Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases

doi:10.1016/S0161-6420(03)00817-0

Ophthalmology

Volume 110, Issue 10, October 2003, Pages 1952-1959

https://doi.org/10.1016/S0161-6420(03)00817-0 Get rights and content

Abstract

Objective

To assess the rate of annual eye examinations over time among older Americans with diabetes and chronic eye diseases.

Design

Longitudinal analysis of Medicare claims data.

Participants

Random sample of Medicare beneficiaries aged 65 years or older.

Methods

Beneficiaries were followed between 1991 and 1999, unless mortality or enrollment in a health maintenance organization for > 6 months in a given 12-month period intervened. All claims data (both physician and facility) during this time were analyzed for the presence of International Classification of Diseases 9 codes consistent with 1 of the 3 study conditions and the performance of eye examinations.

Main outcome measures

Claims submitted by optometrists, ophthalmologists, or other providers of eye care for subjects with diabetes, glaucoma, or age-related macular degeneration (ARMD). Rates were calculated on the basis of a 15-month time window for annual examinations rather than for 12 months to allow for less than full compliance with the guidelines for various reasons (e.g., bad weather).

Results

Among those with diabetes in this population, 50% to 60% had annual eye examinations in a 15-month period. Of those followed for at least 75 months after diagnosis, about three quarters had one or more 15-month gaps between visits. For subjects diagnosed with glaucoma, most visit rates were in the 70% to 90% range per 15-month period. The percentage of subjects with at least one 15-month period with no visits was considerably lower than for diabetes. The patterns for those with ARMD were in between those for diabetes and glaucoma. Over a nine-year period, only slightly over half of persons with at least one of the study conditions complied with practice guidelines.

Conclusions

Annual eye examinations for persons diagnosed with diabetes, glaucoma, and ARMD are important for detecting potentially treatable vision loss among those already diagnosed with these conditions. Currently, actual rates of eye examinations for persons diagnosed with the study conditions fall far short of recommended rates. As such, approaches to enhancing longitudinal follow-up of those already in the eye care system are needed.

Section snippets

Methods

The study population consisted of individuals aged 65 years or older at the time of entry in the study and who were enrolled in the National Long-Term Care Survey (NLTCS). The NLTCS is a random sample of US adults over the age of 65 years. The sample includes institutionalized adults, enabling us to generalize results to the entire population aged 65 years and older. Detailed information about the NLTCS is available at http://www.cds.duke.edu/NLTCS/index.htm. We made use of the NLTCS to draw

Results

Rates of visits for subjects with diagnosed diabetes per 15-month period were generally between 50% and 60% (Table 3). Rates tended to be somewhat higher for subjects observed for more time periods than for those observed for fewer periods. Rates tended to rise over time for persons observed for 6 or 7 periods.

For subjects diagnosed with glaucoma, most visit rates were in the 70% to 90% range per 15-month period. As for diabetes, visit rates were higher, on average, for subjects observed for

Discussion

Longitudinal rates of continuous care demonstrate substantial “gaps” in care among Medicare beneficiaries for all three chronic eye conditions. Overall, over half of the subjects with at least 1 of the 3 study conditions had at least one 15-month gap in eye examinations. However, subjects with less severe forms of disease were more likely to have gaps and to have more gaps. Although these patterns generalize to all 3 groups, we also found some differences. Gaps were more likely to occur among

Acknowledgements

This research was supported in part by National Institute on Aging grant 1RO1-AG-17473, “Visual Impairment, Treatment, and Effects on the Elderly.”

References (18)

S.E. Moss et al.
The 14-year incidence of visual loss in a diabetic population
Ophthalmology
(1998)
R. Klein et al.
The five-year incidence and progression of age-related maculopathythe Beaver Dam Eye Study
Ophthalmology
(1997)
S. Blomdahl et al.
Blindness in glaucoma patients
Acta Ophthalmol Scand
(1997)
Position statementdiabetic retinopathy
Diabetes Care
(2002)
Preferred Practice Pattern. Diabetic Retinopathy. San Francisco: American Academy of Ophthalmology;...
S. Vijan et al.
Cost-utility analysis of screening intervals for diabetic retinopathy in patients with type 2 diabetes mellitus
JAMA
(2000)
Preferred Practice Pattern. Primary Open-Angle Glaucoma. San Francisco: American Academy of Ophthalmology;...
Preferred Practice Pattern. Age-Related Macular Degeneration. San Francisco: American Academy of Ophthalmology;...
R.D. Hays et al.
The impact of patient adherence on health outcomes for patients with chronic disease in the Medical Outcomes Study
J Behav Med
(1994)

There are more references available in the full text version of this article.

Cited by (156)

Teleophthalmology provides earlier eye care access for patients with newly-diagnosed diabetes
2024, Heliyon
Timely diagnosis of diabetic retinopathy is important in preventing vision loss. This study aims to determine if remote retinal imaging enables earlier eye care access among newly-diagnosed diabetic patients.
Retrospective cohort study.
Using the OptumLabs® Data Warehouse – a longitudinal, real-world dataset containing deidentified administrative claims and electronic health record (EHR) data, we included 968 846 adults with newly diagnosed type 2 diabetes and at least 1 year of continuous enrollment. We compared time from initial diabetes diagnosis to first eye exam by remote screening or in-person eye exam.
We found that at year 1 after diagnosis, 5459 (0.56%) patients underwent remote imaging and 208 023 (21.5%) underwent in-person exam. The mean (95% CI) time to eye exam was 3.48 (3.38–3.58) months for remote imaging and 4.22 (4.20–4.23) months for in-person visits (p < 0.0001). Interestingly, 27.5% of remote screenings were performed on the same day of diabetes diagnosis. Excluding same-day encounters, mean time to eye exam was 4.80 (4.68–4.91) months for remote imaging and 4.85 (4.83–4.86) months for in-person eyecare (p = 0.4).
Thus, teleophthalmology may enable earlier eye care access among patients with newly-diagnosed diabetes, primarily with same-day screenings. Increased adoption of teleretinal screening may enable earlier detection of diabetic retinopathy and prevent vision loss.
The Impact of Social Determinants of Health on Eye Care Utilization in a National Sample of People with Diabetes
2023, Ophthalmology
To evaluate the association of social determinants of health (SDoH) with eye care utilization among people with diabetes mellitus using the 2013–2017 National Health Interview Survey (NHIS).
Retrospective cross-sectional study.
Participants ≥ 18 years of age with self-reported diabetes.
The SDoH in the following domains were used: (1) economic stability; (2) neighborhood, physical environment, and social cohesion; (3) community and social context; (4) food environment; (5) education; and (6) health care system. An aggregate SDoH score was calculated and divided into quartiles, with Q4 representing those with the highest adverse SDoH burden. Survey-weighted multivariable logistic regression models evaluated the association of SDoH quartile with eye care utilization in the preceding 12 months. A linear trend test was conducted. Domain-specific mean SDoH scores were calculated, and the performance of domain-specific models was compared using area under the curve (AUC).
Eye care utilization in the preceding 12 months.
Of 20 807 adults with diabetes, 43% had not used eye care. Greater adverse SDoH burden was associated with decrements in odds of eye care utilization (P < 0.001 for trend). Participants in the highest quartile of adverse SDoH burden (Q4) had a 58% lower odds (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.37–0.47) of eye care utilization than those in Q1. The domain-specific model using economic stability had the highest performing AUC (0.63; 95% CI, 0.62–0.64).
Among a national sample of people with diabetes, adverse SDoH were associated with decreased eye care utilization. Evaluating and intervening upon the effects of adverse SDoH may be a means by which to improve eye care utilization and prevent vision loss.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Urgent unmet needs in the care of bacterial keratitis: An evidence-based synthesis
2023, Ocular Surface
Bacterial corneal infections, or bacterial keratitis (BK), are ophthalmic emergencies that frequently lead to irreversible visual impairment. Though increasingly recognized as a major cause of global blindness, modern paradigms of evidence-based care in BK have remained at a diagnostic and therapeutic impasse for over half a century. Current standards of management – based on the collection of corneal cultures and the application of broad-spectrum topical antibiotics – are beset by important yet widely underrecognized limitations, including approximately 30% of all patients who will develop moderate to severe vision loss in the affected eye. Though recent advances have involved a more clearly defined role for adjunctive topical corticosteroids, and novel therapies such as corneal crosslinking, overall progress to improve patient and population-based outcomes remains incommensurate to the chronic morbidity caused by this disease. Recognizing that the care of BK is guided by the clinical axiom, “time equals vision”, this chapter offers an evidence-based synthesis for the clinical management of these infections, underscoring critical unmet needs in disease prevention, diagnosis, and treatment.
Referral pattern and co-management of keratoconus patients in primary eye care: A survey of three European countries
2022, Contact Lens and Anterior Eye
Citation Excerpt :
Second, the use of an anonymous online survey may make it impossible to know the exact completion rate between all possible practitioners. Finally, the questionnaire was not disseminated to general or primary care practitioners because referral practices in primary care have seldom been examined previously, and reports mainly have focused on the referral for high-prevalence eye diseases (such as age-related macular degeneration or glaucoma) [3] or diabetic patients [20], without a focus on infrequent chronic diseases in young people, such as keratoconus. However, this is the first time that current primary eye care practice has been related to keratoconus disease in three different European countries (Portugal, the UK and Spain [24]) where the optometry practice is similar (primary eye care and prescribing contact lenses in healthy and keratoconus patients).
To explore current primary care practices in keratoconus management in Portugal and compare with previous reported results in two European countries (the UK and Spain), with a special focus on interdisciplinary collaboration and referral practice patterns.
An online survey adapted to European professional practice was distributed (via newsletters) by the Portuguese Optometrist Association to explore keratoconus patient management and referral practice patterns among Portuguese practitioners.
Responses of 119 optometrists were compared with previous reported of 464 eye-care practitioners (126 in the UK and 338 in Spain). Most respondents (79% in Portugal, 71% in the UK and 76% in Spain; p = 0.31) had < 5 new keratoconus patients each year. No accepted referral criterion was found (p < 0.01) because small number of the respondents (14%) in Portugal referred out at initial diagnosis (50% in the UK and Spain); 32% referred out when progression was detected (17% in the UK and 30% in Spain); and a minority (10% in Portugal, 9% in the UK, and 6% in Spain) referred out when visual acuity was affected. A majority of respondents (83%) in Portugal reported no co-management with ophthalmologists (60% in the UK and 73% in Spain; p < 0.01).
The results of this study suggest that it is necessary to encourage interdisciplinary collaboration between practitioners to improve referral of patients with suspected keratoconus to an ophthalmology specialist to change the course of this disease, to reduce keratoconus progression and visual acuity impairment and to minimize the impact of this disease on patients’ quality of life.
Trends in Remote Retinal Imaging Utilization and Payments in the United States
2022, Ophthalmology
Correlation Between Ophthalmology Market Saturation and Medicare Utilization Rates
2021, American Journal of Ophthalmology
To characterize usage of ophthalmologic services by Medicare Fee-For-Service (FFS) beneficiaries relative to geography-specific market saturation, demographics, and contextual factors
Cross-sectional study
Data sets from Centers for Medicare & Medicaid Services, US Census Bureau, US Department of Agriculture, and Housing and Urban Development, were used to calculate county- and state-level ophthalmologic service usage, market saturation, and demographic characteristics. Negative binomial regression models were used to evaluate the association between results and demographic or population-specific variables.
Ophthalmologic service usage ranged from 58.2% to 15.2%, whereas saturation ranged from 21,763 to 91.4 FFS beneficiaries per registered ophthalmologist. Usage was significantly associated with demographic characteristics in each geography: lower proportion of African American (P = .009), Hispanic (P < .001), and other race beneficiaries (P < .001), relative to white beneficiaries; a higher proportion of female (P < .001) relative to male; a higher proportion of adults having completed an associate degree or some college (P = .001), or holding a bachelor's degree or higher (P < .001), relative to a high school diploma; a lower proportion of adults in each geography experiencing poverty (P = .009), geographies with lower Multidimensional Deprivation Index (P < .001); a higher urban-influence code (P < .001).
There was no significant correlation between the usage of ophthalmologic services and the geographic market saturation of ophthalmologists (Spearman rho, –0.030, P = .227).
Ophthalmologic service usage is significantly influenced by population demographics; however, increased provider density alone appears insufficient to promote the usage of eye care services.

View all citing articles on Scopus

^☆

Manuscript no. 220581.

Financial support: National Institute on Aging grant 1RO1-AG-17473, “Visual Impairment, Treatment, and Effects on the Elderly.”

Proprietary interest: none.

View full text

Original articleLongitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases☆

Abstract

Objective

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acknowledgements

Ophthalmology

Ophthalmology

Blindness in glaucoma patients

Acta Ophthalmol Scand

Position statementdiabetic retinopathy

Diabetes Care

Cost-utility analysis of screening intervals for diabetic retinopathy in patients with type 2 diabetes mellitus

JAMA

The impact of patient adherence on health outcomes for patients with chronic disease in the Medical Outcomes Study

J Behav Med

Original article
Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases☆