Journal List > J Korean Ophthalmol Soc > v.57(7) > 1010336

Park, Seo, Lee, and Nam: Main Reasons for and Associated Factors of the First Fundus Examination in Diabetic Patients

Abstract

Purpose

To determine the major reasons that diabetics decide to undergo their first fundus examination, and the factors influencing such reasons.

Methods

Of the patients with type II diabetes who presented to the Department of Ophthalmology in Gachon University Gil Medical Center, 164 patients who underwent their first fundus examination after being diagnosed with diabetes were included in the study. Face-to-face and phone interviews with these patients were conducted.

Results

The average prevalence period from the diagnosis of diabetes to the first fundus examination was 8.3 ± 7.5 years. Of the diabetics who underwent their first fundus examination, 52.4% had diabetic retinopathy, with no significant difference in prevalence between the male and female patients (p = 0.118). The most common reason for deciding to undergo the first fundus examination was recommendation by a doctor (53.7%). For those patients who received their first fundus examination after recommendation by a doctor, the prevalence period from diabetes was the shortest among all patients (p < 0.001), and the prevalence and severity of diabetic retinopathy were the lowest (p < 0.001 and p = 0.017, respectively). The number of fundus examinations conducted following recommendation by a doctor was significantly higher in secondary and tertiary hospitals than in primary hospitals (p < 0.001). Education on diabetes and knowledge of diabetic ocular complications were found to be significantly correlated (p < 0.001).

Conclusions

For patients who are diagnosed with diabetes and treated in primary hospitals, who are older, or who did not receive education on diabetes, recommendation by a doctor for early fundus examination is particularly important regardless of subjective visual disturbance. Moreover, patient education should be offered and ophthalmic examination should be recommended in primary hospitals.

References

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Table 1.
Patient's sex, age, duration of diabetes and prevalence of diabetic retinopathy
  No. Age (years) Duration of DM (years) Prevalence of DR (%)
Total 164 55.6 ± 11.8 8.3 ± 7.5 86/164 (52.4)
Male 82 54.3 ± 10.6 7.7 ± 7.9 48/82 (58.5)
Female 82 56.9 ± 11.0 8.8 ± 7.1 38/82 (46.3)
p-value   0.087* 0.247* 0.118

Values are presented as mean ± SD unless otherwise indicated.

DM = diabetes mellitus; DR = diabetic retinopathy.

* Independent t-test

Chi-square test.

Table 2.
Severity of diabetic retinopathy and type of hospital according to main reasons for initial fundus examination
Main reason for initial fundus examination No. Age (years) Duration of DM (years) Prevalence of DR Severity of DR
Type of hospital
NPDR PDR Primary Secondary or Tertiary
Total 164 (100.0%)           108 (100.0%) 56 (100.0%)
Subjective visual 35 (21.3%) 60.6 ± 10.8 14.2 ± 8.1 28/35 (80.0%) 11/35 17/35 (48.6%) 32 (29.6%) 3 (5.4%)
  disturbance         (31.4%)      
Doctor's 88 (53.7%) 54.6 ± 8.9 5.7 ± 6.2 33/88 (37.5%) 27/88 6/88 (6.8%) 40 (37.0%) 48 (85.7%)
  recommendation         (30.7%)      
Family's 11 (6.7%) 60.7 ± 9.8 13.3 ± 6.0 10/11 (90.9%) 6/11 4/11 (36.4%) 10 (9.3%) 1 (1.8%)
  recommendation         (54.5%)      
DM education 23 (14.0%) 48.9 ± 10.2 6.3 ± 7.1 10/23 (43.5%) 5/23 5/23 (21.7%) 19 (17.6%) 4 (7.1%)
          (21.7%)      
Mass media 7 (4.3%) 56.9 ± 11.4 10.7 ± 7.5 5/7 (71.4%) 3/7 2/7 (28.6%) 7 (6.5%) 0 (0.0%)
          (42.9%)      
p-value   0.327 <0.001 <0.001* 0.017* <0.001*

DM = diabetes mellitus; DR = diabetic retinopathy; NPDR = nonproliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy.

* Chi-square test

Analysis of variance (ANOVA).

Table 3.
Severity of diabetic retinopathy and presence of diabetes education
  Hospital
p-value
  Primary Secondary or tertiary
Prevalence of DM 75/108 (69.4%) 11/56 (19.6%) <0.001*
Duration of DM (years) 9.4 ± 8.9 6.3 ± 5.6 <0.001
Severity of DR     0.027*
   NPDR 42 (38.9%) 10 (17.9%)  
   PDR 33 (30.6%) 1 (1.8%)  
DM education     <0.001*
   Yes 34 (31.5%) 47 (83.9%)  
   No 74 (68.5%) 9 (16.1%)  

DM = diabetes mellitus; DR = diabetic retinopathy; NPDR = nonproliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy.

* Chi-square test

Independent t-test.

Table 4.
Knowledge of diabetic ocular complications
  Known ocular complication
  Unknown Known
DM education (n,%)    
   No 64 (77.1) 19 (22.9)
   Yes 9 (11.1) 72 (88.9)
p-value* <0.001

Values are presented as n (%) unless otherwise indicated.

DM = diabetes mellitus.

* Chi-square test.

Table 5.
Prevalence and severity of diabetic retinopathy according to subjective visual disturbance
  Prevalence of DR Severity of DR
    NPDR PDR
Subjective visual disturbance      
   No 56/112 (50.0%) 37 (33.0%) 19 (17.0%)
   Yes 30/52 (57.7%) 15 (28.8%) 15 (28.8%)
p-value* 0.359 0.146

DR = diabetic retinopathy; NPDR = nonproliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy.

* Chi-square test.

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