We Could Prevent More Blindness at Lower Cost in Diabetes
Almost 8 million Americans have diabetic eye disease. This is an increasing problem which almost doubled over a decade. The most common treatment for serious diabetic eye disease is an injection into the eye once a month. These shots may cost as much as $1800 each, just for the medication. Advanced diabetic eye disease is very expensive for patients who usually have multiple other problems and other expensive medications.
This problem could be much less common and much less expensive and it is one more example of the way our current system is broken. Optimal medical therapy (OMT) for diabetes slows the progression of diabetic eye damage by half. Only one third as many patients on OMT progress to blindness compared with usual care. The medications used in the study cited can be obtained for about $30 a month. Medical treatment that precisely interferes with the biology that causes diabetic eye disease is much cheaper.
We could do so much better. Only about 20% of patients with diabetes are achieving OMT and very little is being done to improve that number. We are not creating the primary care teams that could make so much difference. Only about half of the patients with diabetes even get an eye exam annually. That is an opportunity missed to identify eye problems early and help patients understand the benefits of OMT. It is a missed opportunity to achieve patient engagement.
In most practices, a primary care doctor is responsible for making certain that patients get their eye exam and obviously that is not working. She is on a hamster wheel under great pressure to see more patients a day. As a result, important things fall through the cracks including the diabetic eye exam. That is where teams come in. A nurse or medical assistant can have the responsibility to assure that every diabetic gets an eye exam, a urine test, and a neuropathy check every year. That is important work but it is not a complex decision. Every patient should have those tests every year. Because we don’t make these changes, diabetic eye disease is frequently advanced when diagnosed and there are higher costs and worse outcomes as a result. Focused primary care teams can do much better with diabetes and related conditions. Let’s make these changes now!