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


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.

Please login with your free MJA account to view this article in full

  • 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


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.

  • 1. NCD Risk Factor Collaboration. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet 2016; 387: 1513-1530.
  • 2. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol 2012; 96: 614-618.
  • 3. Magliano DJ, Peeters A, Vos T, et al. Projecting the burden of diabetes in Australia: what is the size of the matter? Aust N Z J Public Health 2009; 33: 540-543.
  • 4. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012; 35: 556-564.
  • 5. Ferris FL. How effective are treatments for diabetic retinopathy? JAMA 1993; 269: 1290-1291.
  • 6. Australian Diabetes Society for the Department of Health and Ageing. Guidelines for the management of diabetic retinopathy Canberra: National Health and Medical Research Council, 2008. (accessed Mar 2017).
  • 7. Xie J, Arnold AL, Keeffe J, et al. Prevalence of self-reported diabetes and diabetic retinopathy in indigenous Australians: the National Indigenous Eye Health Survey. Clin Exp Ophthalmol 2011; 39: 487-493.
  • 8. Larizza MF, Hodgson LA, Fenwick EK, et al. Feasibility of screening for diabetic retinopathy at an Australian pathology collection service: a pilot study. Med J Aust 2013; 198: 97-99. <MJA full text>
  • 9. Magliano DJ, Shaw JE, Shortreed SM, et al. Lifetime risk and projected population prevalence of diabetes. Diabetologia 2008; 51: 2179-2186.
  • 10. Australian Bureau of Statistics. Australian Statistical Geography Standard (ASGS) [website]. Updated June 2014. (accessed Mar 2017).
  • 11. Foreman J, Keel S, Xie J, et al. The National Eye Health Survey 2016: full report of the first national survey to determine the prevalence and major causes of vision impairment and blindness in Australia. Melbourne: Centre for Eye Research Australia and Vision 2020 Australia, 2016. (accessed Mar 2017).
  • 12. Tapp RJ, Zimmet PZ, Harper CA, et al. Diabetes care in an Australian population: frequency of screening examinations for eye and foot complications of diabetes. Diabetes Care 2004; 27: 688-693.
  • 13. McCarty CA, Lloyd-Smith CW, Lee SE, et al. Use of eye care services by people with diabetes: the Melbourne Visual Impairment Project. Br J Ophthalmol 1998; 82: 410-414.
  • 14. Turner AW, Mulholland WJ, Taylor HR. Coordination of outreach eye services in remote Australia. Clin Exp Ophthalmol 2011; 39: 344-349.
  • 15. Scanlon PH, Aldington SJ, Leal J, et al. Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening. Health Technol Assess 2015; 19: 1-116.
  • 16. Tapp RJ, Boudville AI, Abouzeid M, et al. Impact of diabetes on eye care service needs: the National Indigenous Eye Health Survey. Clin Exp Ophthalmol 2015; 43: 540-543.
  • 17. Turner AW, Xie J, Arnold AL, et al. Eye health service access and utilization in the National Indigenous Eye Health Survey. Clin Exp Ophthalmol 2011; 39: 598-603.
  • 18. Tapp RJ, Anjou MD, Boudville AI, Taylor HR. The roadmap to close the gap for vision–diabetes-related eye care in the Indigenous Australian population. Diabet Med 2013; 30: 1145-1146.
  • 19. Australian Government Department of Health. Budget 2016–17: Portfolio budget statements 2016–17; Budget related paper No1.10. Health portfolio. Canberra: 2016.$File/2016-17_Health_PBS_0.0_Complete.pdf (accessed Mar 2017).
  • 20. Kostraba JN, Klein R, Dorman JS, et al. The epidemiology of diabetes complications study. IV. Correlates of diabetic background and proliferative retinopathy. Am J Epidemiol 1991; 133: 381-391.
  • 21. Dunstan DW, Zimmet PZ, Welborn TA, et al. The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 2002; 25: 829-834.
  • 22. Welborn T, Knuiman M, Bartholomew H, Whittall D. 1989–90 National Health Survey: prevalence of self-reported diabetes in Australia. Med J Aust 1995; 163: 129-133.
  • 23. Xie J, Arnold A, Keeffe J, et al. Prevalence of self-reported diabetes and diabetic retinopathy in Indigenous Australians: the National Indigenous Eye Health Survey. Clin Exp Ophthalmol 2011; 39: 487-493.
  • 24. Goldman N, Lin I, Weinstein M, Lin Y. Evaluating the quality of self-reports of hypertension and diabetes. J Clin Epidemiol 2003; 56: 148-154.
  • 25. Huerta J, Tormo M, Egea-Caparrós J, et al. Accuracy of self-reported diabetes, hypertension, and hyperlipidemia in the Spanish population. DINO study findings. Rev Esp Cardiol 2009; 62: 143-152.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.