December 2021

Recommendations and Reminders for Eye Care Professionals

Many primary care providers (PCPs) refer our diabetic Federal Employee Program^® (FEP^®) members to eye care specialists for annual eye examinations. We encourage eye care specialists to promptly communicate exam results to the PCP to help coordinate the member’s care.

Some members may be hesitant to be in such close contact with providers due to COVID-19, so please share your office safety protocols.

The American Diabetes Association (ADA) recommends annual diabetic eye exams. In 2017, the ADA updated its position statement on diabetic retinopathy and screening recommendations.¹ A summary of ADA screening recommendations for patients with diabetes is included here for your reference:

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

Incorporate ADA recommendations into practice
Gather patient historical information
Educate your patients
Ensure diabetic eye exam results are made available to the members’ PCP
Remind your diabetic patients to contact the number on their member ID card if they have any questions about their health care coverage details.

Thank you for working with us to support the health and wellness of our FEP members. Together, we can help support improved outcomes for people with diabetes.

¹ Diabetic 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 at: 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 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.

Information provided by BCBSIL is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider, nor is the information presented intended to replace or supersede any requirements set forth in your contract with BCBSIL. Any samples in this communication are for illustrative and/or educational purposes only and should not be relied on in determining how a specific provider will be reimbursed. In the event of a conflict between the information in this communication and your contract, your contract will control.