Prevalence of glaucoma and diabetic retinopathy by self- report and after examination in an urban low-income uninsured adult population Janis E. Winters O.D. Associate Professor Illinois College of Optometry

Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Janis E. Winters No relationships to disclose

Patient history Individual history – Essential part of eye examination – In screening, may be used to determine who is at ‘high risk’ Surveys, some population studies – Determine outcome

Glaucoma and diabetic retinopathy Diagnosis and control / treatment – reduce risk for visual impairment Can be asymptomatic

Glaucoma Conclusive diagnosis might not always exist Tends run in families

Hypothesis Self-report dr or glc based on may not be as accurate as desired among low-income uninsured adults

Vision of Hope Health Alliance (VOHHA) Uninsured, low-income adults were provided eye care. – Less than 200% of federal poverty level

How It Works

VOHHA ? Access to care Barriers

Vision of Hope Health Alliance (VOHHA) Retrospective record review was performed – Glaucoma suspect records re-reviewed 6 months Dx based on findings of attending Dx with condition if present in either eye

RESULTS 4029 kept appointments Majority female % Education – 65.8% complete HS Large majority resided in Cook county – 96% – Chicago- 85% 4% Illinois counties, Indiana and Wisconsin

Age Distribution

Race

Glaucoma data Hx of glc /glc suspect – 140 (3.5 %) A family Hx glc – 425 (10.7%) Personal or fam Hx – 522 (13%) After examination, 325 (8.1%) were diagnosed as having glc / glc suspects – 145(3.6%) were diagnosed with glc – 180 (4.5%) patients were diagnosed as glc suspects

325/522 = 62% ???

Hx Vs. Dx Personal hx dx glc/sus 65.7% -- 2:3 25.7% those dx 1:4 Family hx dx glc/sus 18.2% -- 1:5 22.3% those dx 1:5

Personal/Family History dx glc/sus 26.6% who reported hx were dx (1:4) 38.8 % those dx with glc/sus reported hx (1:3)

The Bottom Line About 3of 4 who reported personal/family history were not dx with glc/suspect The majority (61%) who were dx glc/sus did not report a family /personal history

Diabetic retinopathy 1323 (33.4%) DM2 26 (0.7%) DM1 41 (3.0%) history of dr DR 302 (22.3%) Npdr 255 (18.7%) Pdr 47(3.6%)

Diabetic retinopathy: Hx vs Dx History – Dx with DR 39% reported a history were not diagnosed

Diabetic retinopathy: Hx vs Dx 25 Dx with DR – 12 Dx NPDR – 13 Dx PDR 95% NPDR and 73% PDR no previous history of dr

Patient history Obtaining patient history essential Results support

Patient history Can history be relied upon? – Individual patients – Population studies

History Population studies recognize that history is not always reliable – LALES – independent evaluation for DM Obtaining medical history from PCP/ other provider

History What makes outcomes so different than findings in this population?

History Newly diagnosed? – DR – mostly NPDR – Access to care – Barriers Inaccurate history – Confuse condition? Education Cultural ??

Conclusion History important Patient history cannot always be relied upon – Consider verification Supports routine eye care especially for DM