Disparities Between Teleretinal Imaging Findings and Patient-reported Diabetic Retinopathy Status and Followup Eye Care Interval: A 10-year Prospective study

Objective: To assess self-reported awareness of diabetic retinopathy (DR) and concordance of eye examination follow-up compared to findings from concurrent retinal images. Research Design and Methods: Prospective observational 10-year study of 26,876 consecutive patients with diabetes that underwent retinal imaging during an endocrinology visit. Awareness and concordance was evaluated using questionnaires and retinal imaging. Results: Awareness information and gradable images were available in 25,360 patients (94.3%). Severity of DR by imaging: no DR 14,317(56.5%); mild DR 6,805(26.8%), vision-threatening DR (vtDR) 4,238(16.7%). Patients did not report being aware of any prior DR in 96.7%, 88.5% and 54.9% (no,mild,vtDR). When DR was present, reporting no prior DR was associated with shorter diabetes duration, milder DR, last eye exam >1 year prior, no dilation, no scheduled appointment, and less specialized provider (all P<0.001). Among patients with vtDR, 41.2%, 58.1% and 64.2% did not report being aware of any DR and follow-up was concordant with current DR severity in 66.7%, 41.3% and 25.4% (P<0.001) when prior examination was performed by a retina specialist, non-retina ophthalmologist, or optometrist (P<0.001). Conclusions: Substantial discrepancies exist between DR presence, patient awareness and concordance of follow-up across all DR severity levels. These discrepancies are present across all eye care provider types with the magnitude influenced by provider type. Thus, patient self-report should not be relied upon to reflect DR status. Modification of medical care and education models may be necessary to enhance retention of ophthalmic knowledge in patients with diabetes and assure accurate communication between all health care providers.