Diabetic retinopathy: effective communication to prevent eye complications

Vision loss is one of the most feared complications of diabetes. Diabetic retinopathy affects about one in four people with diabetes and is the most common cause of vision loss and blindness in people with diabetes of working age.  The risk of retinopathy increases the longer a person has diabetes and when blood glucose or blood pressure is out of target range for prolonged period of time. Fortunately, if retinopathy is detected and treated early, the risk of vision loss can be reduced significantly.

The key pathway to early detection of retinopathy is retinal screening, which is usually conducted by an optometrist using specialised equipment. Australian guidelines recommend that people with diabetes screen for retinopathy when diabetes is first diagnosed, and continue with regular retinal screening a minimum of every 2 years thereafter. However, more than one in five Australians with diabetes do not screen for diabetic retinopathy. This proportion is significantly higher in some groups, such as young adults, people from non-English speaking backgrounds, Indigenous Australian, and people from rural and remote areas of Australia.  Unsurprisingly, those who do not initiate retinal screening early, are at much greater risk of being diagnosed with vision-threatening retinopathy when they do eventually attend screening.

The ACBRD’s research program aims to improve knowledge of retinopathy and increase the early uptake of retinal screening. We used a systematic development process to produce two engaging, evidence-based eye health resources, each one tailored to younger adults with type 2 diabetes (T2D) and older adults with T2D. Following best-practice principles, we started with a detailed mixed-methods needs assessment (in-depth interviews, nationwide survey, literature review), to identify the factors influencing retinal screening uptake for both groups, as well as their specific needs and characteristics. Using a systematic framework, and in close consultation with industry and consumer stakeholders, we developed a range of motivational and educational messages, and selected engaging and relevant imagery to reinforce the messages. Finally, we brought all of this together into an engaging and easily accessible leaflet, which was reviewed and piloted with members of each population. The resources were mailed out to all Victorian National Diabetes Service Scheme registrants registered in the three years up to 2016, and are freely available.

The project has been showcased as an example of best practice in a number of conferences and workshops, and peer-reviewed publications provide a blueprint for others wishing to develop similar health promotion resources for at-risk groups.

We have recently published a review focused on the clinical and psychosocial factors influencing uptake of retinal screening among young adults with T2D. In a letter published in the MJA, we have also highlighted the need to include younger adults with T2D in national screening surveys.

brochure young adults brochure old adults

 ACBRD team

The Diabetes & Eye Health project was funded by Vision 2020 Australia as a designated Vision Initiative activity in collaboration with Diabetes Victoria. We also acknowledge our collaborators: Dr Jessica Browne (formerly ACBRD), Dr Gwynn Rees (Centre for Eye Research Australia) and Prof Charles Abraham (Exeter University, UK).

ACBRD Publications

Lake, A. J., Browne, J. L., Rees, G., & Speight, J. (2017). What factors influence uptake of retinal screening among young adults with type 2 diabetes? A qualitative study informed by the Theoretical Domains Framework. Journal of Diabetes and its Complications, 31(6), 997-1006.

Lake, A. J., Browne, J. L., Abraham, C., Tumino, D., Hines, C., Rees, G., & Speight, J. (In press). A tailored intervention to promote uptake of retinal screening among young adults with type 2 diabetes – an intervention mapping approach. BMC Health Services Research. 2018 May 31;18(1):396

Lake, A. J., Rees, G., & Speight, J. (In press). Clinical and Psychosocial Factors Influencing Retinal Screening Uptake Among Young Adults With Type 2 Diabetes. Current Diabetes Reports. 2018 May 24;18(7):41.

Further reading

Click on the hyperlinks above for the key ACBRD publications

Key papers by other researchers in this field include:

Cavan D, Makaroff L, da Rocha Fernandes J, Sylvanowicz M, Ackland P, Conlon J et al. The Diabetic Retinopathy Barometer Study: Global perspectives on access to and experiences of diabetic retinopathy screening and treatment. Diabetes Res Clin Pract, 2017; 129: 16-24

Foreman J, Keel S, Xie J, Van Wijngaarden P, Taylor HR & Dirani M. Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey. Medical Journal of Australia, 2017; 206(9): 402-406

Scanlon PH, Stratton IM, Leese GP, Bachmann MO, Land M, Jones C & Four Nations Diabetic Retinopathy Screening Study Group. Screening attendance, age group and diabetic retinopathy level at first screen. Diabetic Medicine, 2016; 33(7): 904-911