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Health Education Leads to More Eye Exams

Professor Charles Basch and researchers from the Albert Einstein College of Medicine have determined that health education programs can substantially increase the rates of dilated eye exams for African Americans with diabetes, the first step in reducing the risk of vision loss. The results were published in the December 1999 issue of the "American Journal of Public Health."

"These findings clearly show that African Americans with diabetes who receive educational messages about the importance of dilated eye exams are more likely to seek an eye exam than those who do not receive those messages," said Carl Kupfer, MD, director of the National Eye Institute, one of the federal government's National Institutes of Health and the sponsor of the study. "It is important that people with diabetes receive dilated eye exams because early detection and treatment of diabetic eye disease can prevent vision loss. The early detection of diabetic eye disease, as well as laser surgery when needed, has helped preserve vision in about 90 percent of those who might otherwise lose their vision."

There were 280 African American participants involved in the study, according to Charles Basch, Professor of Health Education and Chair of the Department of Health and Behavior Studies, who directed the study along with Elizabeth Walker, DNSC, RN, of the Diabetes Research Center at Albert Einstein College of Medicine.

"We found that about twice as many people in the group that received health education messages received timely eye examinations compared to the group that received usual, standard medical care for their diabetes," Professor Basch said. "The differences between the two groups are very large. In terms of the effectiveness of a health education program, the results are dramatic."

The health education program had three components: a booklet, motivational videotape, and telephone counseling. Both the booklet and videotape emphasized that people with diabetes should have a dilated eye exam at least once a year. The telephone counseling involved one-on-one problem-solving and discussions about each person's reasons for, and/or objections to, having a dilated eye exam.

The booklet and videotape were mailed to those in the health education group, and the telephone outreach was initiated about one week later. Six months after the study began, the medical records of all study participants were assessed to find out how many had received a dilated eye exam.

Walker said the study reminds us what an important communication tool the telephone can be. "Calling people with diabetes and motivating them to have their eyes examined could help prevent vision loss, with its severe economic and quality-of-life implications," she said.

"There's been a tremendous investment in medical research to understand the natural history of diabetic retinopathy, and a tremendous investment in clinical research to develop effective treatment," Dr. Basch said. "Now the emphasis has to be making people aware of the importance of receiving annual dilated eye exams. If this happens, it can have a dramatic influence on the health of Americans."

Nearly half of the nation's estimated 16 million people with diabetes will develop some degree of diabetic retinopathy, the most common form of diabetic eye disease. Other eye problems that can develop in people with diabetes include cataract and glaucoma. Diabetic retinopathy damages the tiny blood vessels in the retina, the light-sensitive tissue that lines the back of the eye. People with diabetes are 25 times more likely to become blind than those without diabetes; diabetic eye disease can cause as many as 25,000 new cases of blindness every year. African Americans suffer a 40 percent higher frequency of severe visual impairment caused by diabetic retinopathy as compared with Whites, and twice the rate of blindness.

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