Improving access to vital eye checks for people with diabetes has been the focus of two Australian research groups.
Diabetic retinopathy (DR) – blindness caused by diabetes — remains a major cause of visual impairment in working-age Australians despite the availability of testing for early detection and treatment of the degenerative disease.
Two new studies, published in the latest edition of the Medical Journal of Australia, investigate possibilities for improving the uptake of available testing in both rural and urban settings. In one study Melanie Larizza from the Centre for Eye Research Australia, University of Melbourne and her colleagues set up testing for DR within a pathology collection centre (PCC) in suburban Melbourne, with a view to testing people with diabetes, as up to 90 per cent of whom regularly attend PCCs for other diabetes-related tests.
Their finding that a third of diabetic patients had not undertaken the recommended biannual DR screening was ‘similar to non-adherence rates found in other studies’, the authors said. While uptake of the offered new service was high – almost 94 per cent of patients accepted the DR testing at the PCC – the study also found that follow-up on results by GPs and patients was the biggest weakness of the PCC delivery method.
“Although our program successfully enrolled patients with diabetes who did not participate in biannual DR screening, our model needs to be revised to ensure that the GP and patients are well informed of the screening results to help patients make informed decisions about their diabetic eye care”, the authors said.
A second study, by Dr Janice J-Y Ku of the Sydney Eye Hospital, was performed as part of the Central Australian Ocular Health Study. It tested the efficacy of single-field fundus photography in detecting DR in Indigenous patients in remote Central Australia: a group which has high rates of diabetes and poor access to eye care.
When compared with a retinal examination by an ophthalmologist, the fundus photography met the minimum requirements for accuracy recommended by the National Health and Medical Research Council.
“It is a valid screening tool for DR in remote communities,” the study found. “Providing optometrists or other trained technicians who visit the communities with fundus cameras or installing fundus cameras in the medical clinics of remote communities and training local staff to recognise signs of DR may help identify patients who require referral in a timely manner.”
In an editorial in the same edition of the MJA, Dr Nigel Morlet and Dr Jonathon Q Ng from the Eye and Vision Epidemiology Research (EVER) Group in said the major challenge for the treatment of DR remained the delivery of adequate preventive care.
“The increasing prevalence of chronic diseases such as diabetes requires paradigm shifts in models of health care delivery”, they said.
“Notwithstanding the benefits of current diabetic retinopathy screening techniques, which require less technical proficiency, the challenge is finding the best means of delivering these services to the community.”