An Eye Exam for an Eye Exam

Dilated eye exams a more cost effective screening tool for seniors enrolling in Medicare

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Giving seniors who join Medicare a dilated eye exam instead of a standard exam or no exam is more likely to pick up on eye problems earlier - and it's more cost-effective long-term too.

A recent study led by David Rein, PhD, at the University of Chicago, analyzed simulations that gave Medicare recipients at age 65 a standard eye exam, a more expensive exam with dilated pupils or no exam at all.

"Schedule annual eye exams to detect potential eye disorders."

They found the current procedure, giving seniors a standard "visual acuity" test, is not cost-effective, but the use of dilated eye exams and a more sensitive "auto-refractive evaluation," though more costly, provides more bang for the buck when quality of life is taken into account.

If patients who did not have diabetes or any previously diagnosed eye conditions were given dilated eye exams instead of no exam at all, the additional cost is $94 initially. A standard exam is $32 more than no screening.

The simulations revealed, however, what the U.S. Preventive Services Task Force already stated three years ago: that a standard "visual acuity" test does not lead to better outcomes than no screening at all.

The researchers wrote that this is probably because standard visual acuity tests cannot detect early cataracts or certain diseases like early glaucoma or macular degeneration. They also are not as effective at identifying uncorrected refractive errors.

The model predicted outcomes for 50,000 people with the same characteristics of those aged 65 and over and then calculated the costs and a quality of life measure for those hypothetical individuals.

The simulations took into account four common eye disorders: macular degeneration (blindness), glaucoma, cataracts and uncorrected refractive errors. Refractive errors include nearsightedness, farsightedness, astigmatism and presbyopia, the difficulty people have with focusing up close that develops with aging.

When the researchers calculated the cost to society for the 2 million new annual enrollees in Medicare, they found that dilated eye exams were preferred 54 percent of the time over no screening and 56 percent of the time over standard screenings.

“This study confirms that a comprehensive dilated eye exam is a cost effective preventative health care benefit," said Dr. Christopher Quinn,an optometrist from Omni Eye Associates who was not involved in the study.

"Vision is one of the most important senses we have and it is vulnerable to deterioration as we age," Quinn said. "Being able to diagnose these common eye disease at the earliest most treatable stage will undoubtedly reduce the overall rate of unnecessary blindness. “

The study, which appeared in the Archives of Ophthalmology, was funded by the Centers for Disease Control and Prevention, the National Eye Institute and Research to Prevent Blindness.

Reviewed by: 
Review Date: 
January 9, 2012
Last Updated:
January 11, 2012