Keeping an Eye on Improved Provider Collaboration

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 communication and coordination of care between primary care providers (PCPs) and eye care specialists.

Many PCPs refer our members with diabetes to eye care specialists for annual eye examinations. PCPs benefit from receiving communication from their patients’ eye care specialists. We want to encourage eye care specialists who do not routinely or promptly share results to consider doing so.

For your reference, the following is a summary of the American Diabetes Association’s (ADA) screening recommendations for patients with diabetes. 1Diabetic annual eye exams remain an American Diabetes Association (ADA) recommended element in the treatment of patients with diabetes. Members may be hesitant or have difficulty getting or adhering to their annual exam, so reminders from their PCPs and eye care specialists can be beneficial to improve compliance. 

Screening:
  • Comprehensive evaluation by an eye care specialist should not be substituted by retinal photography.

Exception: For screening purposes, retinal photography with remote reading by a retinal specialist is acceptable where eye care professionals are not readily available. 
Routine Exams:
  • Annually or 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:
  • For women who are planning to be or are pregnant and who also have diabetes, educate about the risk of diabetic retinopathy developing or progressing
  • Perform an eye exam prior to or at the time of diagnosis of pregnancy, or in the first trimester in patients with preexisting type 1 or type 2 diabetes, and then patients should be monitored every trimester and for 1year post-partum as indicated by the degree of retinopathy 



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.

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 by ensuring prompt communication for annual eye exam for all FEP members with diabetes.

 

1American Diabetes Association Professional Practice Committee ; 12. Retinopathy, Neuropathy, and Foot Care: Standards of Medical Care in Diabetes—2022. Diabetes Care 1 January 2022; 45 (Supplement_1): S185–S194. 

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.