Diabetes Eye Exam Frequency in US Is 'Alarmingly Low'

Miriam E. Tucker

February 12, 2019

The frequency of eye exams among insured patients with type 1 and type 2 diabetes in the United States is "alarmingly low," new research indicates. 

Findings from an analysis of nationwide IBM Watson Health claims data were recently published online in Diabetes Care by Stephen R. Benoit, MD, of the Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues. 

Among nearly 300,000 insured individuals with type 2 diabetes and no diabetic retinopathy at baseline, almost half had no eye exam visits recorded over the past 5 years, and only about one in seven met the American Diabetes Association's (ADA's) recommendations for annual or biennial exams. Among nearly 3000 with type 1 diabetes, about a third had no eye exam visits in 5 years and just a quarter met the ADA recommendations.

"The frequency of eye exams was alarmingly low, adding to the abundant literature that systemic changes in healthcare may be needed to detect and prevent vision-threatening eye disease among people with diabetes," Benoit and colleagues write.

Eye Exam Rates Low for Both Types of Diabetes

The study involved insurance companies and employers that contributed data to IBM Watson Health during 2010-2014.

Among 298,383 patients with type 2 diabetes and no diabetic retinopathy, 48.1% had no eye exam visits over the study period, and just 15.3% met the ADA recommendations for yearly or 2-yearly eye exam visits.

Of 13,215 patients with type 2 diabetes who did have diabetic retinopathy at study onset, 11.2% had no eye exam visits and 50.9% met the ADA recommendations during the study period. In both cases, exam rates were lower among younger adults.

Among 2949 patients with type 1 diabetes for 5 years or more prior to the study and no diabetic retinopathy at baseline, 33.6% had no eye exams during the study period and only 26.3% met the ADA recommendations.

Of the 1429 patients with type 1 diabetes who did have diabetic retinopathy at the start of the study, 8.9% had no eye exams in 5 years and 63.5% met ADA recommendations. And again, exam rates were lower among younger patients with type 1 diabetes. 

Of Those Who Had Eye Exams, High Retinopathy Rates Found

Of the 146,151 patients with type 2 diabetes who did have an eye exam over the 5-year period, 24.4% were found to have diabetic retinopathy and 8.3% had vision-threatening diabetic retinopathy, defined as having severe nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, or macular edema. 

Retinopathy prevalence was higher in older patients and in men compared with women (27.3% vs 21.7%; P < .0001).

Of the 13,882 patients with type 1 diabetes who had eye exams, 54.0% and 24.3% had diabetic retinopathy and vision-threatening diabetic retinopathy, respectively. And similar to type 2 diabetes, those who were older and men had a higher prevalence.

Of particular concern, Benoit and colleagues note, was that almost a third, 30.6%, of patients with type 1 diabetes aged 40-64 years had vision-threatening diabetic retinopathy.

"Systemic Changes in Healthcare May Be Needed"

Although access to care is often cited as a barrier to timely eye exams, all the patients in this study had health insurance so clearly there are other issues, the authors say.

"Due to the consistency in suboptimal eye care utilization among people with diabetes, systemic changes in healthcare may be needed," they urge.

Telemedicine may be one viable option, they suggest, but "other interventions could also simplify and improve the fractionated healthcare system so that eye care is a seamless part of diabetes care.”

"Until this happens, [diabetic retinopathy] will likely remain the leading cause of blindness among working-age adults."

The authors have reported no relevant financial relationships.

Diabetes Care. Published online January 24, 2019. Abstract

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