Questions Linger About Diabetic Eye Care in HMOs

NEW YORK (Reuters Health) Mar 06 – The largest study of diabetic retinopathy outcomes among patients enrolled in an HMO leaves unanswered basic questions about the quality of care, according to a report in the February issue of the American Journal of Ophthalmology.
Previous studies investigating the quality of managed care for patients using ophthalmic services have yielded conflicting results, the authors explain, with some showing under-referral to specialists or undertreatment of disease, and others showing rates of use similar to other settings.

Dr. Donald S. Fong, from Kaiser Permanente Medical Center in Baldwin Park, California, and colleagues used medical records to investigate the visual outcomes of diabetic retinopathy management of 1047 diabetic patients enrolled in one Southern California HMO.

During the 2-year study period, 77.5% of the patients received a screening eye examination by an ophthalmologist or an optometrist or by review of a retinal photograph, the authors report. Only 65.6% of the medical charts recorded the visual acuity of the patients.

Only 1.5% of patients were legally blind (visual acuity no better than 20/200) in their better eye, the report indicates, while 8.2% were legally blind in their worse eye.

Patients with worse visual acuity were more likely to be older, had a longer duration of diabetes, and received a medication other than insulin to treat their diabetes, the researchers note, but their mean levels of HbA1c were similar to patients with better visual acuity.

More than 70% of patients with reduced visual acuity and proliferative diabetic retinopathy had undergone panretinal photocoagulation, the results indicate, but only about 50% of eyes with vitreous hemorrhage had documentation of vitrectomy. …

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