The number one reason diabetes patients in the United States skip their annual eye exam is due to a lack of insurance coverage, according to a large study that analyzed records from the National Health and Nutrition Examination Survey from 2005 to 2016.

The study looked at 4,072 survey results from individuals who represented 20 million Americans aged 20 and older with self-reported diabetes. Investigators found 63.4% of patients went to the doctor for their annual eye exam at 12 months compared with 78.7% who went at 24 months.

Of note, researchers found the national non-adherence rates remained steady over the 10-year study period: 36.6% at 12 months and 21.3% at 24 months.

The investigation listed the following key reasons why diabetes patients skipped their annual eye exams:

• Insurance status: The study reported 76% of Americans on combination private-public insurance were adherent compared with just 36% who were uninsured.
• Age
• Education
• Income
• Cholesterol levels
• Duration of diabetes
• Self-reported retinopathy

Additionally, the study found 70% of Americans with retinopathy still denied having the diagnosis.

“The majority of patients with retinopathy are unaware of this diagnosis, including the majority of those with a dilated funduscopic examination in the past year,” the investigators wrote in their paper. “Further improvements in education and adherence may reduce the visual morbidity caused by diabetes.”