Getting a Diabetic Retinal Eye Exam

Posted on Jul 6th 2018 by Florida Blue

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A diabetic retinal eye exam is when a doctor looks at changes in the blood vessels of your retina. Your retina is the part of your eye that senses light and works with your brain to let you see. By getting a diabetic retinal eye exam, it allows doctors to detect early signs of vision loss linked to diabetes.

Why You Need One

If you have diabetes, you are at risk for vision loss and developing an eye disease called diabetic retinopathy. This is when high blood sugar levels damage the blood vessels in your retina. The blood vessels can leak, swell or close, stopping blood from passing through. All of these changes can cause loss of vision. Diabetic retinopathy is the leading cause of vision loss in adults between 20 and 74.

According to a study published in the journal Eye and Vision, about one-third of people diagnosed with diabetes have signs of diabetic retinopathy. One-third of these adults are at risk of losing their vision.

Your risk for developing diabetic retinopathy is higher the longer you have diabetes. If you have Type 1 diabetes, your odds of developing diabetic retinopathy are lower if your blood sugar is controlled with insulin. People with Type 2 diabetes are more at risk of developing eye problems sooner. Type 2 diabetes is different from Type 1, which is an autoimmune disorder and usually develops in childhood or early adulthood. Type 2 diabetes is more common and usually develops later in life. Your risks from Type 2 diabetes can be lessened if your blood sugar, blood pressure and cholesterol are kept under control.

People with diabetes also have a higher risk of developing glaucoma. So it’s very important to keep close watch of what’s happening in your eyes.

How Much Does It Cost?

A diabetic retinal eye exam is no cost to you as part of your Florida Blue Medicare health plan. If the doctor does find signs of diabetic retinopathy or other abnormalities, you may have a copay or additional costs for specialists or treatment.

What Should You Expect?

Most diabetic retinal eye exams require no preparation and no discomfort. You will be asked to fill out paperwork about your general health history and any medications you are taking. Some medications can affect your vision and the results of the test. Your doctor will ask you about your vision history and have you read an eye chart. The eye chart is similar to a chart in a regular eye exam. It will have different letters and shapes that vary in size. You will be asked to read what you can to assess your vision.

To see the internal structures of your eyes, the doctor will ask you to place your chin on a chin rest and lean your forehead against a strap. Next, the doctor will use an instrument called a slit lamp to look at your eyes. The slit lamp is a high-powered microscope with a light beam that allows the doctor to look at structures they can’t see with the naked eye. They may also use an instrument called an ophthalmoscope. This instrument is either hand-held and looks like a flashlight or can be worn on the head, like a headlamp. The doctor may use a special camera to take photos of the back of your eye for a more detailed exam. Neither of these tests normally causes any discomfort in the patient.

If the doctor decides they need a better view, they may dilate (widen) your pupils with eye drops. This may be unpleasant but is not painful. The dilation causes blurred vision. Because your pupils may still be dilated a few hours after the exam, it’s a good idea to bring a pair of sunglasses and make arrangements for transportation. Ask your doctor ahead of time if you will need your eyes dilated.

After the exam, the doctor should be able to go over the results with you and go over treatment options or decide when your next exam will be. If for some reason your results are not ready to be reviewed, ask your doctor when you will get them.

How Do You Make an Appointment?

If you haven’t had your Annual Wellness Visit yet this year, this is a great time to ask your doctor about any screenings you need. Your primary care doctor can help you set up the appointment or tell you who to call.

If you have had your visit, call your doctor’s office and ask for help. They can give you a referral or make contact with a specialist who performs diabetic retinal eye exams.

We are here to help, too. Here’s what we can do for you:

  • We can help you find a primary care doctor if you don’t have one. If you are a BlueMedicare HMO member, you must have a primary care doctor to coordinate your care. You don’t have to have one if you are in PPO plan. But having a primary care doctor can help you coordinate your care and look at the total picture of your health. It’s especially important if you see multiple specialists. Your primary care doctor will be the one person who has an eye on everything to do with your health.
  • We can also help you schedule any appointments you need during a three-way call.
  • If you have trouble leaving the house, we can send care to you. Florida Blue works with vendors who provide in-home assessments at no cost to you.

Why We're Asking You to Get This Test

Seeing your doctor and getting preventive care is important to you. It’s important to us, too. CMS (Centers for Medicare & Medicaid Services) is the government organization that oversees Medicare Advantage plans like Florida Blue. Similar to how you use stars to rate a restaurant or hotel, CMS uses a five-star quality rating system to measure the experience people with Medicare have with their health plans and health care system.

One of CMS’ most important goals is to improve the health of people with Medicare and the quality of care they receive. CMS uses a measurement system to evaluate the quality of health care you receive. One of the measures CMS looks at is the diabetic retinal eye exam. If our members who need this test get it, Florida Blue scores better. This helps us improve our Star score. If our Star score is four or above, it means we’re helping our members manage their health. It also helps us improve our benefits for our members.

Healthy Blue Rewards

Depending on your plan, you may be able to earn between $25 in HealthyBlue Rewards for completing this screening. To learn more about HealthyBlue Rewards, please visit

Your doctor will help you know when and if you should be screened. Complete a diabetic retinal eye exam anytime between January 1, 2018, and December 31,2018, to earn a reward.

Caregiver Corner

If you have a caregiver who helps you with your health, make sure to share this information with them.

If you are a caregiver for one of our Medicare members, give us a call. Let us help you help the person you care for.

We’re always focused on you. We hope these tools help empower you as you continue to provide care to a loved one.

Note: Plans eligible for HealthyBlue Rewards include BlueMedicare Choice (RPPO), BlueMedicare Select (PPO), BlueMedicare Complete (HMO SNP), BlueMedicare Classic (HMO), BlueMedicare Classic Plus (HMO) and BlueMedicare Premier (HMO).

BlueMedicare Preferred (HMO), BlueMedicare group retiree plan, BlueMedicare Supplement and BlueMedicare Rx (PDP) members are not eligible for HealthyBlue Rewards.

Need help? Call us.

Please call Member Services at 1-800-926-6565. TTY users, please call 1-800-955-8770.

We are open from 8 a.m. to 8 p.m. local time, seven days a week from October 1 to February 14, except for Thanksgiving and Christmas. From February 15 to September 30, we are open Monday through Friday, 8 a.m. to 8 p.m. local time.


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