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Health Benefits of Collaborating with Eye Care Professionals

October 28, 2021

We appreciate the care and services you provide to our Federal Employee Program® (FEP®) members. This article pertains to care/services provided to our FEP members and to encourage continuity and coordination of care.

Many primary care providers (PCPs) refer our diabetic FEP 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 eye care specialists to share results routinely and promptly with PCPs.

Below is a screening recommendation summary from the American Diabetes Association (ADA)1 and additional information to assist you when you are providing annual eye exams to our diabetic FEP members. Members may be hesitant or even have difficulty getting or adhering to their annual exam, especially given the barriers associated with COVID-19. However, diabetic annual eye exams remain an American Diabetes Association (ADA) recommended element in the treatment of patients with diabetes.

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’ Primary Care Provider (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.

We thank our primary care providers and eye care specialist for collaborating and supporting the ongoing health and wellness of our FEP members. Working together, we can help support improved continuity of care and health 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 Learn more about third-party links.

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.