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The American Journal of Managed Care (AJMC®): What is diabetic retinopathy? How has it been traditionally diagnosed? At what point do patients usually present or get referred for evaluation, and is it too early or too late?

Michael D. Abramoff, MD, PhD: Diabetic retinopathy is a complication of diabetes and also the most important cause of blindness overall among all working-age Americans, not just individuals with diabetes. Traditionally, healthcare providers who take care of people who have diabetes are supposed to make sure that these [patients] get an eye exam every year. This requires a referral to an eye care specialist. Unfortunately, most patients do not follow through on these referrals and never see an eye care specialist: Just 15% of insured patients 10 to 64 years of age completed an annual eye exam, according to the results of a large, recently published study.1 Many of the noncompliant patients do not have diabetic retinopathy or diabetic macular edema and so do not need additional treatment. However, in some patients, diabetic retinopathy and/or diabetic macular edema is missed [because they do not get an annual eye exam]. They will make an appointment with the eye care specialist only when they have symptoms of vision loss, when it is usually too late to prevent permanent visual loss.