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Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey

Joshua Foreman, Stuart Keel, Jing Xie, Peter Van Wijngaarden, Hugh R Taylor and Mohamed Dirani
Med J Aust 2017; 206 (9): 402-406. || doi: 10.5694/mja16.00989

Summary

Objective: To determine adherence to NHMRC eye examination guidelines for Indigenous and non-Indigenous Australian people with diabetes.

Design: Cross-sectional survey using multistage, random cluster sampling.

Setting: Thirty randomly selected geographic sites in the five mainland Australian states and the Northern Territory, stratified by remoteness.

Participants: 1738 Indigenous Australians aged 40–92 years and 3098 non-Indigenous Australians aged 50–98 years were recruited and examined between March 2015 and April 2016 according to a standardised protocol that included a questionnaire (administered by an interviewer) and a series of standard eye tests.

Main outcome measures: Adherence rates to NHMRC eye examination guidelines; factors influencing adherence.

Results: Adherence to screening recommendations was significantly greater among non-Indigenous Australians (biennial screening; 77.5%) than Indigenous Australians (annual screening; 52.7%; P < 0.001). Greater adherence by non-Indigenous Australians was associated with longer duration of diabetes (adjusted odds ratio [aOR], 1.19 per 5 years; P = 0.018), while increasing age was associated with poorer adherence in non-Indigenous Australians (aOR, 0.70 per decade; P = 0.011). For Indigenous Australians, residing in inner regional areas (aOR, 1.66; P = 0.007) and being male (aOR, 1.46; P = 0.018) were significant factors positively associated with adherence.

Conclusions: More than three-quarters of non-Indigenous Australians with diabetes and more than half of Indigenous Australians with diabetes adhere to the NHMRC eye examination guidelines. The discrepancy between the adherence rates may point to gaps in the provision or uptake of screening services in Indigenous communities, or a lack of awareness of the guidelines. A carefully integrated diabetic retinopathy screening service is needed, particularly in remote areas, to improve adherence rates.

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  • Joshua Foreman1
  • Stuart Keel1
  • Jing Xie1,2
  • Peter Van Wijngaarden1
  • Hugh R Taylor3
  • Mohamed Dirani1

  • 1 Centre for Eye Research Australia, Melbourne, VIC
  • 2 Xinxiang Medical University, Xinxiang, China
  • 3 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC


Acknowledgements: 

The Centre for Eye Research Australia (CERA) and Vision 2020 Australia recognise the contributions of all the National Eye Health Survey project steering committee members and the core CERA research team who assisted with the survey field work. Further, we acknowledge the overwhelming support from all collaborating Indigenous organisations who assisted with implementing the survey, and the Indigenous health workers and volunteers at each survey site who contributed to the field work. The National Eye Health Survey was funded by the Australian government, and also received financial contributions from Australia and in-kind support from our industry and sector partners, OPSM, Carl Zeiss, Designs for Vision, the Royal Flying Doctor Service, Optometry Australia and the Brien Holden Vision Institute. We specifically acknowledge OPSM, who kindly donated sunglasses to each study participant. The Centre for Eye Research Australia receives operational infrastructure support from the Victorian government. The principal investigator, Mohamed Dirani, is supported by a National Health and Medical Research Council Career Development Fellowship (#1090466). Joshua Foreman is supported by an Australian Postgraduate Award.

Competing interests:

No relevant disclosures.

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