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Undetected Eye Disease in a Primary Care Clinic Population

Undetected Eye Disease in a Primary Care Clinic Population Abstract Background: Population-based data have indicated that a significant proportion of persons with undiagnosed ocular disease in the community are regular users of general medical services. This, combined with the high prevalence of chronic medical disorders known to be risk factors for ocular disease in such clinics, makes them an attractive site for screening. Methods: The prevalence of ocular disease was estimated in a sample of 405 general medicine patients attending an adult primary care clinic in an urban teaching hospital. Results: Overall, 205 (50.6%) of 405 patients were found to have clinically important ocular pathology. One third of those affected (n=68) were unaware of their eye disease, and 26% (n=18) of these 68 patients required immediate medical or surgical intervention. Patients 65 years or older (odds ratio [OR], 1.76), in fair or poor general health (OR, 1.78), with diabetes mellitus (OR, 2.07), or with self-reported fair or poor vision (OR, 3.03), were at increased risk for the presence of ocular disease. Among patients with eye disease, those who had no insurance coverage for eye care (OR, 3.45), those who had not had an eye examination during the previous 2 years (OR, 4.03), and those whose last eye examination was performed by an optometrist (OR, 7.25, reference ophthalmologist) were more likely to not be aware of their eye disease. Conclusions: Our results underscore the importance of screening for ocular disease in primary health care settings, especially for patients who are older than 65 years, are in poor health, report poor vision, have had infrequent eye examinations, or have inadequate insurance coverage for eye care.(Arch Intern Med. 1994;154:1821-1828) References 1. Steinberg EP, Javitt JC, Sharkey PD, et al. The content and cost of cataract surgery . Arch Ophthalmol. 1993;111:1041-1049.Crossref 2. Tielsch JM, Sommer A, Witt K, Katz J, Royall RM, the Baltimore Eye Survey Research Group. Blindness and visual impairment in an American urban population: the Baltimore Eye Survey . Arch Ophthalmol. 1990;108:286-290.Crossref 3. Kahn HA, Moorhead HB. Statistics on Blindness in the Model Reporting Area 1969-1970 . Washington, DC: Office of Biometry and Epidemiology, National Eye Institute; 1973. Dept Health, Education, and Welfare publication NIH 73-427. 4. Leibowitz HM, Krueger DE, Maunder LR, et al. The Framingham Eye Study monograph . Surv Ophthalmol. 1980;24( (suppl) ):335-610.Crossref 5. Sommer A, Tielsch JM, Katz J, al. Racial differences in the cause-specific prevalence of blindness in east Baltimore . N Engl Med. 1991;325:1412-1417.Crossref 6. Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J. Racial variations in the prevalence of primary open-angle glaucoma: the Baltimore Eye Survey . JAMA . 1991;266:369-374.Crossref 7. Witkin SR, Klein R. Ophthalmologic care for persons with diabetes . JAMA . 1984; 251:2534-2537.Crossref 8. Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, VI: retinal coagulation . Ophthalmology . 1987;94:747-753.Crossref 9. Klein R, Moss SE, Klein BEK, Davis MD, DeMets DL. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, VIII: the incidence of retinal photocoagulation . J Diabetic Complications . 1988;2:79-87.Crossref 10. Levi L, Schwartz B. Glaucoma screening in the health care setting . Surv Ophthalmol. 1983;28:141-143.Crossref 11. Brancati FL, Ford DE, Appel LJ, Klag MJ, Whelton PK. Patient characteristics related to intensity of weight reduction care in a university medical clinic . J Gen Intern Med. 1992;7:609-614.Crossref 12. Strahlman E, Ford DE, Whelton PK, Sommer A. Vision screening in a primary care setting: a missed opportunity? Arch Intern Med. 1990;150:2159-2164.Crossref 13. Sprafka M, Fritsche TL, Baker R, Kurth D, Whipple D. Prevalence of undiagnosed eye disease in high-risk diabetic individuals . Arch Intern Med. 1990; 150:857-861.Crossref 14. Kini MM, Leibowitz HM, Colton T, Nickerson RJ. Prevalence of senile cataract, diabetic retinopathy, senile macular degeneration, and open-angle glaucoma in the Framingham Eye Study . Am J Ophthalmol. 1978;85:28-34. 15. Kahn HA, Milton RC. Alternative definition of open-angle glaucoma: effect on prevalence and association in the Framingham Eye Study . Arch Ophthalmol. 1980;98:2172-2177.Crossref 16. Klein R, Klein BEK, Linton KLP, DeMets DL. The Beaver Dam Eye Study: visual acuity . Ophthalmology. 1991;98:1310-1315.Crossref 17. Klein BEK, Klein R, Linton KLP. Prevalence of age-related lens opacities in a population: The Beaver Dam Eye Study . Ophthalmology . 1992;99:546-552.Crossref 18. Klein BEK, Klein R, Sponsel WE, et al. Prevalence of glaucoma: The Beaver Dam Eye Study . Ophthalmology . 1992;99:1499-1504.Crossref 19. Klein R, Klein BEK, Moss SE, Linton KLP. The Beaver Dam Eye Study: retinopathy in adults with newly discovered and previously diagnosed diabetes mellitus . Ophthalmology . 1992;99:58-62.Crossref 20. Ganley JP, Roberts J. Eye conditions and related need for eye care . Vital Health Stat. 1983;228:1-69. 21. Statistical Abstract of the United States . The National Data Bank . Washington, DC: US Dept Commerce Economics and Statistics Administration, Bureau of the Census; 1992. 22. Sharkness CM, Hamburger S, Kaczmarek RG, Hamilton PM, Bright RA, Moore RM. Racial differences in the prevalence of intraocular lens implants in the United States . Am J Ophthalmol. 1992;114:667-674. 23. Kahn HA, Leibowitz HM, Ganley JP, et al. The Framingham Eye Study, II: association of ophthalmic pathology with single variables previously measured in the Framingham heart study . Am J Epidemiol. 1977;106:33-41. 24. Ederer F, Hiller R, Taylor HR. Senile lens changes and diabetes in two population studies . Am J Ophthalmol. 1981;91:381-395. 25. Phillips CI, Bartholomew RS, Clayton RM, et al. Cataract: a search for associations or causative factors . In: Regnault F, ed. Symposium on the Lens . Princeton, NJ: Excerpta Medica; 1980:19-25. 26. Clayton RM, Cuthbert J, Phillips CI, et al. Analysis of individual cataract patients and their lenses: a progress report . Exp Eye Res. 1980;31:553-566.Crossref 27. Linton KL, Klein BE, Klein R. The validity of self-reported and surrogatereported cataract and age-related macular degeneration in the Beaver Dam Eye Study . Am J Epidemiol. 1991;134:1438-1446. 28. Klein R, Klein BEK, Moss SE, DeMets DL. The validity of a survey question to study diabetic retinopathy . Am J Epidemiol. 1986;124:104-110. 29. Tielsch JM, Sommer A, Katz J, Quigley H, Ezrine S. Socioeconomic status and visual impairment among urban Americans . Arch Ophthalmol. 1991; 109:637-641.Crossref 30. Lurie N, Kamberg CJ, Brook RH, Keeler EB, Newhouse JP. How free care improved vision in the health insurance experiment . Am J Public Health . 1989; 79:640-642.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Undetected Eye Disease in a Primary Care Clinic Population

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References (33)

Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420160054007
Publisher site
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Abstract

Abstract Background: Population-based data have indicated that a significant proportion of persons with undiagnosed ocular disease in the community are regular users of general medical services. This, combined with the high prevalence of chronic medical disorders known to be risk factors for ocular disease in such clinics, makes them an attractive site for screening. Methods: The prevalence of ocular disease was estimated in a sample of 405 general medicine patients attending an adult primary care clinic in an urban teaching hospital. Results: Overall, 205 (50.6%) of 405 patients were found to have clinically important ocular pathology. One third of those affected (n=68) were unaware of their eye disease, and 26% (n=18) of these 68 patients required immediate medical or surgical intervention. Patients 65 years or older (odds ratio [OR], 1.76), in fair or poor general health (OR, 1.78), with diabetes mellitus (OR, 2.07), or with self-reported fair or poor vision (OR, 3.03), were at increased risk for the presence of ocular disease. Among patients with eye disease, those who had no insurance coverage for eye care (OR, 3.45), those who had not had an eye examination during the previous 2 years (OR, 4.03), and those whose last eye examination was performed by an optometrist (OR, 7.25, reference ophthalmologist) were more likely to not be aware of their eye disease. Conclusions: Our results underscore the importance of screening for ocular disease in primary health care settings, especially for patients who are older than 65 years, are in poor health, report poor vision, have had infrequent eye examinations, or have inadequate insurance coverage for eye care.(Arch Intern Med. 1994;154:1821-1828) References 1. Steinberg EP, Javitt JC, Sharkey PD, et al. The content and cost of cataract surgery . Arch Ophthalmol. 1993;111:1041-1049.Crossref 2. Tielsch JM, Sommer A, Witt K, Katz J, Royall RM, the Baltimore Eye Survey Research Group. Blindness and visual impairment in an American urban population: the Baltimore Eye Survey . Arch Ophthalmol. 1990;108:286-290.Crossref 3. Kahn HA, Moorhead HB. Statistics on Blindness in the Model Reporting Area 1969-1970 . Washington, DC: Office of Biometry and Epidemiology, National Eye Institute; 1973. Dept Health, Education, and Welfare publication NIH 73-427. 4. Leibowitz HM, Krueger DE, Maunder LR, et al. The Framingham Eye Study monograph . Surv Ophthalmol. 1980;24( (suppl) ):335-610.Crossref 5. Sommer A, Tielsch JM, Katz J, al. Racial differences in the cause-specific prevalence of blindness in east Baltimore . N Engl Med. 1991;325:1412-1417.Crossref 6. Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J. Racial variations in the prevalence of primary open-angle glaucoma: the Baltimore Eye Survey . JAMA . 1991;266:369-374.Crossref 7. Witkin SR, Klein R. Ophthalmologic care for persons with diabetes . JAMA . 1984; 251:2534-2537.Crossref 8. Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, VI: retinal coagulation . Ophthalmology . 1987;94:747-753.Crossref 9. Klein R, Moss SE, Klein BEK, Davis MD, DeMets DL. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, VIII: the incidence of retinal photocoagulation . J Diabetic Complications . 1988;2:79-87.Crossref 10. Levi L, Schwartz B. Glaucoma screening in the health care setting . Surv Ophthalmol. 1983;28:141-143.Crossref 11. Brancati FL, Ford DE, Appel LJ, Klag MJ, Whelton PK. Patient characteristics related to intensity of weight reduction care in a university medical clinic . J Gen Intern Med. 1992;7:609-614.Crossref 12. Strahlman E, Ford DE, Whelton PK, Sommer A. Vision screening in a primary care setting: a missed opportunity? Arch Intern Med. 1990;150:2159-2164.Crossref 13. Sprafka M, Fritsche TL, Baker R, Kurth D, Whipple D. Prevalence of undiagnosed eye disease in high-risk diabetic individuals . Arch Intern Med. 1990; 150:857-861.Crossref 14. Kini MM, Leibowitz HM, Colton T, Nickerson RJ. Prevalence of senile cataract, diabetic retinopathy, senile macular degeneration, and open-angle glaucoma in the Framingham Eye Study . Am J Ophthalmol. 1978;85:28-34. 15. Kahn HA, Milton RC. Alternative definition of open-angle glaucoma: effect on prevalence and association in the Framingham Eye Study . Arch Ophthalmol. 1980;98:2172-2177.Crossref 16. Klein R, Klein BEK, Linton KLP, DeMets DL. The Beaver Dam Eye Study: visual acuity . Ophthalmology. 1991;98:1310-1315.Crossref 17. Klein BEK, Klein R, Linton KLP. Prevalence of age-related lens opacities in a population: The Beaver Dam Eye Study . Ophthalmology . 1992;99:546-552.Crossref 18. Klein BEK, Klein R, Sponsel WE, et al. Prevalence of glaucoma: The Beaver Dam Eye Study . Ophthalmology . 1992;99:1499-1504.Crossref 19. Klein R, Klein BEK, Moss SE, Linton KLP. The Beaver Dam Eye Study: retinopathy in adults with newly discovered and previously diagnosed diabetes mellitus . Ophthalmology . 1992;99:58-62.Crossref 20. Ganley JP, Roberts J. Eye conditions and related need for eye care . Vital Health Stat. 1983;228:1-69. 21. Statistical Abstract of the United States . The National Data Bank . Washington, DC: US Dept Commerce Economics and Statistics Administration, Bureau of the Census; 1992. 22. Sharkness CM, Hamburger S, Kaczmarek RG, Hamilton PM, Bright RA, Moore RM. Racial differences in the prevalence of intraocular lens implants in the United States . Am J Ophthalmol. 1992;114:667-674. 23. Kahn HA, Leibowitz HM, Ganley JP, et al. The Framingham Eye Study, II: association of ophthalmic pathology with single variables previously measured in the Framingham heart study . Am J Epidemiol. 1977;106:33-41. 24. Ederer F, Hiller R, Taylor HR. Senile lens changes and diabetes in two population studies . Am J Ophthalmol. 1981;91:381-395. 25. Phillips CI, Bartholomew RS, Clayton RM, et al. Cataract: a search for associations or causative factors . In: Regnault F, ed. Symposium on the Lens . Princeton, NJ: Excerpta Medica; 1980:19-25. 26. Clayton RM, Cuthbert J, Phillips CI, et al. Analysis of individual cataract patients and their lenses: a progress report . Exp Eye Res. 1980;31:553-566.Crossref 27. Linton KL, Klein BE, Klein R. The validity of self-reported and surrogatereported cataract and age-related macular degeneration in the Beaver Dam Eye Study . Am J Epidemiol. 1991;134:1438-1446. 28. Klein R, Klein BEK, Moss SE, DeMets DL. The validity of a survey question to study diabetic retinopathy . Am J Epidemiol. 1986;124:104-110. 29. Tielsch JM, Sommer A, Katz J, Quigley H, Ezrine S. Socioeconomic status and visual impairment among urban Americans . Arch Ophthalmol. 1991; 109:637-641.Crossref 30. Lurie N, Kamberg CJ, Brook RH, Keeler EB, Newhouse JP. How free care improved vision in the health insurance experiment . Am J Public Health . 1989; 79:640-642.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Aug 22, 1994

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