In this random sample of Medicare beneficiaries aged 65 years or older between 1991 and 1999, the authors found that 70 to 90 percent of those with glaucoma had annual eye examinations, 65 to 80 percent of those with macular degeneration had eye examinations, but only 50 to 60 percent of those with diabetes had such examinations. Also, more than half of those with at least one of the three eye diseases had at least one 15-month gap in eye examinations. Those with diabetes were more likely to have gaps in eye examinations than those in the other two eye disease groups.
"These exams are important because some patients with these diseases have no symptoms at a stage where treatment could prevent later visual loss," said Academy spokesperson Michael F. Marmor, MD, professor of ophthalmology at Stanford University. "This study suggests that changes in medical practice are necessary if we are to optimally serve the public. Physicians must encourage patients to be aware of the need for exams."
The study authors offer several possible reasons for the difference between the recommended guidelines and patient compliance. Lack of physician consensus on the recommendations, lack of knowledge of the current guidelines among community physicians, failure of physicians to communicate to patients the benefits of compliance, patient preference and the cost of visits were cited as reasons. In addition, the authors said that barriers in access to care may also play a role in patients' poor compliance rates.
Paul P. Lee, MD, JD, professor of ophthalmology at Duke University in Durham, North Carolina, and lead author of the study, said, "Physicians need to be more proactive in ensuring that patients maintain regular follow-up visits." He also identified some of the limitations of the study, pointing out that guidelines regarding frequency of examinations are based on criteria not documented in the Medicare claims data, and that the guidelines vary depending on the type and extent of the disease.
"Perhaps the greatest change in practice may need to come through our educating internal medicine and family doctors that eye disease is prevalent in the elderly and that eye exams are needed, particularly for any newly-diagnosed adult patient with diabetes and for periodic routine glaucoma screening," Dr. Marmor said. He suggested this problem can also be partly addressed by better publicity and information through the media.
This study was supported by a grant from the National Eye Institute, part of the National Institutes of Health.
The American Academy of Ophthalmology is the world's largest association of eye physicians and surgeons--Eye M.D.s--with more than 27,000 members worldwide. For more information about eye health care, visit the Academy's partner Web site at www.medem.com/eyemd. To find an Eye M.D. in your area, visit the Academy's Web site at www.aao.org.