Knowledge of ocular complications of diabetes in community-based people with type 2 diabetes: The Fremantle Diabetes Study II

  • Jocelyn J. Drinkwater
    Medical School, The University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
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  • Fred K. Chen
    Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia

    Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia

    Department of Ophthalmology, Perth Children’s Hospital, Nedlands, Western Australia, Australia
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  • Wendy A. Davis
    Medical School, The University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
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  • Timothy M.E. Davis
    Corresponding author at: Medical School, University of Western Australia, Fremantle Hospital, P. O. Box 480, Fremantle, Western Australia 6959, Australia.
    Medical School, The University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
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Published:February 04, 2021DOI:


      • Lack of knowledge is a barrier to diabetic retinopathy (DR) screening.
      • Most participants knew diabetes can affect the eye and cause blindness.
      • Knowledge beyond this was suboptimal including recommended screening intervals.
      • Those who were younger, better educated and who had worse DR had greater knowledge.
      • These data support the need for targeted intensified eye-related education.



      To assess knowledge of diabetes-related eye disease in Australians with type 2 diabetes and its associations with diabetic retinopathy (DR), other ocular complications and vision-related quality of life.


      A random sample from the Fremantle Diabetes Study Phase II cohort (n = 360) was invited to participate. Knowledge was assessed using 10 multiple-choice questions covering how diabetes affects the eyes, frequency of ophthalmic screening, risk factors, prevention, available treatments, and prognosis. DR was assessed from fundus photographs. Multiple linear regression was used to identify independent associates of the knowledge score (KS).


      We included 264 participants (mean ± SD age 72.1 ± 9.2 years, 56.8% male, median [IQR] diabetes duration 15.4 [11.1–22.3] years). The mean ± SD KS out of 10 was 5.3 ± 1.8. Most (67%) participants knew diabetes can affect the eye and lead to blindness. Only 13.6% knew that DR screening intervals depend on risk factors. Those with moderate non-proliferative DR (NPDR) or worse had a better knowledge score (B = 1.37,P = 0.008) after adjusting for age (B = −0.03, P = 0.004) and education beyond primary school (B = 1.75, P < 0.001).


      Overall knowledge of diabetes-related ocular complications was suboptimal. Education targeting eye disease may benefit people with type 2 diabetes who are older, less well educated and/or who have no DR/mild NPDR.


      DR (diabetic retinopathy), eGFR (estimated glomerular filtration rate), FDS2 (Fremantle Diabetes Study Phase II), KS (knowledge score), NEI (National Eye Institute), NPDR (non-proliferative diabetic retinopathy), PDR (proliferative diabetic retinopathy), VRQoL (vision related quality of life)


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