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Primary Capstone Advisor: Mona Sarfaty, MD, MPH Committee Members: Albert Crawford, MBA, PhD; Rob Simmons, DrPH, MPH;


Diabetic retinopathy (DR) is the leading cause of blindness among the working age population in the US. Several studies have shown that a large proportion (37%-79%) of diabetics do not get their dilated fundus examinations (DFEs) as per the recommended guidelines. The present study was undertaken to assess the knowledge of DR and DFE in diabetic patients of a large academic primary care practice. Study population included 200 patients (67 each from Aetna and Independence Blue Cross IBC and 66 from Keystone Mercy KMHP) randomly selected from the lists of diabetic patients within age range of 18-64 years receiving primary care at the Jefferson Family Medicine practice. A survey tool was designed based on the health belief model to assess the awareness level of DR and DFE, and to assess the barriers/facilitators to getting an eye examination regularly. A complete package of the survey sheet, a cover letter and a self addressed stamped return envelope was mailed. Fifty-six (28%) responses were received. 70% were females and 30% males. 68% of the population got a DFE within 1 year and 12.5% between 1-2 years. Barriers identified were cost, transportation, lack of symptoms, and fear of the exam. Facilitators were awareness, eye problems and information from their doctors. Patient’s knowledge of DFE had a statistically significant relationship with their last eye exam done within 2 years (p=0.012). There was a significant difference in eye exams by insurance: 60% for KMHP vs. 89% for IBC and 95% for Aetna (p=0.015). Results suggest that improved awareness of DR and DFE and efforts to address the barriers may increase adherence to the recommended guidelines for getting a DFE. A more detailed study needs to be done with KMHP patients to identify and address their barriers. This is an important step in preventing diabetes-related blindness.