Using large, cross-sectional population statistics, researchers can possibly better determine the geographic and socioeconomic profile of at-risk populations for developing diabetic retinopathy among adults between ages 40 years and 64 years in large urban areas, including those that might benefit from interventions to increase screening eye exams, researchers report in the Canadian Journal of Ophthalmology.
The cross-sectional study sought to understand resource allotment need in diabetic screening in Canada by looking at key demographic (including age, sex, income quintile, and immigrant status) and geographic factors (such as rurality and patient local health integration network) in unscreened and screened patients in Ontario.
The Ontario Health Insurance Plan (OHIP) records, used in physician and optometry billing, were accessed, matching patients 19 years and older with prevalent diabetes between 2011 and 2013.
They found that of the nearly 1,146,000 patients included in the analysis, about 406,000 were unscreened, including 234,000 adults between the ages of 40 years and 64 years. Of the total, approximately 818,000 patients with diabetes lived in large cities, and 301,000 (37%) were unscreened.
“When the City of Toronto was analyzed as an urban area with the highest density of unscreened prevalence, autocorrelation between the percentage of eye examinations among patients with diabetes aged more than 40 years and low-income revealed that large areas of Toronto Central correlated for low examination rates and low income. The majority (13/22) of Community Health Centres are present in these areas,” the report says.
“Such interventions would target forming alliances between family physicians, diabetologists, diabetic care givers, and ophthalmic practitioners to ensure that persons with diabetes meet periodic [diabetic retinopathy] screening examination targets,” the report says.
“Further, the role of [nonmydriatic fundus photography] and telemedicine [diabetic retinopathy] screening programs, including computer-assisted evaluation, may decrease the barrier to access by improving the efficiency of periodic screening examination for both patient and practitioner,” they add.
Ballios BG, Park T, Chaudhary V, et al. Identifying gaps in patient access to diabetic screening eye examinations in Ontario: a provincially representative cross- sectional study. Can J Ophthalmol. Published online November 21, 2020. doi:10.1016/j.jcjo.2020.10.018