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Importance Screening for diabetic retinopathy for early detection and treatment can prevent vision loss. Background: We aimed to assess rates of eye examination of people with diabetes, adherence with national guidelines and investigate characteristics of those who do not adhere. Design We used data from the 45 and Up Study, a cohort study of 267 153 randomly selected residents aged ≥45 years from New South Wales, Australia. Individual survey data collected in 2006 to 2009 were linked to corresponding national Medicare Benefits Schedule claims data for 2006 to 2016. Participants: The study sample included 24 832 participants who reported having diabetes and at least 5 years of observation. Methods: Claims for visits to optometrists or ophthalmologists were assessed to estimate rates of eye examination. Poisson regression models were used to investigate factors associated with non‐adherence. Main outcome measure: Participants were classified as adherent if the average time between eye care claims was consistent with national guideline of having an eye exam every 2 years. Results: Of 50% to 75% people with diabetes met the biennial eye examination guidelines and only 21% to 28% with diabetes duration ≥10 years were adherent to the annual eye examination guideline. Characteristics associated with greatest (~1.3‐fold) risk of non‐adherence were smoking, age <60 years and higher income. Conclusions and relevance: There is a clear need to improve rates of adherence to eye examination guidelines among people with diabetes to reduce the personal and societal burden of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

Abstract: Importance: The novel intervention was effective at improving compliance to appropriate tertiary eye care after community eye screening. Background: Elderly individuals from low socio‐economic background with visual impairment (VI) often do not attend tertiary care, even if significant eye diseases are detected while in the community. We evaluate a novel incentive care scheme (ICS) to improve compliance to appropriate follow‐up after community eye screening. Design: Randomized controlled trial in a population‐based setting was conducted. Participants: A total of 140 elderly individuals with VI (visual acuity <6/12, mean age ± SD = 66.6 ± 8.9 years, 46.4% female) were included. Methods: Participants were randomized to either ICS (N = 72) or usual care (UC; N = 68). ICS incorporated patient education, social support and financial assistance to assist individuals in attending tertiary eye care. UC comprised of a standard referral letter and advice. Main outcome measure: Primary outcome included compliance to eye care referral. Secondary outcomes included best‐corrected visual acuity and vision‐related quality of life assessed at baseline and 3 months. Results: Participants receiving the ICS intervention had higher rates of compliance to tertiary eye care attendance compared to UC (31.9% vs. 16.2%, respectively, P = 0.027). While we observed an overall significant improvement in best‐corrected visual acuity at 3 months in both groups (P < 0.05), we found no significant differences in Rasch‐transformed vision‐related quality of life scores between groups (all P > 0.05). Identified barriers for tertiary healthcare access included patient attitudes and financial‐ and health‐related barriers. Conclusion and Relevance: Our pilot RCT found that ICS improved adherence to appropriate tertiary eye care referrals after community eye screening in elderly people with VI. [ABSTRACT FROM AUTHOR]