Patterns of referral and examination for retinopathy in pregnant women with diabetes by primary care physicians

Abstract

Purpose Family practice (FP), General Practice (GP) and obstetrics-gynecology (OB/GYN) physicians were surveyed to determine whether they routinely referred pregnant patients with diabetes to an ophthalmologist, looked into the patient's eyes to screen for retinopathy, and dilated the eyes for fundi examination.

Methods Hospitals providing obstetrical services were contacted to identify primary-care physicians. Physicians identified as having obstetrical privileges were surveyed by mail to determine if they were actively providing obstetrical care. Physicians who provided both obstetrical and diabetes care were mailed a survey.

Results Of 668 physicians surveyed, 429 responded: 224 FPS, 184 OB/GYNS and 21 GPS. A relatively small percentage (27%) of physicians in both groups routinely refer all of their pregnant patients with pre-existing diabetes to an ophthalmologist. Family practice physicians were more likely to perform an eye exam to screen for retinopathy in patients with both pre-existing and gestational diabetes than OB/GYNS (p<.0005). Only 11% of FPS and no OB/GYNS reported that they dilated the eyes when performing a fundus examination (p=.04).

Conclusion The physicians surveyed under-utilize recommended strategies for eye care of pregnant women with pre-existing diabetes. Based upon these results, we call for a recommitment to partnership of primary-care physicians and ophthalmologists in the detection and treatment of diabetic retinopathy during pregnancy.

Key Words:

• diabetes
• pregnancy
• retinopathy
• eye care
• referral patterns