Purpose: Quality improvement project to improve diabetic retinopathy education and screening in a rural primary care clinic to meet the standard of care. Aims: To improve the delinquency rate of diabetic retinopathy screening. Processes: Participants included those with type 1 and type 2 diabetes ages 18 and up in the rural health clinic. Diabetic retinopathy screening importance education was displayed in the clinic and provided to each applicable patient in the form of a handout. A diabetic eye camera was brought to the rural health primary care clinic to offer more convenient access and free eye exams to clinic patients with diabetes. The project was deemed quality improvement by the IRB. Results: (To be determined after project implementation – results anticipated to be excellent based on the number of patients who are signed up to participate in this day.) There are 486 patients with a diagnosis of diabetes in the clinic. ___ were delinquent in eye exam prior to implementation and ___ were delinquent after. Limitations: Project performed in only one clinic; project leader is employed at the clinic in this study. Conclusions: Implementation of the eye exam day improved the delinquency rate of diabetic retinopathy screening in the clinic and proved to be a valuable means of enhancing patient compliance and satisfaction of routine eye health monitoring in patients with diabetes.

Introduction: Diabetic retinopathy (a diabetes complication that affects eyes) is one of the leading causes of blindness and low vision in the US. More than 90% of vision loss caused by diabetes can be prevented by a routine annual eye examination and early treatment. However, data shows that about half of people with diabetes in the US do not receive the recommended annual eye screening exams, and there is a scarcity of literature assessing the specific role of health insurance. This study aimed to assess if having health insurance had an impact on eye screening. Methods: The nationally representative 2021 Behavioral Risk Factor Surveillance System (BRFSS) was used to examine having an eye exam within the past year among individuals 18 years of age and older who self-reported living with diabetes. Those who reported having some form of health insurance were considered as having access to health insurance and those who reported no, or don’t know or refused or missing responses were considered as having no access to insurance. Meeting the national recommendations of having a dilated eye exam within the past year was the primary outcome of interest. Those who reported having an eye exam within the past year were considered as meeting the recommendations and who reported no, or don’t know or more than one year ago were considered as not having the recommended service. Other independent variables were defined according to the Andersen Model of Healthcare Services Utilization (predisposing factors, enabling factors, need factors, environment, and health behavior. Chi-square analysis and multivariable logistic regression with OR and 95% CI were used to determine the association between eye screening and health insurance adjusting for other covariates. Results and conclusions: Ninety-one percent (91.3%, 53,919) of the adults reported having some form of health insurance, as compared to 8.7%(3,697) who reported having no form of insurance coverage. Approximately 66.2% of the study population had an eye exam at least once within the past year. A higher proportion of adults who had health insurance reported having an eye exam compared to those with no health insurance (68.6 vs. 44.8%; p=0.000). Among those older than 65 years, 73.9% had eye exam as compared to 42.7% among those younger than 35 years (p=$50,000, 71% had eye exam as compared to 59.9% in those earning

Bien que les examens optométriques soient essentiels pour éviter et traiter les pertes de vision, l’accès aux soins oculovisuels de première ligne au Canada est inéquitable. La technologie permet maintenant aux optommétristes d’effectuer des examens de la vue via la télé-optométrie, mais la littérature scientifique actuelle est insuffisante pour affirmer que les examens télé-optométriques sont équivalents aux examens traditionnels présentiels. Ce mémoire portant sur la télé-optométrie s’inscrit dans une démarche de pratique fondée sur les données probantes et vise à informer les optométristes et les organismes décisionnels sur la qualité des examens généraux télé- optométriques. Une étude comparant les examens de la vue à distance avec ceux effectués en présentiel a d’abord confirmé que la télé-réfraction est statistiquement équivalente à la réfraction subjective présentielle et que l’évaluation de la santé oculaire à distance permet d’identifier la plupart des anomalies oculaires retrouvées dans l’échantillon de l’étude, permettant ainsi d’obtenir des diagnostics similaires entre les deux modalités d’examen. Les résultats de cette première étude ainsi que l’expérience acquise lors de sa réalisation ont permis la publication d’une procédure d’examen de la vue à distance visant à standardiser la télé-pratique afin d’assurer que la qualité des examens à distance au Canada se rapproche le plus possible de celle des examens présentiels. Bien que davantage d’études soient nécessaires pour valider que les examens télé-optométriques sont cliniquement équivalents aux examens présentiels, les résultats de ce mémoire suggèrent que des examens télé-optométriques pourraient être une alternative intéressante lorsque l’accès aux soins oculovisuels en personne n’est pas possible. / Although eye exams are essential to prevent and treat vision loss, access to primary eye care in Canada is inequitable. Technology now makes it easier to access eye exams via tele-optometry. However, the current scientific literature is insufficient to affirm that comprehensive tele- optometric exams are equivalent to traditional in-person eye exams. This master’s thesis on tele- optometry is part of an evidence-based practice approach and aims to inform optometrists and decision-making bodies about the quality of comprehensive tele-optometric exams. A study comparing remote eye exams with those performed in-person first confirmed that tele- refraction is statistically equivalent to in-person subjective refraction and that remote ocular health assessment can identify most of the ocular abnormalities found in the study sample, thus making it possible to obtain similar diagnoses between the two exam modalities. The results of this first study as well as the experience acquired during its realization allowed for the publication of a clinical framework for comprehensive tele-optometric exams aiming at standardizing tele-practice to ensure that the quality of remote eye exams in Canada is as close as possible to that of in-person eye exams. Although more studies are needed to confirm that tele-optometric exams are clinically equivalent to in-person examinations, the results of this master’s thesis suggest that tele-optometric examinations could be an interesting alternative when access to in-person eye care is not possible.