Evaluating the Role of A Comprehensive Eye Exam When Joining Medicare

Abstract

Purpose : Medicare does not currently cover preventive eye care visits. Many age-associated eye diseases are silent until irreversible damage has occurred. A prior analysis found that a screening eye exam at entry into Medicare is cost-effective. We assessed the uptake of a complimentary eye exam among 64 year olds and characterized eye disease in this population.

Methods : 5 academic medical practices invited individuals seen in their health system within the past 5 years to receive a complementary comprehensive eye exam. Willing individuals completed a questionnaire on current ocular history and received a dilated exam. Afterwards, a coordinator called participants to assess their opinions regarding the exam.

Results : 33% of individuals successfully contacted attended an eye exam; participation varied across sites (22-80%). The main reason (63%) for not participating was already having an eye care provider. 431 participants completed an eye exam and ocular history questionnaire. Nearly 40% had not had an eye exam in the past 2 years, and 31% stated their current vision was fair or poor. 18% presented (habitual correction) with distance vision worse than 20/40 in at least one eye but with refraction, 96% achieved vision better than 20/40.
4% of participants had glaucoma (N=19), and half of these did not self-report glaucoma. An additional 10% (n=41) were glaucoma suspect, and only 2 of these self-reported. 17 (4%) had diabetic retinopathy (DR), and only 3 of these self-reported DR. 18 had AMD; 4 of whom self-reported. 196 (45%) had some degree of cataract.
351 completed a follow up questionnaire (81.4%). Of these, 93% said they were very satisfied with the exam experience, and 85% of these indicated willingness to pay an average of $84 for a similar exam in the future. The majority of those not willing to pay stated the reason was that they already had insurance to cover the exam.

Conclusions : There was significant interest in accessing a complimentary comprehensive eye exam among those becoming eligible for Medicare. Glaucoma and diabetic retinopathy were relatively common and frequently undiagnosed, and monitoring these diseases regularly can prevent vision loss. Prospective evaluation of the benefits of providing a free introductory eye exam at the time of entering Medicare in reducing visual impairment and blindness is needed.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.