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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
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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
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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
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Glaucoma and diabetic retinopathy Diagnosis and control / treatment – reduce risk for visual impairment Can be asymptomatic
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Glaucoma Conclusive diagnosis might not always exist Tends run in families
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Hypothesis Self-report dr or glc based on may not be as accurate as desired among low-income uninsured adults
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Vision of Hope Health Alliance (VOHHA) Uninsured, low-income adults were provided eye care. – Less than 200% of federal poverty level
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How It Works
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VOHHA ? Access to care Barriers
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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
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RESULTS 4029 kept appointments Majority female - 53.3% Education – 65.8% complete HS Large majority resided in Cook county – 96% – Chicago- 85% 4% Illinois counties, Indiana and Wisconsin
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Age Distribution
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Race
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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
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325/522 = 62% ???
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Hx Vs. Dx Personal hx 140 92 dx glc/sus 65.7% -- 2:3 25.7% those dx 1:4 Family hx 425 80 dx glc/sus 18.2% -- 1:5 22.3% those dx 1:5
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Personal/Family History 522 139 dx glc/sus 26.6% who reported hx were dx (1:4) 38.8 % those dx with glc/sus reported hx (1:3)
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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
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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%)
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Diabetic retinopathy: Hx vs Dx History – 41 25 Dx with DR 39% reported a history were not diagnosed
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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
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Patient history Obtaining patient history essential Results support
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Patient history Can history be relied upon? – Individual patients – Population studies
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History Population studies recognize that history is not always reliable – LALES – independent evaluation for DM Obtaining medical history from PCP/ other provider
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History What makes outcomes so different than findings in this population?
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History Newly diagnosed? – DR – mostly NPDR – Access to care – Barriers Inaccurate history – Confuse condition? Education Cultural ??
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Conclusion History important Patient history cannot always be relied upon – Consider verification Supports routine eye care especially for DM
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