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Recommendations and Reminders for Eye Care Professionals

November 12, 2019

Many primary care providers (PCPs) refer our diabetic Federal Employee Program® (FEP) members to eye care specialists for annual eye examinations. PCPs then need to receive communication about the eye care their patients receive from the patients’ eye care specialists. We encourage providers who do not routinely share results to consider doing so.

For quick reference, below is the 2017 American Diabetes Association (ADA) updated position statement on diabetic retinopathy and screening recommendations1 to assist eye care specialists when providing annual eye exams to diabetic FEP members.

Screening:
  • Comprehensive evaluation by an eye care specialist should not be substituted by retinal photography. However, retinal photography with remote reading by retinal specialist is acceptable where eye care professionals are not readily available.

 

Initial Exam:
  • Within five years of diagnosis for adults who have Type 1 diabetes
  • At the time of diagnosis for adults with Type 2 diabetes

Routine Exams:
  • Every two years in the absence of retinopathy
  • Annually in the presence of retinopathy
  • At more frequent intervals in the presence of progressive retinopathy and/or deterioration of vision due to disease progression

Pregnancy:
  • Educate women who are planning to be or are pregnant and who also have diabetes about the risk of diabetic retinopathy developing or progressing
  • Perform an eye exam prior to or at the time of diagnosis of pregnancy, during every trimester, and one year after delivery in the presence of pre-existing Type 1 or Type 2 diabetes

 

  • Incorporate ADA recommendations into practice. Follow the above screening recommendations to ensure best practice for patients.
  • Gather patient information. Ask the patient about their diabetes history, medications they are taking, symptoms they are experiencing and if they have any questions.
  • Educate your patients. Help them understand why a retinal exam for patients with diabetes is different from an eye exam for glasses and why it is essential to help prevent future problems.
  • Remind your diabetic patients to contact the number on their member ID card if they have any questions about their health care coverage details. A yearly retinal exam may be a covered benefit for patients with diabetes.
  • Submit claims accurately. When submitting a claim for a diabetic patient eye exam, be sure to include “diabetes” as a diagnosis to help ensure proper application of benefits.

We thank you for collaborating with us to support the health and wellness of our FEP members. Working together, we can help support improved outcomes for people with diabetes.

1Diabetic Retinopathy: A Position Statement by the American Diabetes Association, Sharon D. Solomon, Emily Chew, Elia J. Duh, Lucia Sobrin, Jennifer K. Sun, Brian L.VanderBeek, Charles C. Wykoff, Thomas W. Gardner, Diabetes Care, Mar 2017, 40 (3) 412-418; DOI: 10.2337/dc16-2641. Additional information on diabetic retinopathy can be found on the ADA site .

The information in this article is being provided for educational purposes only and is not the provision of medical care or advice. Physicians and other health care providers are to their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.