Diabetic Retinopathy and Age-related Macular Degeneration in the U.S

Background: Diabetic retinopathy and age-related macular degeneration (AMD) are two of the most common eye diseases in the U.S. Effective treatments exist for some stages of these conditions.

Purpose: This goal of this study was to examine the frequency and predictors of unawareness of diabetic retinopathy and AMD.

Methods: The 2005-2008 National Health and Nutrition Examination Survey (NHANES) collected digital retinal images of survey participants aged ≥40 years that were graded for diabetic retinopathy and AMD using standard protocols. A sample of individuals with diabetic retinopathy was created, as was a separate sample of individuals with AMD. Individuals were categorized as unaware of their condition if they did not report that they had the condition. Separate logistic regression models of unawareness of diabetic retinopathy and AMD were estimated in 2011.

Results: This study estimated that 73% of individuals with diabetic retinopathy and 84% of individuals with AMD were unaware of their condition. The odds of unawareness of diabetic retinopathy were higher for individuals with less-severe diabetic retinopathy, shorter diabetes duration, smaller families, or who had not had a recent eye exam. The odds of unawareness of AMD were higher for individuals with "early" AMD or who were younger, less educated, or not primarily English speakers.

Conclusions: The very high frequency of unawareness of diabetic retinopathy and AMD suggests that unawareness of these conditions should be a major public health concern and that efforts are needed to increase the frequency of eye exams among those at risk for these conditions.