Assessing the unmet need for diabetic eye screening in regional Queensland

Diabetic retinopathy (DR) is the leading cause of vision impairment in working-age individuals worldwide.¹ The UK has demonstrated that screening for DR can significantly reduce blindness due to DR,¹ but currently Australia lacks a formal DR screening program, relying instead on people living with diabetes remembering to see community optometrists. The KeepSight program aims to improve attendance for DR screening² but lacks rigourous audit mechanisms inherent in a formal screening program. In our regional ophthalmology service, we regularly see patients present with advanced diabetic eye disease as their first presentation suggesting that the current process is failing some individuals. In a crude attempt to audit the community screening service, consecutive consenting patients attending the hospital diabetes clinic underwent non-mydriatic retinal photography during their clinic attendance. The aims were to: (1) determine how many had undergone community DR screening within the past 2 years; and (2) assess the prevalence of vision-threatening DR (VTDR). Audit standards followed Royal Australian and New Zealand College of Ophthalmologists DR guidelines.³

During the 4-month audit, 237 patients were screened of whom 83.1% had previously seen their optometrist within 2 years and 70.4% within 1 year (median 7 months). Compared to published data from other Australian community programs the overall prevalence of DR was high (42%). A toal of 20% had VTDR and 6% proliferative DR (Table 1).⁴ Of those patients with VTDR, 80% were unknown to an ophthalmologist, and at the time of the audit only one patient with VTDR had been informed that they had significant disease requiring referral.

Our findings are limited by voluntary participation and therefore do not represent all patients attending our diabetes clinic. Moreover, without consent to share data with third parties we could not contact the optometrist to verify all possible referrals to ophthalmologists. Despite these limitations, our findings suggest that a significant proportion of high-risk patients living with diabetes have VTDR which is either unrecognised or not referred as per national guidelines, despite the vast majority of patients having attended a community optometrist within the past 12 months. Further research is needed to assess whether these findings are representative of practice in the wider community and if so, why referable VTDR is going unrecognised.