December 2019

Recommendations and Reminders for Eye Care Professionals

This article pertains to care/services provided to our Federal Employee Program^® (FEP^®) members.

Many primary care providers (PCPs) refer our diabetic FEP and other members to eye care specialists for annual eye examinations. PCPs need to know details about the care their patients receive and to receive communications from their patients’ eye care specialists. We want to encourage providers who do not routinely share results to consider doing so.

For quick reference purposes, a recommendation summary and additional information are included below to assist you when you are providing annual eye exams to our diabetic FEP members.

In 2017, the American Diabetes Association (ADA) updated its position statement on diabetic retinopathy and screening recommendations.¹ A summary of ADA recommendations is included here for your reference purposes.

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

To help improve patient outcomes, please consider the following practices:

Incorporate ADA recommendations into practice. Following the above recommendations can help 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 than 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.

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.

¹ ADA, Diabetic Retinopathy: A Position Statement by the American Diabetes Association, March2017, http://care.diabetesjournals.org/content/40/3/412

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 use 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.