Rates of untreated eye disease higher in diabetic adults in managed care

Medicare beneficiaries at high risk for eye disease due to diabetes are more likely to have unrecognized and untreated eye disease if they are enrolled in managed care than if they have fee-for-service (FFS) health insurance, according to an article in a recent issue of the JAMA/Archives journal Archives of Ophthalmology.

Background information in the article revealed that diabetics 65 and older are at high risk for eye diseases – including cataract, glaucoma and diabetic retinopathy (an eye disease in the retina that can result in seriously distorted or blurred vision). Although prior studies have shown that appropriate ophthalmic care can reduce eye disease progression and reduce or reverse visual disability, eye care for seniors with diabetes may not be adequate.

Arleen F. Brown, MD, PhD, of the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues interviewed Medicare beneficiaries in Los Angeles County with diabetes about their medical history and health care and eye care service use. Ophthalmologic examinations were performed to assess need for eye care services. The researchers also evaluated whether the rates of need for eye care differed in fee-for-service Medicare and the for-profit Medicare + Choice network model (MC) managed care plan.

Three-hundred-eleven patients with managed care health insurance and 107 with fee-for-service health insurance completed the interviews and clinical examinations. The researchers discovered  high rates of untreated eye disease in individuals with both types of insurance, reporting that managed care patients had significantly higher rates of cataract (36% versus 22%) and somewhat higher rates of diabetic retinopathy and glaucoma. Overall, managed care patients were more likely to have at least one of the three eye diseases, diabetic retinopathy, cataract, or glaucoma or suspected glaucoma, (68% versus 46%) than fee-for-service patients.

“Our findings indicate that older adults with diabetes are at risk for undetected and untreated age-related eye diseases, suggesting that more than just treatment for retinopathy must be considered when evaluating the appropriateness of the interval between eye care visits for older persons with diabetes,” the authors concluded. “Additionally, older adults with diabetes who were enrolled in a network-model managed care setting were more likely to need care for treatable ophthalmic conditions that comparable persons who obtain service under FFS Medicare.”

SOURCE: Arch Ophthalmol. May 2005; 123:669-675.