McCarty C A, Lloyd-Smith C W, Lee S E, Livingston P M, Stanislavsky Y L, Taylor H R
Department of Ophthalmology, University of Melbourne, Australia.
Br J Ophthalmol. 1998 Apr;82(4):410-4. doi: 10.1136/bjo.82.4.410.
The use of eye care services by people with and without diabetes was investigated in the Melbourne Visual Impairment Project (VIP), a population based study of eye disease in a representative sample of Melbourne residents 40 years of age and older.
A comprehensive interview was employed to elicit information on history of diabetes, medication use, most recent visit to an ophthalmologist and optometrist, and basic demographic details. Presence and extent of diabetic retinopathy was determined by dilated fundus examination.
The Melbourne VIP comprised 3271 people who ranged in age from 40 to 98 years; 46.2% of them were male. Of 3189 people who had the fundus examination and knew their diabetes status, 162 (5.1%) reported having been previously diagnosed with diabetes and, of these, 37 (22.2%) were found to have diabetic retinopathy. Seven people (4.3%) had developed diabetes before age 30. The mean duration of diabetes was 9.2 years. People with diabetes were significantly more likely to have visited an ophthalmologist ever or in the past 2 years than people without diabetes. However, 31.8% of people with diabetes had never visited an ophthalmologist. The proportion of people who had never seen an ophthalmologist was 47.1% for people without diabetes, 34.2% for people with diabetes but without diabetic retinopathy, and 25% for people with diabetic retinopathy. Sixty one per cent of people with diabetic retinopathy had seen an ophthalmologist in the past year and a further 3% within the past 2 years. People with diabetes were not significantly more likely to have visited an optometrist than people without diabetes (p = 0.51). Overall, 37.7% of people with diabetes and 32.9% of people without diabetes had visited an optometrist within the past year (chi 2 = 2.25, 1 df, p = 0.13). Information concerning retinal examinations was available for 135 individuals (83.3% of people with diabetes). Only 74 (54.8%) could recall ever having a dilated fundus examination; 10 (14%) by an optometrist, 62 (86%) by an ophthalmologist, and five (7%) by a general practitioner. Of those 68 people who had seen an ophthalmologist in the past 2 years, 48 (71%) reported a dilated fundus examination during that time. This compares with 28 (43%) reported dilated fundus examinations in the 65 people who had seen an optometrist in the past 2 years. This finding is statistically significant (chi 2 = 10.2, 1 df, p < 0.005).
These results indicate that nearly half of people with diabetes in Melbourne are not receiving adequate screening or follow up for diabetic retinopathy, despite universal health care.
在墨尔本视力损害项目（VIP）中，对患有和未患糖尿病的人群使用眼部护理服务的情况进行了调查。该项目是一项基于人群的眼病研究，研究对象为墨尔本40岁及以上居民的代表性样本。
采用全面访谈的方式，获取糖尿病病史、用药情况、最近一次看眼科医生和验光师的情况以及基本人口统计学细节等信息。通过散瞳眼底检查确定糖尿病视网膜病变的存在和程度。
墨尔本VIP项目共有3271人，年龄在40至98岁之间；其中46.2%为男性。在3189名接受了眼底检查且知道自己糖尿病状况的人中，162人（5.1%）报告曾被诊断患有糖尿病，其中37人（22.2%）被发现患有糖尿病视网膜病变。7人（4.3%）在30岁之前就患上了糖尿病。糖尿病的平均病程为9.2年。与未患糖尿病的人相比，患糖尿病的人更有可能曾经或在过去两年内看过眼科医生。然而，31.8%的糖尿病患者从未看过眼科医生。未患糖尿病的人从未看过眼科医生的比例为47.1%，患有糖尿病但无糖尿病视网膜病变的人为34.2%，患有糖尿病视网膜病变的人为25%。61%患有糖尿病视网膜病变的人在过去一年中看过眼科医生，另有3%在过去两年内看过。患糖尿病的人看验光师的可能性并不比未患糖尿病的人高（p = 0.51）。总体而言，37.7%的糖尿病患者和32.9%的非糖尿病患者在过去一年中看过验光师（卡方检验=2.25，自由度为1，p = 0.13）。有135人（占糖尿病患者的83.3%）提供了有关视网膜检查的信息。只有74人（54.8%）能回忆起曾经接受过散瞳眼底检查；其中10人（14%）由验光师进行，62人（86%）由眼科医生进行，5人（7%）由全科医生进行。在过去两年中看过眼科医生的68人中，48人（71%）报告在此期间接受了散瞳眼底检查。相比之下，在过去两年中看过验光师的65人中，有28人（43%）报告接受了散瞳眼底检查。这一发现具有统计学意义（卡方检验=10.2，自由度为1，p < 0.005）。
这些结果表明，尽管有全民医疗保健，但墨尔本近一半的糖尿病患者没有得到充分的糖尿病视网膜病变筛查或随访。
