Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases.

OBJECTIVE To assess the rate of annual eye examinations over time among older Americans with diabetes and chronic eye diseases. DESIGN Longitudinal analysis of Medicare claims data. PARTICIPANTS Random sample of Medicare beneficiaries aged 65 years or older. METHODS Beneficiaries were followed between 1991 and 1999, unless mortality or enrollment in a health maintenance organization for > 6 months in a given 12-month period intervened. All claims data (both physician and facility) during this time were analyzed for the presence of International Classification of Diseases 9 codes consistent with 1 of the 3 study conditions and the performance of eye examinations. MAIN OUTCOME MEASURES Claims submitted by optometrists, ophthalmologists, or other providers of eye care for subjects with diabetes, glaucoma, or age-related macular degeneration (ARMD). Rates were calculated on the basis of a 15-month time window for annual examinations rather than for 12 months to allow for less than full compliance with the guidelines for various reasons (e.g., bad weather). RESULTS Among those with diabetes in this population, 50% to 60% had annual eye examinations in a 15-month period. Of those followed for at least 75 months after diagnosis, about three quarters had one or more 15-month gaps between visits. For subjects diagnosed with glaucoma, most visit rates were in the 70% to 90% range per 15-month period. The percentage of subjects with at least one 15-month period with no visits was considerably lower than for diabetes. The patterns for those with ARMD were in between those for diabetes and glaucoma. Over a nine-year period, only slightly over half of persons with at least one of the study conditions complied with practice guidelines. CONCLUSIONS Annual eye examinations for persons diagnosed with diabetes, glaucoma, and ARMD are important for detecting potentially treatable vision loss among those already diagnosed with these conditions. Currently, actual rates of eye examinations for persons diagnosed with the study conditions fall far short of recommended rates. As such, approaches to enhancing longitudinal follow-up of those already in the eye care system are needed.

[1]  N. Fineberg,et al.  Primary care physicians' practice patterns and diabetic retinopathy. Current levels of care. , 1997, Archives of family medicine.

[2]  R. Hayward,et al.  Cost-utility analysis of screening intervals for diabetic retinopathy in patients with type 2 diabetes mellitus. , 2000, JAMA.

[3]  K. Flegal,et al.  Prevalence of Diabetes, Impaired Fasting Glucose, and Impaired Glucose Tolerance in U.S. Adults: The Third National Health and Nutrition Examination Survey, 1988–1994 , 1998, Diabetes Care.

[4]  D. Singer,et al.  Screening for Diabetic Retinopathy , 1993, Diabetes Care.

[5]  B. Tengroth,et al.  Blindness in glaucoma patients. , 2009, Acta ophthalmologica Scandinavica.

[6]  A. Wajda,et al.  Incidence and Prevalence of Diabetes in Manitoba, 1986–1991 , 1996, Diabetes Care.

[7]  H. Quigley.  Number of people with glaucoma worldwide. , 1996, The British journal of ophthalmology.

[8]  Q. Wang,et al.  Barriers to compliance with screening guidelines for diabetic retinopathy. , 1999, Ophthalmic epidemiology.

[9]  R. Klein,et al.  Ten-year incidence and progression of age-related maculopathy: The Beaver Dam eye study. , 2002, Ophthalmology.

[10]  J. Keeffe,et al.  Examination compliance and screening for diabetic retinopathy: a 2‐year follow‐up study , 2000, Clinical and Experimental Ophthalmology.

[11]  C. Sherbourne,et al.  The impact of patient adherence on health outcomes for patients with chronic disease in the medical outcomes study , 1994, Journal of Behavioral Medicine.

[12]  P. Khaw,et al.  Primary open-angle glaucoma , 2004, The Lancet.

[13]  Lloyd Paul Aiello,et al.  Preventive Eye Care in People With Diabetes Is Cost-Saving to the Federal Government: Implications for health-care reform , 1994, Diabetes Care.

[14]  R. Klein,et al.  Understanding the value of diabetic retinopathy screening. , 2001, Archives of ophthalmology.

[15]  R. Klein,et al.  Ten-year incidence of visual loss in a diabetic population. , 1994, Ophthalmology.