Examination Practices and Referral of Patients With Diabetic Retinopathy by Optometrists in Routine Clinical Care

Chen, Andrew X.
Hsueh, Jessica
Han, Michael M.
Conti, Thais F. MD
Conti, Felipe F. MD
Immler, Wes K. OD
Babiuch, Amy S. MD
Singh, Rishi P. MD

From Case Western Reserve University School of Medicine, Cleveland, Ohio (AXC, JH, MMH, RPS); Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio (TFC, FFC, ASB, RPS); and the Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio (TFC, FFC, WKI, ASB, RPS).

Supported by a continuing medical education grant from Genentech.

Dr. Babiuch has received personal fees from Allergan, MCME Global, and Vindico outside the submitted work. Dr. Singh has received grants and personal fees from Genentech during the conduct of this study, as well as grants and personal fees from Regeneron and Novartis/Alcon and personal fees from Optos, Bausch + Lomb, and Zeiss outside the submitted work. The remaining authors report no relevant financial disclosures.

Dr. Singh did not participate in the editorial review of this manuscript.

Address correspondence to Rishi P. Singh, MD, 9500 Euclid Avenue, Desk i32, Cleveland, OH 44195; email: [email protected].

Received August 09, 2018

Accepted March 11, 2019

Ophthalmic Surgery, Lasers, and Imaging Retina 50(10):p 608-612, October 01, 2019. | DOI: 10.3928/23258160-20191009-02

BACKGROUND AND OBJECTIVE:

To analyze the examination practices and referral of patients with diabetic retinopathy (DR) by optometrists in routine clinical care.

PATIENTS AND METHODS:

Diabetic patient records from 2012 to 2018 were retrospectively reviewed for documentation of dilated fundus exam (DFE), imaging, follow-up appointments, and referrals. Concordance between clinical exam and coding was also analyzed.

RESULTS:

For 97.8% of encounters, DFE was performed, the patient was referred for DFE, or DFE was scheduled for follow-up. When DFE was performed at the initial visit, this resulted in referral of 19.8% of patients to an ophthalmologist. Imaging was obtained occasionally, with fundus photos in 2.6% and optical coherence tomography in 14.5% of encounters. Concordance of DR grading between exam and coding was 78.8%. Recommended follow-up times were incorrect based on DR severity level in 13.8% of encounters.

CONCLUSION:

Although DFE was performed reliably by optometrists, utilization of imaging, DR grading and coding, and appropriate follow-up periods could be improved.

[Ophthalmic Surg Lasers Imaging Retina. 2019;50:608–612.]