Prevalence of Diabetic Retinopathy and Dilated Fundus Examinations by Metropolitan Status from 2017-2021: An Assessment of the Behavioral Risk Factor Surveillance System.

Purpose: Diabetic eye disease, namely diabetic retinopathy (DR), remains a leading cause of preventable blindness worldwide. Research has shown that treatment for diabetes and eye care was disrupted during the pandemic - with disparities between urban and rural populations being unknown. Thus, we aimed to assess the prevalence of reported rates of DR and dilated fundus exams from 2017 to 2021.

Methods: We performed a cross-sectional analysis using data from the Behavioral Risk Factor Surveillance System (BRFSS). Among US residents with diabetes, we calculated the rates of DR and annual dilated fundus exams - overall and by metropolitan statistical area (MSA) - measuring differences using X² tests.

Results: In 2017, the rate of DR was 19.78% among US residents reporting diabetes, which increased to the highest rate in 2018 at 22.19% before dropping to the lowest rates in 2019 and 2020 (18.44%). These annual changes were statistically significant (p < .001), but we found no significant differences by MSA status. Each year, nearly ⅔ of all individuals reported receiving dilated fundus examinations which peaked in 2019 at 71.5%. These annual deviations, as well as deviations by MSA were statistically significant (p < .001).

Conclusion: Although populations outside of an MSA experienced an increase in dilated fundus examinations, the national prevalence of DR continues to rise. Further research into sociodemographic and cultural factors influencing diabetic eye disease and access to ophthalmic care will be crucial for the prevention of DR and improving vision outcomes.