Adherence to Diabetic Retinopathy Screening Guideline During COVID Pandemic Era
Pasha Anvari1 *, Reza Mirshahi2 , Faezeh Hashemi Nezhad3 , Alireza Helal Birjandi3 , Kimia Daneshvar 4 , Khalil Ghasemi Falavarjani 1
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, School of Medicine, Iran University of Medical Sciences
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Early detection of diabetic retinopathy (DR) is critical to prevent vision loss. Therefore, routine adherence to ophthalmic screening guidelines can significantly decrease diabetic visual complications. A substantial proportion of patients with diabetes do not attend regular ophthalmic examinations annually, which inversely affects their outcomes. The current study aimed to evaluate the adherence rate of diabetic subjects to the retinopathy screening program and to identify the characteristics associated with non-compliance to regular screening.
Methods: A cross-sectional study was conducted involving 240 patients with diabetes who attended outpatient non-ophthalmology clinics at four tertiary university hospitals between March 2020 and March 2021. A validated questionnaire collected data that included socio-demographic variables, characteristics of diabetes, diabetes-related complications and comorbidities, knowledge and attitudes toward DR and its screening, and barriers to DR screening. To identify the associated factors with adherence to the annual diabetic eye examination, univariate and multivariate logistic regression were employed. Adherence was defined as a history of the dilated ophthalmic exam in the past year and subsequent follow-ups recommended by the ophthalmologist
Results: The participants had an average age of 59 ± 14.2 years, and 53% were females. The average duration of diabetes was 108 ± 89.62 months. Based on the last ophthalmic examination, 50.8% of patients were non-adherent to the suggested DR screening guidelines. A history of smoking (p-value=0.013, 95%CI for OR: 1.21-5.10), lower education levels (p-value=0.045, 95%CI for OR: 1.02-3.82), and not clarifying the necessity of ophthalmic examination by primary physicians (p-value < 0.001, 95%CI for OR: 2.19-12.35) were significantly associated with non-adherence. Among non-adherent subjects, 38 % reported fear of COVID-19 pandemic, 21.3% cited the lack of information regarding DR screening, 10.7% cited lack of access to the ophthalmologist, 5.7% cited financial problems, and 10.7% noted a lack of support from family and friends as the main reason for non-attendance to the annual eye care.
Conclusion: Half of the diabetic subjects attending tertiary hospitals for non-ophthalmic complaints were non-adherent to recommended retinopathy screening. Lower education, smoking, and unawareness of the necessity of annual eye care had the strongest association with non-compliance.
