Ophthalmologist Dr Robert Finger
General Practitioners take on average three years to refer patients with type 2 diabetes for an eye examination, according to results from a Melbourne survey of doctors.
Head of Population Health at the Centre for Eye Research Australia, ophthalmologist Dr Robert Finger sent the survey to 600 GPs and 180 responded.
‘National Health and Medical Research Council Diabetic Retinopathy Management guidelines recommend that patients when diagnosed with type 2 diabetes should be referred to an optometrist or ophthalmologist for eye screening,’ Dr Finger said.
‘Among those GPs surveyed, a lot did not refer on diagnosis of type 2 diabetes; there was a mean delay of three years before referral. We don’t know why they aren’t referring immediately but often reasons include that they have a lot of patients and don’t have time to refer or patients may be reluctant to go or patients currently have good diabetes control and seem to not have any problems with their eyes.’
Dr Finger said that doctors and patients needed to be made aware that just because they were not experiencing current problems with their diabetes or visual symptoms, this did not mean that they should not have scheduled eye checks.
A second inter-related study, the RetPath screening for diabetic retinopathy study, run by Dr Gwyn Rees at CERA, involved patients attending pathology centres.
Staff members were trained to use retinal cameras to take images that were sent to the Royal Victorian Eye and Ear Hospital for grading. All patients and their GPs were then sent the results of the DR screening.
Follow-up interviews with participants asking whether GPs had made the referral were conducted several months later.
‘Quite a lot of the participants who needed a referral were never referred or were referred but did not take it up,’ Dr Finger said.
‘Only about one-third of doctors discussed the DR screening results with their patient, for example, what is the disease, implications, treatment and the need for regular and different tests.
‘Two-thirds did not discuss their screening results with their GP such as what it meant and why they should go for review. Of those who did not discuss results, 23 per cent should have been referred urgently and 36 per cent should have been referred within the next year,’ he said.
Researchers plan to conduct further research with the GPs, looking at screening outcomes and barriers.
‘We will ask GPs why they don’t refer and whether they are aware this is urgent although the patient may not have vision problems and may have good diabetes control,’ Dr Finger said. ‘The largest hurdle appears to be getting them to refer in time and the patient to take up the referral in time as well.’