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

In reply:

We thank Lake and colleagues for the letter on our article.1 The concern that Australia has insufficient population-based data on the frequency of diabetic eye examinations in younger Australians is probably warranted. The primary objective of the National Eye Health Survey was to determine the prevalence of vision loss in Indigenous (aged ≥ 40 years) and non-Indigenous (aged ≥ 50 years) Australians.2,3 Research on diabetes and its complications in younger Australians was beyond the scope of this study and not the primary focus of the National Eye Health Survey. Further to the recommendations by Lake and colleagues in their letter, adherence rates in patients with type 1 diabetes should also be quantified.4

The National Eye Health Survey focused on an older demographic because there was a gap in knowledge on nation-wide figures on vision loss and major eye diseases in this population. Eighty-five per cent of vision loss occurs in people aged ≥ 50 years, and the World Health Assembly’s Global Action Plan 2014–2019 recommended this age cut-off for surveys on the prevalence of vision impairment and blindness.5 In addition, we intended to compare our findings with Australian and global literature, most of which has specifically investigated this older demographic.

Nonetheless, the National Eye Health Survey achieved very good coverage of Indigenous and non-Indigenous populations across all levels of remoteness, and until further research investigates younger Australians, the adherence rates reported in our article may be cautiously extrapolated to the younger population. The overall message is likely to remain; adherence rates have improved in recent years, but further improvements are required.

Readers should be cognisant of current efforts to provide care for all Australians with diabetes regardless of their age and type of diabetes. The federal government has invested $33.8 million to support new Medicare Benefits Schedule items for primary care services to cover diabetic retinal screening using non-mydriatic retinal photography,6 and efforts are underway for an integrated national diabetic retinopathy screening program. Younger Australians with diabetes will benefit from these interventions and are unlikely to be neglected in future planning.