title: Underuse of the health care system by persons with diabetes mellitus and diabetic macular edema in the United States.
abstract: OBJECTIVE
  Thickening of the center of the retina, diabetic macular edema (DME), is the most common cause of visual loss due to diabetes mellitus. Treatment of DME has improved dramatically, and the prompt diagnosis of DME and referral of these patients have become more critical. Nonetheless, awareness of and care for DME in the US population is uncharacterized.
  
  
  OBJECTIVE
  To characterize eye care and awareness of eye disease among persons with DME in the general US population.
  
  
  METHODS
  Cross-sectional analysis of data from participants in the 2005 to 2008 National Health and Nutrition Examination Survey 40 years or older with diabetes mellitus and fundus photographs.
  
  
  METHODS
  Among persons with DME, (1) awareness that diabetes has affected their eyes; (2) report on the last time they visited a diabetes specialist; (3) report on their last eye examination with pupil dilation; and (4) prevalence of visual impairment.
  
  
  RESULTS
  In 2010, only 44.7% (95% CI, 27.0%-62.4%) of US adults 40 years or older with DME reported being told by a physician that diabetes had affected their eyes or that they had retinopathy; 46.7% (95% CI, 27.5%-66.0%), that they had visited a diabetes nurse educator, dietician, or nutritionist for their diabetes mellitus more than 1 year ago or never; and 59.7% (95% CI, 43.5%-75.9%), that they had received an eye examination with pupil dilation in the last year. Among persons with DME, 28.7% (95% CI, 12.7%-44.7%) were visually impaired (defined as visual acuity worse than 20/40 in the eye with DME) based on visual acuity at the initial examination and 16.0% (95% CI, 2.5%-29.4%) based on best-corrected visual acuity.
  
  
  CONCLUSIONS
  Many persons with diabetes mellitus in the United States are not getting care that can prevent visual impairment and blindness. Strategies to increase awareness are warranted, especially given the recent availability of improved therapies for DME.
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland.
authors.forename: Neil M
authors.initials: NM
authors.lastname: Bressler
authors.affiliation: Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago.
authors.forename: Rohit
authors.initials: R
authors.lastname: Varma
authors.affiliation: Outcomes Insights, Inc, Westlake Village, California.
authors.forename: Quan V
authors.initials: QV
authors.lastname: Doan
authors.affiliation: Outcomes Insights, Inc, Westlake Village, California.
authors.forename: Michelle
authors.initials: M
authors.lastname: Gleeson
authors.affiliation: Outcomes Insights, Inc, Westlake Village, California.
authors.forename: Mark
authors.initials: M
authors.lastname: Danese
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Julie K
authors.initials: JK
authors.lastname: Bower
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.affiliation: Genentech, Inc, South San Francisco, California.
authors.forename: Chantal
authors.initials: C
authors.lastname: Dolan
authors.affiliation: Genentech, Inc, South San Francisco, California.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fine
authors.affiliation: Genentech, Inc, South San Francisco, California.
authors.forename: Shoshana
authors.initials: S
authors.lastname: Colman
authors.affiliation: Genentech, Inc, South San Francisco, California.
authors.forename: Adam
authors.initials: A
authors.lastname: Turpcu
mesh_terms: D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D014792:Visual Acuity