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EW NEWS & OPINION 16 October 2014 by Michelle Dalton EyeWorld Contributing Writer Eyes really are the windows to … everything According to a recent white paper, eyecare professionals can identify numerous systemic diseases via a comprehensive eye exam A recent white paper noted that eyecare professionals can facilitate identific - tion and intervention of various high cost chronic diseases. Eye exams can also facili- tate the management of diagnosed medical conditions, the study authors said. The study, "Impact of Eye Exams in Identifying Chronic Conditions," was performed by Op- tum on behalf of UnitedHealthcare, Minneapolis, "to illustrate the prev- alence of chronic diseases identified through comprehensive eye exams by eyecare practitioners," said Linda M. Chous, OD, chief eyecare officer of UnitedHealthcare, and one of the two study authors. "Many systemic diseases can show up in the eye," she said. The most common conditions identified by eyecare practitioners (ECPs) were diabetes (1,453), high cholesterol (1,343), and hyper- tension (1,001). Multiple sclerosis (15.1%), diabetes (15.0%), juvenile rheumatoid arthritis (12.0%), and Crohn's disease (5.0%) were most likely to be identified by an EC . There is a "multitude of condi- tions that can be identified, mon - tored, and what excited me about the results is that many are diseases the general public wouldn't expect," Dr. Chous said. "When we looked at the data, we saw that since a lot of these conditions were being diag- nosed on the day of their eye exam, there was a very high possibility that these patients were self-re- porting their conditions and had not received care for more than 18 months," she said. "This provides an opportunity for eyecare providers to reengage the patients into care." "Many of the diseases mentioned don't have symptoms," Dr. Chous said. For example, of the 34,025 diagnoses of high cholesterol, 1,343 of those were attributable to a comprehensive eye exam. Similarly, 24,562 cases of hypertension were identified, of which 1,001 were attributed to a comprehensive eye exam. She also noted that people no- tice when their vision has changed and will take it upon themselves to have their eyesight checked, but may or may not regularly visit their primary care physician. The paper The study builds upon United- Healthcare's previous white paper, "Integrating Eye Care with Disease Management: It's Not Just About Diabetes Anymore," which used the company's prevalence and medical cost data, Dr. Chous said. "We took this information and investigated the diseases in which eyecare pro- viders can have the most impact." This study links vision benefits and identification of chronic disea - es by determining the percentage of specified chronic diseases where the disease was identified or reported through a comprehensive eye exam. The study used UnitedHealthcare commercial membership with both medical and vision coverage for calendar years 2011 and 2012, which amounted to about 820,000 members. Of those members, 739,633 had at least one medical or vision claim. As eyecare professionals do not often diagnose chronic conditions, the study attempted to isolate the impact of comprehensive eye exams on chronic condition identification First evidence of a specified chronic condition was verified by the absence of claims for the condition in a review of the prior 18 months of claims from when the chronic condition was iden- tified by the eyecare professional. Eyecare professionals were credited with identification if plan partic - pants with chronic conditions were reported during a comprehensive eye exam or identified by another healthcare professional within 60 days following the eye exam, which would indicate that likely a referral to address a condition had taken place. Commonly identified condition Due to a high incidence rate, diabetes, high cholesterol, and hypertension are the most com- monly identified chronic conditions through a comprehensive eye exam, Dr. Chous said. Approximately 90% of diabetes and juvenile rheumatoid arthritis conditions were identified on the day of the comprehensive eye exam, indicating that in many of these cases, the diagnoses may have been self-reported by the member and there was a lack of care for more than 18 months. "Since eyecare professionals often see members more frequently than primary care physicians, this provides an excellent opportunity for eyecare providers to reengage members into care for their chronic conditions that may have been otherwise lost to follow-up," Dr. Chous said. "This previously overlooked role for eyecare may create improved health outcomes and cost avoid- ance." Musculature and nervous system disorders can also be detected by a comprehensive eye exam, she said. "The study has been used to promote the value of a comprehensive eye exam. We're trying to ensure more people go on a yearly basis to help identify more diseases by eyecare professionals," she said. EW Editors' note: Dr. Chous is an employee of UnitedHealthcare. Contact information Chous: will.shanley@uhc.com Condition name Early identified condition ECP identifie Percent of conditions identified first by E Crohn's disease 27 545 5.0% Diabetes 1,453 9,700 15.0% Graves disease 81 1,691 4.8% High cholesterol 1,343 34,025 3.9% Hypertension 1,001 24,562 4.1% Juvenile rheumatoid arthritis 9 75 12.0% Multiple sclerosis 51 338 15.1% Rheumatoid arthritis 69 1,598 4.3% Grand total 4,034 72,534 5.6% Chronic conditions identified y an eyecare practitioner "Since eyecare professionals often see members more frequently than primary care physicians, this provides an excellent opportunity for eyecare providers to reengage members into care for their chronic conditions that may have been otherwise lost to follow-up." – Linda M. Chous, OD