Oct. 3, 2025
People with diabetes are at a higher risk of vision loss and eye diseases, but 60% don’t get annual eye exams, according to the Centers for Disease Control and Prevention. Early diagnosis and proper treatment can greatly lower the risk of blindness from diabetic retinopathy.
In its Standards of Care in Diabetes for retinopathy, the American Diabetes Association recommends annual dilated retinal exams by an ophthalmologist or optometrist for members with any level of retinopathy. See our preventive care and clinical practice guidelines for more information on diabetes.
Closing care gaps: We track Eye Exam for Patients with Diabetes, a Healthcare Effectiveness Data and Information Set (HEDIS®) measure from the National Committee for Quality Assurance. This measure captures the percentage of our members ages 18 to 75 with type 1 or type 2 diabetes who have a retinal eye exam by an eye care professional during the measurement year to screen or monitor for diabetic retinal disease.
To help close care gaps, consider the following tips:
In early stages of retinopathy, people often don’t experience any symptoms. Discuss the importance of annual eye exams with our members who have diabetes, including members who are planning to be pregnant or are pregnant. We have information to share with members.
Build care gap alerts for eye exams in our members’ electronic medical records and send them reminders.
Eye care specialists can support care coordination by communicating exam results to our members’ primary care providers.
Resource for you: We created a resource for you on coding and documentation for HEDIS measures, called Quality Care 2025. You can access it in Availity® Essentials in our payer space. Download it from the Resources section under Quality Improvement. It includes information on Eye Exam for Patients with Diabetes and other diabetes measures, such as Hemoglobin A1c Control, Blood Pressure Control and Kidney Health Evaluation.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate 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.
HEDIS is a registered trademark of NCQA.