The leading cause of blindness in working-age adults is diabetic retinopathy, which is why this news is so dismaying: a recent study found that rates of eye exams in the diabetic population are very low. This is particularly concerning when you factor in the rate of diabetic retinopathy diagnosis among those who do get eye exams.

Annual eye exams are important to catch diabetic retinopathy in its early stages, but this can’t happen if people aren’t screened.

Study Design

Researchers looked at eye exam visits over five years in a large American population of people with diabetes and with insurance between the age of 10 and 64. They used claims data from IBM Watson Health to identify patients with diabetes and continuous insurance coverage between the years 2010 and 2014. The researchers state they “calculated eye exam visit frequency by diabetes type over a 5-year period and estimated period prevalence and cumulative incidence of [diabetic retinopathy] among those receiving an eye exam.”

Study Outcome

Of the 298,383 insured type 2 patients and no diagnosed diabetic retinopathy, “almost half had no eye exam visits over the 5-year period and only 15.3% met the American Diabetes Association (ADA) recommendations for annual or biennial eye exams,” state the study authors in their abstract.

Of the 2,949 type 1 diabetes patients, a third had no eye exam visits, and 26.3% met the ADA recommendations.

This wouldn’t be so startling if it weren’t for the following: The five-year prevalence and cumulative incidence of diabetic retinopathy in patients with type 2 diabetes was 24.4% and 15.8%, respectively and among those with type 1 diabetes it was 54% and 33.4%. In other words, there is a high rate of diabetic retinopathy diagnosis happening, particularly among patients with type 1 diabetes. This means that many who are not getting exams are likely suffering from diabetic retinopathy and going undetected. Diabetic retinopathy progresses over time and is easier to treat in the early stages.


The study authors conclude that “The frequency of eye exams was alarmingly low, adding to the abundant literature that systemic changes in health care may be needed to detect and prevent vision-threatening eye disease among people with diabetes.”

Why are so many insured people with diabetes not getting regular diabetic eye exams?

For many, rising costs of medical care and medications have led to pressure to do without certain healthcare–eye exams being one possibility. If you have to choose between insulin and a check-up, the choice is easy but that can leave critical tests behind. For others, the fear and anxiety of a possible diagnosis can lead to avoidance. As understandable as those feelings are, we know that the best way to deal with a health problem is to entirely confront it.

The incidence of diabetic retinopathy is not the same for everyone. In fact, recent research states that “the risk of progression from no retinopathy to proliferative diabetic retinopathy or clinically significant macular edema was [only] 1.0% over 5 years among patients with a glycated hemoglobin level of 6% as compared with 4.3% over 3 years among patients with a glycated hemoglobin level of 10%.” Those with better blood glucose management have fewer cases of retinopathy. However, if blood sugar levels aren’t normal or very close to normal, testing is especially important to address issues early on.

If you’ve been putting off an eye exam and need one, we encourage you to get your test scheduled, today.

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