PDF(Pubmed)
Abstract：
OBJECTIVE: To investigate reasons for delayed presentation in patients with proliferative diabetic retinopathy (PDR).
METHODS: A questionnaire was designed to investigate consecutive PDR patients with delayed presentation who visited our center between January 2021 and December 2021. The questionnaire was divided into four sections: knowledge regarding diabetic retinopathy (DR), attitude toward DR treatment, difficulties adhering to follow-up plans, and medical care. The systemic disease status and severity of DR were recorded. Logistic analysis was undertaken to investigate DR treatment refusal and delay factors.
RESULTS: A total of 157 patients were included in this study, with an average age of 50.0 ± 11.6 years. The median glycated hemoglobin level (HbA1c) was 7.8% (IQR 2.5%). Among the 157 eyes, most required vitrectomy intervention (144, 91.7%); 17 developed neovascular glaucoma (NVG), while only 13 required additional photocoagulation. Among the 36 patients with undiagnosed DM, the reason for delayed DR presentation was a lack of awareness of DM status among these patients (36 cases, 100.0%). Most of the patients with a known history of DM exhibited inadequate DR knowledge (29, 24.0%), believed their good visual acuity did not require DR screening (98, 81.0%), and had poorly controlled diabetes (113, 93.3%). Factors related to refusing DR treatment were patients with an inability to receive regular diabetes treatment in internal medicine clinics (OR 6.78, 95% CI 1.73-26.59, p = 0.006), patients who could not tolerate discomfort during ophthalmic examination and treatment (OR 15.15, 95% CI 2.70-83.33, p<0.001), and patients who did not have any retinal abnormalities detected and were not informed about the need for regular screening (OR 2.05, 95% CI 1.36-3.09, p<0.001).
CONCLUSIONS: This study investigated the factors contributing to delayed presentation among patients with PDR. Many individuals in the delayed population were found to have undiagnosed DM. Among patients already aware of their DM status, reasons for delay included insufficient knowledge about DR, negative attitudes toward screening and treatment, and difficulties seeking medical care in real-life situations. Furthermore, there needed to be more improvements in the detection, treatment, and follow-up of DR by internal medicine practitioners and ophthalmologists.
METHODS: A questionnaire was designed to investigate consecutive PDR patients with delayed presentation who visited our center between January 2021 and December 2021. The questionnaire was divided into four sections: knowledge regarding diabetic retinopathy (DR), attitude toward DR treatment, difficulties adhering to follow-up plans, and medical care. The systemic disease status and severity of DR were recorded. Logistic analysis was undertaken to investigate DR treatment refusal and delay factors.
RESULTS: A total of 157 patients were included in this study, with an average age of 50.0 ± 11.6 years. The median glycated hemoglobin level (HbA1c) was 7.8% (IQR 2.5%). Among the 157 eyes, most required vitrectomy intervention (144, 91.7%); 17 developed neovascular glaucoma (NVG), while only 13 required additional photocoagulation. Among the 36 patients with undiagnosed DM, the reason for delayed DR presentation was a lack of awareness of DM status among these patients (36 cases, 100.0%). Most of the patients with a known history of DM exhibited inadequate DR knowledge (29, 24.0%), believed their good visual acuity did not require DR screening (98, 81.0%), and had poorly controlled diabetes (113, 93.3%). Factors related to refusing DR treatment were patients with an inability to receive regular diabetes treatment in internal medicine clinics (OR 6.78, 95% CI 1.73-26.59, p = 0.006), patients who could not tolerate discomfort during ophthalmic examination and treatment (OR 15.15, 95% CI 2.70-83.33, p<0.001), and patients who did not have any retinal abnormalities detected and were not informed about the need for regular screening (OR 2.05, 95% CI 1.36-3.09, p<0.001).
CONCLUSIONS: This study investigated the factors contributing to delayed presentation among patients with PDR. Many individuals in the delayed population were found to have undiagnosed DM. Among patients already aware of their DM status, reasons for delay included insufficient knowledge about DR, negative attitudes toward screening and treatment, and difficulties seeking medical care in real-life situations. Furthermore, there needed to be more improvements in the detection, treatment, and follow-up of DR by internal medicine practitioners and ophthalmologists.
摘要：
目的：探讨增殖性糖尿病视网膜病变（PDR）患者出现延迟的原因。
方法：设计了一份调查问卷，以调查2021年1月至2021年12月来我们中心就诊的连续PDR延迟就诊患者。问卷分为四个部分：关于糖尿病视网膜病变（DR）的知识，对DR治疗的态度，坚持后续计划的困难，和医疗保健。记录全身疾病状况及DR严重程度。采用Logistic分析探讨DR治疗拒绝和延迟因素。
结果：本研究共纳入157例患者，平均年龄50.0±11.6岁。糖化血红蛋白水平（HbA1c）中位数为7.8％（IQR2.5％）。在157只眼睛中，最需要玻璃体切割术干预（144，91.7%）；17例发生新生血管性青光眼（NVG），而只有13个需要额外的光凝。在36例未确诊的DM患者中，延迟出现DR的原因是这些患者缺乏对DM状态的认识(36例，100.0%）。大多数已知糖尿病病史的患者表现出DR知识不足（29，24.0%），认为他们的良好视力不需要DR筛查（98，81.0%），糖尿病控制不佳（113，93.3%）。与拒绝DR治疗相关的因素是无法在内科诊所接受常规糖尿病治疗的患者（OR6.78，95％CI1.73-26.59，p=0.006），在眼科检查和治疗期间无法耐受不适的患者（OR15.15，95％CI2.70-83.33，p<0.001），和未检测到任何视网膜异常且未被告知需要定期筛查的患者(OR2.05,95%CI1.36-3.09,p<0.001).
结论：本研究调查了导致PDR患者延迟就诊的因素。发现延迟人群中的许多人患有未诊断的DM。在已经知道他们的DM状态的患者中，延误的原因包括对DR的知识不足，对筛查和治疗的消极态度，以及在现实生活中寻求医疗护理的困难。此外，在检测方面需要更多的改进，治疗,以及内科医师和眼科医生对DR的随访。
方法：设计了一份调查问卷，以调查2021年1月至2021年12月来我们中心就诊的连续PDR延迟就诊患者。问卷分为四个部分：关于糖尿病视网膜病变（DR）的知识，对DR治疗的态度，坚持后续计划的困难，和医疗保健。记录全身疾病状况及DR严重程度。采用Logistic分析探讨DR治疗拒绝和延迟因素。
结果：本研究共纳入157例患者，平均年龄50.0±11.6岁。糖化血红蛋白水平（HbA1c）中位数为7.8％（IQR2.5％）。在157只眼睛中，最需要玻璃体切割术干预（144，91.7%）；17例发生新生血管性青光眼（NVG），而只有13个需要额外的光凝。在36例未确诊的DM患者中，延迟出现DR的原因是这些患者缺乏对DM状态的认识(36例，100.0%）。大多数已知糖尿病病史的患者表现出DR知识不足（29，24.0%），认为他们的良好视力不需要DR筛查（98，81.0%），糖尿病控制不佳（113，93.3%）。与拒绝DR治疗相关的因素是无法在内科诊所接受常规糖尿病治疗的患者（OR6.78，95％CI1.73-26.59，p=0.006），在眼科检查和治疗期间无法耐受不适的患者（OR15.15，95％CI2.70-83.33，p<0.001），和未检测到任何视网膜异常且未被告知需要定期筛查的患者(OR2.05,95%CI1.36-3.09,p<0.001).
结论：本研究调查了导致PDR患者延迟就诊的因素。发现延迟人群中的许多人患有未诊断的DM。在已经知道他们的DM状态的患者中，延误的原因包括对DR的知识不足，对筛查和治疗的消极态度，以及在现实生活中寻求医疗护理的困难。此外，在检测方面需要更多的改进，治疗,以及内科医师和眼科医生对DR的随访。
