USE OF EYE CARE SERVICES BY PEOPLE WITH DIABETES - THE MELBOURNE VISUAL IMPAIRMENT PROJECT

Aim-The use of eye care services by people with and without diabetes w as investigated in the Melbourne Visual Impairment Project )VIP), a po pulation based study of eye disease in a representative sample of Melb ourne residents 40 years of age and older. Methods-A comprehensive int erview was employed to elicit information on history of diabetes, medi cation use, most recent visit to an ophthalmologist and optometrist, a nd basic demographic details. Presence and extent of diabetic retinopa thy was determined by dilated fundus examination. Results-The Melbourn e VIP comprised 3271 people who ranged in age from 40 to 98 years; 46. 2% of them were male. Of 3189 people who had the fundus examination an d knew their diabetes status, 162 (5.1%) reported having been previous ly diagnosed with diabetes and, of these, 37 (22.2%) were found to hav e diabetic retinopathy. Seven people (4.3%) had developed diabetes bef ore age 30. The mean duration of diabetes was 9.2 years. People with d iabetes were significantly more likely to have visited an ophthalmolog ist ever or in the past 2 years than people without diabetes. However, 31.8% of people with diabetes had never visited an ophthalmologist. T he proportion of people who had never seen an ophthalmologist was 47.1 % for people without diabetes, 34.2% for people with diabetes but with out diabetic retinopathy; and 25% for people with diabetic retinopathy . Six-ty one per cent of people with diabetic retinopathy had seen an ophthalmologist in the past Fear and a further 3% within the past 2 ye ars. People with diabetes were not significantly more Likely to have v isited an optometrist than people without diabetes (p=0.51). Overall, 37.7% of people with diabetes and 32.9% of people without diabetes had visited an optometrist within the past year (chi(2)=2.25, 1 df, p=0.1 3). Information concerning retinal examinations was available for 135 individuals (83.3% of people with diabetes). Only 74 (54.8%) could rec all ever having a dilated fundus examination; 10 (14%) by an optometri st, 62 (86%) by an ophthalmologist, and five (7%) by a general practit ioner. Of those 68 people who had seen an ophthalmologist in the past 2 years, 48 (71%) reported a dilated fundus examination during that ti me. This compares with 28 (43%) reported dilated fundus examinations i n the 65 people who had seen an optometrist in the past 2 years. This finding is statistically significant (chi(2)=10.2, 1 df, p<0.005). Con clusion-These results indicate that nearly half of people with diabete s in Melbourne are not receiving adequate screening or follow up for d iabetic retinopathy; despite universal health care.