Diabetes: Eye Exam (NQF 0055)

eMeasure Name Diabetes: Eye Exam eMeasure Id F5BF9CA1-3AB4-4E2B-BA96-0B6C2A44D6F8
Version number 1 eMeasure Set Id EECBEE49-2D85-45AE-8CA6-A7F3A2D89F73
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance
Endorsed by National Quality Forum
Description The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had a retinal or dilated eye exam or a negative retinal exam (no evidence of retinopathy) by an eye care professional.
Copyright
© National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
This measure evaluates the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who had an eye (retinal) exam performed. Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life-threatening, life-ending or life-altering complications, including glaucoma and blindness. Diabetic retinopathy is the most common diabetic eye disease and causes 21,000–4,000 new cases of blindness annually. The consensus among established clinical guidelines is that patients with both types of diabetes should have an initial dilated and comprehensive eye exam soon after diagnosis (ADA 2009). Guidelines also recommend consultation with an ophthalmologist for treatment options if a patient has any level of macular edema or diabetic retinopathy (proliferative and nonproliferative). This measure facilitates the prevention and long-term management of retinal-based complications for patients diagnosed with diabetes.
Clinical Recommendation Statement
American Diabetes Association (ADA) – 2009: 
•	Adults and children aged 10 years or older with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (B)
•	Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist shortly after the diagnosis of diabetes. (B)
•	Subsequent examinations for type 1 and type 2 diabetic patients should be repeated annually by an ophthalmologist or optometrist. Less frequent exams (every 2–3 years) may be considered following one or more normal eye exams. Examinations will be required more frequently if retinopathy is progressing. (B)
•	Women with preexisting diabetes who are planning pregnancy or who have become pregnant should have a comprehensive eye examination and be counseled on the risk of development and/or progression of diabetic retinopathy. (B)
•	Eye examination should occur in the first trimester with close follow-up throughout pregnancy and for 1 year postpartum. (B)
•	Promptly refer patients with any level of macular edema, severe nonproliferative diabetic retinopathy (NPDR), or any proliferative diabetic retinopathy (PDR) to an ophthalmologist who is knowledgeable and experienced in the management and treatment of diabetic retinopathy. (A) 
•	Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with high-risk PDR, clinically significant macular edema, and in some cases of severe NPDR. (A)
•	The presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection, as this therapy does not increase the risk of retinal hemorrhage. (A)

American Geriatric Society (AGS) – 2003: The older adult who has new-onset DM should have an initial screening dilated-eye examination performed by an eye-care specialist with funduscopy training. (Level I, Grade B)
Improvement notation
Higher score indicates better quality
Measurement duration
24 month(s)
Reference
Guidelines for Improving the Care of the Older Person with Diabetes Mellitus.  California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes.  American Geriatrics Society.  May 2003 – Vol. 51, No. 5 Supplement, JAGS.
Reference
Standards of Medical Care in Diabetes – 2009.  Diabetes Care January 2009 32:S6-S12; doi: 10.2337/dc09-S006
Definition
Initial Patient Population(s): All patients 18 to 75 years of age during the measurement period.
Definition
Denominator(s): Patients in the initial population with a diagnosis of diabetes and at least 2 non-acute inpatient or outpatient encounters, or currently receiving medications indicative of diabetes during the measurement period or in the 12 months prior to the measurement period.
Definition
Denominator Exclusion(s): Patients with a diagnosis of polycystic ovaries, gestational diabetes or steroid-induced diabetes who did not have any face-to-face encounters in any setting, with a diagnosis of diabetes, during the measurement period or the 12 months prior to the measurement period.
Definition
Numerator(s): The number of patients who had an eye screening for diabetic retinal disease during the measurement period or a negative retinal exam in the 12 months prior to the measurement period.
Definition
Denominator Exception(s): Patients with an active diagnosis of diabetic retinopathy determined during the 12 months prior to the measurement period.
Guidance
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012