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Progress in Chronic Disease Prevention Preventing Blindness From Diabetic Eye Disease -- Texas

Diabetic eye disease (DED)* is a leading cause of new cases of blindness in the United States among persons aged 20-74 years (1). Because timely detection and treatment can substantially reduce the incidence of blindness caused by DED (2,3), the identification of persons at high risk for DED is important to ensure that they receive annual eye evaluations, education, and, if appropriate, follow-up care and treatment. This report describes a program to prevent blindness from DED in two areas of southern Texas.

In 1986, the Texas Diabetes Control Program (TDCP) implemented DED screening projects as part of comprehensive diabetes-control activities in the Harris County Hospital District (Houston) and the Laredo-Webb County Health Department. Clients of these projects received medical care through local health departments or community health-care centers; many had no access to routine eye care.

From October 1986 through September 1988, the two programs screened 2741 persons with diabetes for DED. Priority for screening was given to persons with high-risk characteristics (e.g., persons with Type II diabetes, persons aged greater than or equal to 18 years with Type I diabetes, and persons who had not had an eye examination in the preceding year). In the Harris County project, persons at high risk were screened by ophthalmologists and specially trained primary-care physicians at eight community health centers. In the Laredo-Webb County project, persons at high risk were referred to two local ophthalmologists for screening.

Of the 2741 persons screened for DED, 87% were members of minority groups (47% Hispanic; 39% black; and 2% Native American, Alaskan Native, Asian, or Pacific Islander). Eighty-six percent were greater than or equal to 45 years of age, and 72% were female. Of those screened, 146 (5.3%) were recommended for immediate treatment of DED (Table 1). Ten patients had two different treatable conditions (total treatable conditions: 156). Identified conditions requiring immediate treatment were retinopathy (2.2% of total screened), glaucoma (1.9%), and cataracts (1.6%) (Table 1). Hispanics and blacks had the highest prevalence of eye disease requiring immediate treatment. Women had slightly higher rates than men; greater than or equal to 90% of the patients recommended for immediate treatment were aged greater than or equal to 45 years.

The TDCP tracked persons recommended for immediate treatment and assisted them in obtaining private and public third-party reimbursement. Three months after the screening period, 108 (74%) of those recommended for immediate treatment had initiated therapy, and 16 (11%) had treatment scheduled. Barriers to treatment initiation among the remaining 22 persons included cost (eight persons), treatment refusal by client (five), loss of client to follow-up (two), physician postponement of treatment (one), and other/unknown (six). Reported by: S Baker, PhD, Dept of Community Medicine, Baylor Coll of Medicine, Houston; J Santos, Laredo-Webb County Dept of Health, Laredo; C Laramey, Chronic Disease Prevention Program, Texas Dept of Health. Div of Diabetes Translation, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Barriers to optimal care for preventing complications of diabetes include cost, availability, and accessibility of health care; inadequate knowledge among health-care practitioners about the existence and/or appropriate timing of effective therapies; and lack of awareness by patients of the need for and benefit of specific treatments, including self-care practices. This report describes efforts of the TDCP to reduce barriers to optimal eye care in targeted communities through patient and professional education and by coordination and enhancement of eye-care practices among local, state, and federal health agencies. These efforts have increased the accessibility of eye care to persons with diabetes at high risk for blindness.

In addition to Texas, diabetes-control programs (DCPs), which are supported by CDC, have been established in 25 other states and one territory. The primary mission of DCPs is to reduce the gap between optimal medical care and current care practices, particularly in medically underserved communities. Since September 1986, CDC has provided resources and technical assistance to DCPs to implement DED interventions specifically designed to improve current eye-care practices.

References

  1. Klein R, Klein BEK. Vision disorders in diabetes. In: National Institutes of Health, Diabetes in America: diabetes data compiled, 1984. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, 1985; NIH publication no. 85-1468.

  2. Herman WH, Teutsch SM, Sepe SJ, Sinnock P, Klein R. An approach to the prevention of blindness in diabetes. Diabetes Care 1983;6:608-13.

  3. Herman WH, Teutsch SM, Geiss IM. Closing the gap: the problem of diabetes mellitus in the United States. Diabetes Care 1985;8:391-406.

    • Diseases with an etiology of diabetes, including diabetic

    retinopathy, cataracts, and glaucoma.



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