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What Is Diabetic Retinopathy?

Discover what is diabetic retinopathy including the risk factors, how to prevent it, and other Medicare diabetes services.

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Diabetes affects 10.5% of the U.S. population and nearly 27% of Americans ages 65 and older. The percentage of adults managing diabetes only increases with age.

People commonly suffer from vision problems as a side-effect of diabetes. Diabetic retinopathy — a complication of type 1 or type 2 diabetes that affects the eyes and can lead to blindness — is caused by high blood sugar damaging the blood vessels in the retina.

There are two major types of retinopathy. Nonproliferative retinopathy is the most common form, where capillaries in the back of the eye expand and form pouches, blocking blood vessels. Proliferative retinopathy is what happens after the condition has progressed for several years and can lead to painful retinal detachment.

What is Your Diabetic Retinopathy Risk?

According to the Mayo Clinic , the longer you have diabetes and the longer you wait to get your blood sugar under control, the more likely it is that you’ll develop diabetic retinopathy.

In addition to simply having diabetes, some biological risk factors can increase the possibility of developing diabetic retinopathy.

People with other medical conditions, like high blood pressure and cholesterol, are high-risk for diabetic retinopathy. Avoiding alcohol and smoking can help prevent or slow the progression of diabetic retinopathy.

For Medicare beneficiaries with diabetes, Medicare Part B covers yearly eye exams for diabetic retinopathy. The Part B deductible applies, and patients will pay 20% of the Medicare-approved amount for the once-per-year exam. 

The once-yearly eye exams can be a key factor in early detection, which can be difficult if going off symptoms alone. While few symptoms typically occur in the beginning stages of
diabetic eye disease, chronic symptoms that require an eye exam include:

  • Recurrent changes in vision clarity

  • Desaturated colors

  • Blurred, wavy or shadow-like vision

  • Vision with spots, flashes of light or dark strings

Medicare Part B Offers Important Diabetes Services

For those unsure whether they have diabetes, Medicare also offers up to two diabetes screenings per year.

Tobacco users with diabetes can eliminate smoking-related risk factors by quitting as soon as possible. Medicare Part B covers up to eight visits of smoking and tobacco-use cessation counseling visits per year, and Medicare Advantage plans and Medicare Part D will both cover smoking cessation prescriptions approved by the U.S. Food and Drug Administration (FDA).

If your condition rises to the severity of a detached retina, Medicare Part B will cover the surgery , but beneficiaries will be responsible for the deductible and 20% co-insurance. Medicare Advantage plans typically cover the surgery, but out-of-pocket costs will depend on the individual plan.

Medicare beneficiaries with well-controlled cases of diabetes may medically qualify for a Medicare Supplement plan outside their six-month Medigap Open Enrollment Period . Find out if you qualify for a Medigap plan by calling Senior Healthcare Direct at 1-833-465-3262, TTY 711 to speak with a licensed agent.

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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.