1. Prevalence of glaucoma and diabetic retinopathy by self- report and after examination in an urban low-income uninsured adult population Janis E. Winters O.D. Associate Professor Illinois College of Optometry

2. Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Janis E. Winters No relationships to disclose

3. Patient history Individual history – Essential part of eye examination – In screening, may be used to determine who is at ‘high risk’ Surveys, some population studies – Determine outcome

4. Glaucoma and diabetic retinopathy Diagnosis and control / treatment – reduce risk for visual impairment Can be asymptomatic

5. Glaucoma Conclusive diagnosis might not always exist Tends run in families

6. Hypothesis Self-report dr or glc based on may not be as accurate as desired among low-income uninsured adults

7. Vision of Hope Health Alliance (VOHHA) Uninsured, low-income adults were provided eye care. – Less than 200% of federal poverty level

8. How It Works

9. VOHHA ? Access to care Barriers

10. Vision of Hope Health Alliance (VOHHA) Retrospective record review was performed – Glaucoma suspect records re-reviewed 6 months Dx based on findings of attending Dx with condition if present in either eye

11. RESULTS 4029 kept appointments Majority female - 53.3% Education – 65.8% complete HS Large majority resided in Cook county – 96% – Chicago- 85% 4% Illinois counties, Indiana and Wisconsin

12. Age Distribution

13. Race

14. Glaucoma data Hx of glc /glc suspect – 140 (3.5 %) A family Hx glc – 425 (10.7%) Personal or fam Hx – 522 (13%) After examination, 325 (8.1%) were diagnosed as having glc / glc suspects – 145(3.6%) were diagnosed with glc – 180 (4.5%) patients were diagnosed as glc suspects

15. 325/522 = 62% ???

16. Hx Vs. Dx Personal hx 140 92 dx glc/sus 65.7% -- 2:3 25.7% those dx 1:4 Family hx 425 80 dx glc/sus 18.2% -- 1:5 22.3% those dx 1:5

17. Personal/Family History 522 139 dx glc/sus 26.6% who reported hx were dx (1:4) 38.8 % those dx with glc/sus reported hx (1:3)

18. The Bottom Line About 3of 4 who reported personal/family history were not dx with glc/suspect The majority (61%) who were dx glc/sus did not report a family /personal history

19. Diabetic retinopathy 1323 (33.4%) DM2 26 (0.7%) DM1 41 (3.0%) history of dr DR 302 (22.3%) Npdr 255 (18.7%) Pdr 47(3.6%)

20. Diabetic retinopathy: Hx vs Dx History – 41 25 Dx with DR 39% reported a history were not diagnosed

21. Diabetic retinopathy: Hx vs Dx 25 Dx with DR – 12 Dx NPDR – 13 Dx PDR 95% NPDR and 73% PDR no previous history of dr

22. Patient history Obtaining patient history essential Results support

23. Patient history Can history be relied upon? – Individual patients – Population studies

24. History Population studies recognize that history is not always reliable – LALES – independent evaluation for DM Obtaining medical history from PCP/ other provider

25. History What makes outcomes so different than findings in this population?

26. History Newly diagnosed? – DR – mostly NPDR – Access to care – Barriers Inaccurate history – Confuse condition? Education Cultural ??

27. Conclusion History important Patient history cannot always be relied upon – Consider verification Supports routine eye care especially for DM