Abstract

Importance: Diabetic retinopathy (DR) is a leading cause of preventable blindness. Given both under diagnosis of diabetes and suboptimal DR screening among those with diabetes, there is substantial burden of undiagnosed DR. Objective: To estimate the prevalence and determine the correlates of undiagnosed DR among US adults. Design: Cross-sectional Setting: 2005-2008 National Health and Nutrition Examination Survey Participants: 5,563 participants aged 40+ years who underwent fundus photography. . Main Outcome(s) and Measure(s): Undiagnosed DR, defined as lack of awareness of DR found on fundus photography. Results: Prevalence of undiagnosed DR in adults aged 40+ was 10.6%, representing an estimated 9.8 million individuals. This included nearly one-quarter (23.1%) of those with self-reported diabetes (2.9 million) and 6.8% of those who reported not having diabetes (6.9 million). Notably, among those who reported having diabetes and had photographic evidence of retinopathy, 70.1% had undiagnosed DR. Conclusions and Relevance: A substantial proportion of DR goes undiagnosed. Greater, more targeted efforts are needed to diagnosis and treat DR to decrease the burden of preventable blindness.

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