Don’t Overlook the Importance of Annual Dilated Retinal Exams

Health plan administrators put a lot – or some might say all – of their focus on maintaining member health and reducing long-term costs. In this pursuit, it's important not to overlook the annual dilated retinal exam (DRE).

This unique tool, which uses drops to dilate the pupil, is not just about eye health. It offers a comprehensive view of a member's overall well-being, potentially identifying serious health issues at an early stage. This makes it a powerful addition to your health plan strategy.

Here are some key reasons why an annual DRE can be important for your members.

A Brighter Future Starts with Clear Vision: Prioritizing Children's Eye Exams

The American Optometric Association (AOA) has raised a significant public health concern: vision problems in children. Shockingly, one in five preschoolers and one in four school-aged children require corrective lenses. As healthcare professionals, and as health plan administrators, it is our shared responsibility to address this issue and ensure early detection and intervention for optimal eye health and vision development in children.

One of the most significant disparities in healthcare is access to vision care. Children with uncorrected vision are more likely to face misdiagnosis of behavioral and/or developmental issues, struggle in school, and even drop out. This lack of access disproportionately affects low-income communities, both urban and rural. Financial limitations, language barriers, complex healthcare systems, and even a shortage of eye care professionals in their area all contribute to this disparity.

These statistics are alarming: According to the Centers for Disease Control and Prevention (CDC), less than 15% of preschoolers receive an eye exam and only 22% of preschool children receive any vision screening. The importance of comprehensive eye exams for early detection and treatment of eye disease cannot be overstated. It's a critical preventive care measure that many children are missing out on.

By prioritizing and covering annual eye exams for children within your health plans, you can significantly contribute to their overall health and well-being. Early intervention ensures a brighter future for our youngest members.

Catching Diabetes and More Through the Retina

The prevalence of obesity and diabetes mellitus are on the rise in both children and adults. A DRE can detect the first signs of diabetes by spotting subsequent damage to the retina, known as diabetic retinopathy. Some patients develop this eye condition before they are even diagnosed with diabetes. According to the Centers for Disease Control (CDC), diabetic retinopathy is one of the leading causes of blindness in the U.S. That makes these annual exams critical – and not just for adults.

A recent study published in JAMA Opthalmology and reported on in Managed Healthcare Executive highlighted a concerning trend: an increase in diabetic retinopathy in young people. As more youths are being diagnosed with Type 1 and 2 diabetes due to poor diet and lack of exercise, they are becoming more susceptible to retinopathy.

By the time these young adults understand and try to manage their disease, they may be in their mid-20s, have lost part of their sight, and have had lasers and injections to control their retinopathy.

A Window into Overall Health

The retina, at the back of the eye, can provide health professionals with a wealth of information. During a DRE, an eye doctor will look for glaucoma and other common eye diseases. This early detection is crucial because managing and keeping blood glucose (sugar) levels close to a normal range can prevent systemic conditions later in life in adulthood. In addition, a DRE can detect certain conditions early, such as:

High Blood Pressure: The blood vessels in the retina are microscopic versions of those throughout the body. During a DRE, an eye doctor can examine these vessels for signs of damage or narrowing, indicating high blood pressure. Early detection and management of high blood pressure can significantly reduce the risk of heart attack, stroke, and kidney disease.

1. Cardiovascular Disease: Like high blood pressure, changes in the retina's blood vessels can also be a warning sign for cardiovascular disease. A DRE may reveal signs of hardening or fatty deposits in the retinal vessels, prompting further investigation by the doctor to assess a patient’s cardiovascular health.
2. Neurological Conditions: Conditions like multiple sclerosis or even tumors on the brain can sometimes manifest as changes in the retina during a DRE. Those with diabetes mellitus (type 1 and type 2) with chronically elevated blood glucose levels are also at risk of slowly developing nerve damage in the hands and feet. Early detection of these conditions allows for prompt treatment and improved patient outcomes.

Recommended Screenings for Diabetic Retinopathy

The American Diabetic Association (ADA) recommends the following retinopathy screening guidelines:

An initial dilated and comprehensive eye examination is recommended once youth have had type 1 diabetes for 3–5 years, provided they are aged ≥11 years or puberty has started, whichever is earlier.

• Screening for retinopathy should be performed by dilated fundoscopy at or soon after type 2 diabetes diagnosis and annually thereafter.

An annual dilated retinal eye exam is the best medicine for youth with type 1 and 2 diabetes to detect eye damage from diabetes. By catching retinopathy early through DREs, a provider and patient can implement better diabetes management, potentially preventing vision loss and other serious complications.

Coverage for Medicaid & Medicare

DREs are a cost-effective way to identify potential health problems early on and save significant resources for your plan. Additionally, annual dilated eye exams are especially important for populations covered by Medicaid and Medicare.

According to a 2023 report by KFF, Medicaid enrollees tend to report a worse health status than those with other types of coverage. However, coverage of DREs varies by state. For Medicare patients, DREs are covered at 80 percent for patients with diabetes and at a higher risk of glaucoma.

Encouraging DREs: A Win-Win Situation

Here are some suggestions to encourage your members to undergo annual DREs:

• Member Education: Partner with eye care professionals to develop educational materials that highlight the benefits of DREs, especially for children's development and overall health.
• Coverage clarity: Ensure your plan clearly outlines DRE coverage and is easy for members to understand. Consider offering incentives for completing annual DREs.
• Provider network: Partner with eye care providers who prioritize DREs and make them readily accessible to your members.

By encouraging annual DREs, you're not just promoting eye health; you're investing in the overall well-being of your members. This translates to a healthier population, better health outcomes, and potentially lower healthcare costs – a win-win situation for both your plan and your members.

Afrouz Motedaeiny, OD, is the senior medical director at Premier Eye Care.