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Peoples N, McBee D, Shangzhi X, Alvarez A, Wang E, Ricciardelli A, Wang S, Clark DL, Wong TY. Diabetic Retinopathy Screening Rates at Student-Run Clinics in the United States: A Systematic Review and Meta-Analysis. Ophthalmic Epidemiol 2024:1-5. [PMID: 39212490 DOI: 10.1080/09286586.2024.2378778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/24/2024] [Accepted: 07/05/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Nicholas Peoples
- College of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Dylan McBee
- College of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Xiong Shangzhi
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alexandra Alvarez
- College of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Emily Wang
- College of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Shiwei Wang
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Dana L Clark
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Tien Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China
- Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
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Rahmati M, Smith L, Boyer L, Fond G, Yon DK, Lee H, Soysal P, Piyasena MP, Pardhan S. Factors Affecting Global Adherence for the Uptake of Diabetic Retinopathy Screening: A Systematic Review and Meta-Analysis. Am J Ophthalmol 2024; 268:94-107. [PMID: 39094991 DOI: 10.1016/j.ajo.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/16/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE To evaluate diabetic retinopathy (DR) screening global adherence rate and the association between sociodemographic and clinical variables and adherence rates to DR screening in individuals with diabetes. DESIGN Systematic review and meta-analysis. METHODS This systematic review was registered with International Prospective Register of Systematic Reviews (ID: CRD42024507035). We conducted a systematic review of relevant literature from inception of databases to February 24, 2024, using electronic databases searches including PubMed, MEDLINE (Ovid), EMBASE, Web of Science, Cochrane CENTRAL, and CDSR and national level DR screening databases through Google searches following PRISMA guidelines. The articles were screened for title and abstract and then for the full-text reports by two independent reviewers and study quality was appraised. Meta-analysis was performed using random effects model to calculate the pooled effects size and 95% confidence interval (CI) of each finding. RESULTS Data from a total of 11,383,715 participants from 77 studies and two national websites from 28 countries over five continents were included. Global DR screening adherence rate was 66.9% in high-income countries and 39.3% in low-and-middle-income countries. DR screening adherence rate was lowest in Africa (36.1%) and was highest in Europe (81.3%). Older age (odds ratio [OR] 1.45, 95% CI 1.30-1.62), higher education level (OR = 1.65, 95% CI 1.45-1.78), marriage (OR = 1.42, 95% CI 1.14-1.77), living in an urban area (OR = 1.57, 95% CI 1.08-2.29), higher family income (OR = 1.29, 95% CI 1.24-1.35), having any health insurance (OR = 1.90, 95% CI 1.56-2.31), longer duration of diabetes (OR = 1.57, 95% CI 1.27-1.94), type 2 diabetes (OR = 1.68, 95% CI 1.34-2.10), family history of diabetes (OR = 2.25, 95% CI 1.56-3.25), vision impairment (OR = 2.07, 95% CI 1.43-2.98), history of eye diseases (OR = 1.99, 95% CI 1.36-2.90), insulin treatment (OR = 1.38, 95% CI 1.37-1.39), and good mental health (OR = 1.14, 95% CI 1.04-1.24) were associated with DR screening adherence. CONCLUSION This meta-analysis provides key information about which population subgroups may require more targeted intervention and highlights the urgent need to identify ways to improve adherence to DR screening. REGISTRATION INFORMATION PROSPERO; ref. no. CRD42024507035, (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=507035).
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Affiliation(s)
- Masoud Rahmati
- From the Research Centre on Health Services and Quality of Life, Aix Marseille University (M.R., L.B., G.F.), Marseille, France; Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University (M.R.), Khoramabad, Iran; Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan (M.R.), Rafsanjan, Iran.
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University (L.S.), Cambridge, United Kingdom
| | - Laurent Boyer
- From the Research Centre on Health Services and Quality of Life, Aix Marseille University (M.R., L.B., G.F.), Marseille, France
| | - Guillaume Fond
- From the Research Centre on Health Services and Quality of Life, Aix Marseille University (M.R., L.B., G.F.), Marseille, France
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine (D.K.Y., H.L.), Seoul, Republic of Korea; Department of Pediatrics, Kyung Hee University College of Medicine (D.K.Y.), Seoul, Republic of Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine (D.K.Y., H.L.), Seoul, Republic of Korea
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University (P.S.), Istanbul, Turkey
| | - Mapa Prabhath Piyasena
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University (M.P.P., S.P.), Cambridge, United Kingdom
| | - Shahina Pardhan
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University (M.P.P., S.P.), Cambridge, United Kingdom; Centre for Inclusive Community Eye Health, Anglia Ruskin University (S.P.), Cambridge, United Kingdom.
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Li T, Mayo-Wilson E, Shaughnessy D, Qureshi R. Studying harms of interventions with an equity lens in randomized trials. Trials 2024; 25:403. [PMID: 38902776 PMCID: PMC11191320 DOI: 10.1186/s13063-024-08239-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024] Open
Abstract
Equity and health equity are fundamental pillars in fostering a just and inclusive society. While equity underscores fairness in resource allocation and opportunity, health equity aims to eradicate avoidable health disparities among social groups. The concept of harms in interventions-undesirable consequences associated with the use of interventions-often varies across populations due to biological and social factors, necessitating a nuanced understanding. An equity lens reveals disparities in harm distribution, urging researchers and policymakers to address these differences in their decision-making processes. Furthermore, interventions, even well-intentioned ones, can inadvertently exacerbate disparities, emphasizing the need for comprehensive harm assessment. Integrating equity considerations in research practices and trial methodologies, through study design or through practices such as inclusive participant recruitment, is pivotal in advancing health equity. By prioritizing interventions that address disparities and ensuring inclusivity in research, we can foster a more equitable healthcare system.
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Affiliation(s)
- Tianjing Li
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
| | - Evan Mayo-Wilson
- Department of Epidemiology, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Daniel Shaughnessy
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Riaz Qureshi
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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Browning DJ, Ong SS, Clarkson JG, Huang H. Charity Care in Ophthalmology, 2024. Am J Ophthalmol 2024; 262:19-24. [PMID: 38341168 DOI: 10.1016/j.ajo.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To review changes in the provision of charity eye care in the past 50 years with hypothesized resulting effects on surgical training and patient outcomes. DESIGN Perspective. METHODS Case report, comparison of experience in community and training program settings, and selected literature review. RESULTS The population to which charity care applies has shrunk as broader insurance coverage has been legislated, but in 2023 remains at approximately 7.3% of the US population. In areas with ophthalmology training programs, house staff supervised by faculty provide most of the charity care. In areas without training programs, a shrinking pool of willing private practitioners provides charity care. Because there is no organized financial support behind provision of charity, nonanecdotal data needed to assess the problem and guide decision making are lacking. CONCLUSIONS Charity eye care in ophthalmology in 2024 is a patchwork of transient, local efforts that have a few common themes: absent material basis for sustainability, a narrowing base of support by clinicians, transfer of care to training programs, and financial vetting of applicants by nonclinicians. Unless universal health care legislation passes, which would eliminate the issue, suggestions for improvement include broader voluntary participation by private practice ophthalmologists in charity eye care, allocation of charity care spending by nonprofit hospitals to support this effort, and clinician-determined criteria for provision of charitable surgery supported by involved hospital systems.
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Affiliation(s)
- David J Browning
- From the Department of Ophthalmology, Wake Forest University School of Medicine (D.J.B., S.S.O., H.H.), Winston-Salem, North Carolina.
| | - Sally S Ong
- From the Department of Ophthalmology, Wake Forest University School of Medicine (D.J.B., S.S.O., H.H.), Winston-Salem, North Carolina
| | - John G Clarkson
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (J.G.C.), Miami, Florida, USA
| | - Harrison Huang
- From the Department of Ophthalmology, Wake Forest University School of Medicine (D.J.B., S.S.O., H.H.), Winston-Salem, North Carolina
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Yang YM, Lu YM, Hsu CH. Limitations of Assessing Barriers in Diabetic Retinopathy Screening. JAMA Ophthalmol 2024; 142:491. [PMID: 38512271 DOI: 10.1001/jamaophthalmol.2024.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Yu-Mei Yang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Mou Lu
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Hao Hsu
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Wang SY, Ludwig CA, Ravindranath R. Limitations of Assessing Barriers in Diabetic Retinopathy Screening-Reply. JAMA Ophthalmol 2024; 142:491-492. [PMID: 38512268 DOI: 10.1001/jamaophthalmol.2024.0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Sophia Y Wang
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Cassie A Ludwig
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Rohith Ravindranath
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
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Lieng MK, Emami-Naeini P, Lee SC, Alber S, Yiu G. Teleophthalmology provides earlier eye care access for patients with newly-diagnosed diabetes. Heliyon 2024; 10:e25845. [PMID: 38384560 PMCID: PMC10878910 DOI: 10.1016/j.heliyon.2024.e25845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
Purpose Timely diagnosis of diabetic retinopathy is important in preventing vision loss. This study aims to determine if remote retinal imaging enables earlier eye care access among newly-diagnosed diabetic patients. Design Retrospective cohort study. Methods Using the OptumLabs® Data Warehouse - a longitudinal, real-world dataset containing deidentified administrative claims and electronic health record (EHR) data, we included 968 846 adults with newly diagnosed type 2 diabetes and at least 1 year of continuous enrollment. We compared time from initial diabetes diagnosis to first eye exam by remote screening or in-person eye exam. Results We found that at year 1 after diagnosis, 5459 (0.56%) patients underwent remote imaging and 208 023 (21.5%) underwent in-person exam. The mean (95% CI) time to eye exam was 3.48 (3.38-3.58) months for remote imaging and 4.22 (4.20-4.23) months for in-person visits (p < 0.0001). Interestingly, 27.5% of remote screenings were performed on the same day of diabetes diagnosis. Excluding same-day encounters, mean time to eye exam was 4.80 (4.68-4.91) months for remote imaging and 4.85 (4.83-4.86) months for in-person eyecare (p = 0.4). Conclusions Thus, teleophthalmology may enable earlier eye care access among patients with newly-diagnosed diabetes, primarily with same-day screenings. Increased adoption of teleretinal screening may enable earlier detection of diabetic retinopathy and prevent vision loss.
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Affiliation(s)
- Monica K. Lieng
- Tschannen Eye Institute, University of California, Davis, Sacramento, CA, USA
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Parisa Emami-Naeini
- Tschannen Eye Institute, University of California, Davis, Sacramento, CA, USA
| | - Sophie C. Lee
- Tschannen Eye Institute, University of California, Davis, Sacramento, CA, USA
| | - Susan Alber
- Department of Public Health Sciences / Biostatistics, Clinical and Translational Science Center, University of California Davis, Sacramento, CA, USA
| | - Glenn Yiu
- Tschannen Eye Institute, University of California, Davis, Sacramento, CA, USA
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