Further research into sociodemographic and cultural factors influencing diabetic eye disease and access to ophthalmic care will be crucial for the prevention of DR and improving vision outcomes. Photo: Jay M. Haynie, OD. Click image to enlarge.

Diabetic retinopathy (DR) remains a leading cause of preventable blindness worldwide. Research has shown that treatment for diabetes and preventive eye care visits was disrupted during the pandemic, with disparities between urban and rural populations being unknown. So, in a recent study, researchers from Oklahoma aimed to assess the prevalence of reported rates of DR and dilated fundus exams from 2017 to 2021. They found that the national prevalence of diabetic retinopathy increased over those years, but dilated fundus examination (DFE) rates—something the American Diabetes Association recommends within five years of diabetes mellitus diagnosis—decreased in all populations except non-metropolitan statistical area communities. The team’s paper on the work was recently published in Ophthalmic Epidemiology.

A cross-sectional analysis using data from the Behavioral Risk Factor Surveillance System was conducted. Among residents with diabetes, the rates of DR and annual dilated fundus exams were calculated overall and by metropolitan statistical area.

In 2017, the rate of DR was 19.8%, which increased to the highest rate in 2018 at 22.2% before dropping to it lowest level in 2019 and 2020 (18.4%). These annual changes were statistically significant, but they found no significant differences by metropolitan statistical area status. Each year, nearly two-thirds of all individuals reported receiving dilated exams, which peaked in 2019 at 71.5%.

In 2020, there was a decrease in DFE overall, with the notable exception being non-metropolitan communities that experienced a steady increase in both DR and DFE. “Considering that only 20% of the US population resides outside of a metropolitan statistical area, it becomes evident that these populations bear a higher burden of DR,” the researchers wrote in their paper. “Hypotheses for this rural disease predominance include factors such as limited access to primary care facilities, health illiteracy and mistrust of the healthcare system.”

A previous study showed that rural residents were 4.2% less likely to visit a doctor to manage their diabetes due to financial costs. “Greater resilience to the pandemic’s effects has also been observed in rural areas—aligning with our finding of increased DFE rates,” the authors wrote. They added that this could be attributed to higher employment in essential trades like farming, resulting in less unemployment and uninsurance when compared to metropolitan populations at that time.

“These results call for a greater understanding of health disparities between metropolitan statistical area populations and emphasize the importance of implementing policies and community health initiatives to prevent further DR incidence and vision loss,” the authors concluded.