SAN FRANCISCO People with chronic diseases such as diabetes, glaucoma and age-related macular degeneration fall far short of having annual eye examinations. This, according to a study appearing in the October issue of Ophthalmology, points to the need for new approaches to enhancing long-term follow-up of those already in the health care system. Ophthalmology is the clinical journal of the American Academy of Ophthalmology, the Eye M.D. Association.

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
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American Academy of Ophthalmology
22-Sep-2003

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