes knew that diabetic retinopathy screening intervals depend on risk factors, the research published in Primary Care Diabetes shows. 

Researchers sought to discover the extent of knowledge Australians with type 2 diabetes have regarding ocular complications, and vision-related quality of life.

The investigators included 264 participants (mean age of 72.1 years, median diabetes duration of 15.4 years) randomly selected from the Fremantle Diabetes Study Phase II (FDS2) community-based study of people with type 2 diabetes. Overall, 53 participants had DR; 42 participants had mild cases, 7 participants had moderate cases, and 4 participants had severe cases.

Researchers collected medical histories and conducted physical and eye exams, questionnaires, usual-care biochemical tests of fasting blood, and first-morning urine samples. To calculate a knowledge score (KS), the researchers asked patients 10 questions regarding diabetes, eye disease, and blindness as well as diabetic eye disease preventive behaviors. They also assessed the participants using the National Eye Institute’s Visual Functioning Questionnaire 39.

While most patients were aware that diabetes affects the eye and 97.3% thought that diabetes could lead to blindness, eye disease, or both, more detailed knowledge “appeared suboptimal,” the research says.

Recommended frequency of screening was answered correctly by 13.6% of participants, and 16.7% DR as the most common cause of vision loss in the working-age population .

Participants with at least moderate nonproliferative DR (NPDR) had a higher KS than the others(7.0 ± 1.2 vs 5.3 ± 1.8, P =.001).

Those with moderate nonproliferative DR (NPDR) or worse had a better knowledge score (B =1.37, P =.008) after adjusting for age (B = −0.03, P =.004) and education beyond primary school (B =1.75, P <.001).

Moderate NPDR or worse was significantly associated with a higher score on diabetes, eye disease, and blindness questions while those with more severe DR were more likely to be aware of their DR status.

The researchers recommended targeting older, less well-educated patients with no DR/mild NPDR for additional diabetes education to increase their awareness of ophthalmic screening intervals and preventive interventions.

Limitations of the study include that the present sample was a survivor cohort of FDS2 participants, which may affect generalizability, and that since it was a multiple-choice test, KS may have been overestimated.


Drinkwater JJ, Chen FK, Davis WA, Davis TME. Knowledge of ocular complications of diabetes in community-based people with type 2 diabetes: The Fremantle Diabetes Study II. Primary Care Diabetes. Published online February 4, 2021. doi:10.1016/j.pcd.2021.01.008