Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Dr. Laura Kuensting


Dr. Laura Kuensting-Chairperson

Dr. Carla Beckerle

Dr. Natalie Murphy



Purpose: Diabetic retinopathy (DR), a microvascular complication occurs in patients with poorly controlled diabetes mellitus (DM). A known risk of increased visual impairment associated with DM occurs in patients when the glycosylated hemoglobin level (HbA1c) increases over 7.0%. Therefore, an annual retinal assessment as a quality care measure in diabetes management is necessary. The conducted study aimed to evaluate the documentation of an annual eye exam in all patients with DM in a private family practice clinic and to investigate any possible association between HbA1c level.

Method: This quality improvement study included a retrospective medical record review in a cohort of patients with DM in a private Midwestern family practice clinic from June 1, 2017, through March 31, 2018. All adult patients, aged 18-90 years, meeting criteria for DM were included. The HbA1c for each patient with the presence or absence of a documented eye examination were recorded.

Results: All patients seen with DM had a documentation of HbA1c (n=129, 100%), average HbA1c results was 7.41%, SD = 1.78. Only 30% (n=39) had documented eye exam results.

Implications: An opportunity exists for lowering the HbA1c and documenting completed eye examinations in this family practice clinic. Consideration for a template for tracking HbA1c and eye exam results may fulfill the quality care measure requirements for DM. Lowering HbA1c reduces the risk for DR, and obtaining an annual eye exam allows early recognition and treatment for DR in patients with DM.

Additional Files

Meera Shekar Eye Exam Poster Presentation.pdf (504 kB)
Poster presentation

Meera Shekar Eye Exam Power Point Presentation.pdf (1693 kB)
Power Point Presentation