Abstract
Background Retinal screening is mandatory to prevent vision loss and
blindness due to diabetic retinopathy (DR). The aim of the study was to
determine retinopathy screening rates and potential barriers in a German
metropolitan diabetes care center.
Methods Between May and October 2019, 265 patients with diabetes mellitus
(95% type 2 diabetes; age 62±13.2 years; diabetes duration
11.1±8.5 years, HbA1c 7.4±1.0%) were referred to an
ophthalmologist (referral form with order “Fundoscopy in diabetes
mellitus, findings requested,” completed documentation form
“General practitioner’s/diabetologist’s report
to the ophthalmologist” and prepared documentation form
“Ophthalmologist’s report”). A structured interview was
used to assess the level of compliance with the guidelines and to identify
potential barriers to retinopathy screening in a real-world setting, including
the quantification of extra payments.
Results All patients were interviewed at 7.9±2.5 months after the
referral for retinopathy screening had been issued. According to patient
reporting, fundoscopy was performed in 191 (75%) patients.
Ophthalmological reports were obtained from 119/191 (62%)
patients (46% of the entire cohort). 10/119 (8%)
patients had been previously diagnosed with DR and 6/119 (5%)
with new-onset DR. In 158/191 (83%) of patients, the referral
had been accepted by the ophthalmology practice, of which 25,1% made a
co-payment of 36.2±37.6 €.
Discussion Despite a high screening performance in a real-world setting,
complete screening in compliance with German guidelines, including written
reporting, was found in less than half of the cohort. The prevalence and
incidence of DR are high. Even when referred according to the regulations,
one-quarter of patients made a co-payment. Efficient solutions to current
barriers can emerge with mutual time-saving information prior to examination and
feedback about the implementation of findings into treatment.
Keywords
diabetic retinopathy - dysfunctional screening - diabetes mellitus - screening
