Filling a Need in Diabetes Care

Optometrists play an integral role in the modern health care system. Although our focus is on the eyes and the visual system, we know that these are intrinsically connected to the entire body and are thus affected by systemic conditions. In fact, the eyes are the only organs in the body that can be visualized noninvasively to assess vascular and neurologic health. As primary eye care providers, we have a responsibility not only to care for our patients’ vision and eye health, but also to take into account their systemic health. By acting as part of our patients’ health care team, we can truly differentiate ourselves from our competitors.

In this regard, consider the fact that diabetes remains the leading cause of blindness among adults ages 20 to 74 years despite our knowledge of modifiable risk factors and advances in diagnostic tools and treatment tactics. Diabetic retinopathy causes between 12,000 and 24,000 new cases of blindness each year.¹ And although advances in the management of diabetes and diabetic retinopathy have reduced the risk of vision loss and blindness, more than one-third of people with diabetes do not receive an annual eye examination. This situation presents a significant opportunity for optometrists to become the gatekeepers for diabetic eye care.

THE PROBLEM IDENTIFIED

The epidemic of diabetes, the seventh leading cause of death in the United States, is very real.² An estimated 30.3 million Americans, or 13% of the adult US population, have diabetes.³ Of these individuals, approximately 21 million have been diagnosed and 8.1 million are undiagnosed.¹ In 2015, about 1.5 million new cases of diabetes (6.7 per 1,000 persons) were diagnosed in people aged 18 years and older.⁴ If this trend continues, one in three adults in the United States could have diabetes by 2050.⁵

Given its asymptomatic nature, the rate of prediabetes is growing at an even more alarming rate. Prediabetes is indicated by a fasting blood sugar level of 100 to 125 mg/dL (5.6 to 7.0 mmol/L),⁶ and approximately 84 million Americans have blood-sugar levels high enough to be considered prediabetic.⁷ It is estimated that 37% of American adults over age 20 and 51% of adults over age 65 are considered prediabetic.⁷

What’s more, 90% of individuals with prediabetes are not aware that they have prediabetes.⁷ And unfortunately, roughly 70% of people with prediabetes will develop type 2 diabetes over time.⁵ The good news is that prediabetes can be reversed with simple lifestyle changes, provided the patient knows that he or she has the condition.

THE ECONOMIC BURDEN

The economic burden of diabetes in the United States—that is, the total direct and indirect estimated costs of diagnosed diabetes—reached nearly $404 billion in 2017, including $327.2 billion for diagnosed diabetes, $31.7 billion for undiagnosed diabetes, $43.4 billion for prediabetes, and nearly $1.8 billion for gestational diabetes.⁵ Average medical expenditures for a person with diagnosed diabetes were about $13,700 per year, and about $7,900 of this amount was attributed specifically to diabetes. This figure is more than twice as high as average medical expenditures for a person without diabetes.⁴

Employers have long recognized that healthy employees are more productive than unhealthy employees. Besides the staggering costs to our health care system, employers encounter loss of productivity in employees who have diabetes. The added burden of time off work for medical visits, hospitalizations, pharmaceutical costs, and mental distractions can stifle productivity in the workplace.

FIGHTING THE EPIDEMIC

Our government and our health insurance companies recognize that healthier people have lower health care costs. This is one reason why CMS and most health plans use the Healthcare Effectiveness Data and Information Set (HEDIS) to evaluate care for insured patients. Medical insurance companies receive a HEDIS score from the government, and Medicare offers financial incentives for providers and insurers who achieve scores that meet certain criteria.⁸

Many HEDIS measures reward actions that promote preventive care because this reduces the number of overall doctor visits and improves patient outcomes. One such HEDIS indicator is the dilated retinal exam. Not only is an annual eye exam important for protecting the health of individuals with diabetes, it also lowers overall health care costs.

This scenario creates a major opportunity for optometry. Every day we see patients who have undiagnosed diabetes and prediabetes. This offers optometrists a unique opportunity to detect signs of diabetes and prediabetes that can lead to a confirmed diagnosis.

Many vision care plans are taking action in this regard. For example, VSP promotes optometry’s role as the primary eye care provider to thousands of employers and their employees. Specific to diabetes, VSP is partnering with the American Diabetes Association to educate the public about the critical role that optometrists and eye exams play in the prevention and detection of diabetic eye disease. To reinforce this effort, the company sends thousands of recall letters to patients with diabetes who have not received an annual eye examination.

Once patients with signs of diabetes are identified in our offices, we can then coordinate their care and benefits with other health care providers and transition them to their medical insurance benefits for continuation of medical eye care.

A NO-BRAINER

What on the surface may seem like a simple initial vision encounter carries the potential for a lifetime of engagement with each patient. Given the number of individuals with prediabetes and diabetes, the chronic nature of the condition, and the favorable insurance and payer outlook toward preventive wellness, specializing in diabetic eye care could be a sweet spot for medically minded optometrists.