An inexpensive tool for routine fundus examination at primary eye care centres. (2006)

Introduction: General practitioners (GPs) are important members of the diabetic care network. Awareness levels of general practitioners are vital in planning strategies to prevent diabetic blindness. The present study was done to assess the knowledge, attitudes and practices (KAP) of urban GPs regarding the screening and management of diabetic retinopathy.

Research design and methods: A questionnaire was designed to assess the GPs KAP in handling diabetic retinopathy. Questions related to referrals, direct ophthalmoscopy, and barriers to diabetic retinopathy screening. Urban GPs from Chennai were contacted through telephonic interview. GPs telephone numbers were traced from the Yellow Pages and a random digit dialing strategy was used. Telephonic survey was done for 450 telephone numbers of GPs.

Results: Of the 450 telephone numbers of GPs that were dialled, only 187(41.6 per cent) responded to the questionnaire. 52 per cent of the GPs declined to answer questions. Among those who responded to the call, only 85 per cent (n =159) completed the tele-survey completely. Most of the GPs could not be contacted in the morning, as they were busy with their practice. Among those who successfully completed the survey, 46.6 per cent (n=74) of the GPs responded to the tele-survey after they were called more than five times. 33.4 per cent (n = 53) of the general practitioners responded after three to five calls and the remaining 20 per cent responded immediately.

31.3 per cent (n=50) feel that diabetics should undergo an eye examination every six months and 53.3 per cent (n=85) feel that diabetics should undergo eye examination every year. 15.4 per cent felt that eye examination every two years is sufficient for diabetics. Ophthalmoscopy was done by 1.3 per cent (2/159) of the GPs. Of the two, one GP performs ophthalmoscopy with dilation while the other performs it without dilation. The reason stated for not dilating was lack of time. Almost all GPs said that they would refer a patient with diabetes to an ophthalmologist. 84 per cent of the practicing physicians were aware of laser photocoagulation as a treatment modality for diabetic retinopathy.

54 per cent of GPs were aware of annual dilated eye examination referral guidelines for diabetics. Regarding attitudes for screening for diabetic retinopathy, only 1.3 per cent of GPs were using direct ophthalmoscope. Among them only 50 per cent were practicing dilated direct ophthalmoscopy. Barriers for doing diabetic retinopathy screening by general practitioners were lack of time, lack of ophthalmoscopes and lack of training.

Discussion: This study shows the need for training GPs about diabetic retinopathy and its detection with direct ophthalmoscope. Barriers for dilated eye examination, as perceived by GPs, need to be addressed. McCarty et al.1 reported that lack of dilating drops in the practice, lack of confidence in detecting changes, concern about time taken and fear of precipitation of angle-closure glaucoma with their patients were some of the barriers expressed by GPs.1 Knowledge of the guidelines is another important factor to consider. Residency programmes should focus on providing more exposure to ophthalmoscopy practice among GPs, compared to the current low levels of exposure of only a few hours.