Comprehensive Adult Medical Eye Evaluation Preferred Practice Pattern

Publication Date: November 12, 2020
Last Updated: March 14, 2022

Recommendations 

The recommended frequency for adult comprehensive medical eye examinations for asymptomatic patients, and for patients who do not have risk factors for eye disease, is as follows:
  • <40 years: every 5–10 years
  • 40–54 years: every 2–4 years
  • 55–65 years: every 1–3 years
  • >65 years: every 1–2 year
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The first recommended adult comprehensive medical eye examination, and subsequent frequency of examination for patients who have diabetes mellitus, varies depending on the type of diabetes and whether a woman is pregnant. The recommendations are as follows:
  • Type 1 diabetes mellitus – first examination 5 years after onset and yearly afterwards
  • Type 2 diabetes mellitus – first examination at the time of diagnosis and yearly afterwards
  • For women with type 1 or type 2 diabetes – first examination prior to conception and then early in the first trimester of pregnancy
(Note: Women who develop gestational diabetes do not require an eye examination during pregnancy, and they do not appear to be at increased risk for developing diabetic retinopathy during pregnancy.)
  • Interval recommendations thereafter will be based on findings at first examination.
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Recommended frequency of comprehensive medical eye examinations for adults who have risk factors for glaucoma, such as African Americans and Hispanics, by age group is as follows:
  • <40 years: every 1–2 years
  • 40–54 years: every 1–3 years
  • ≥55: every 1–2 years
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Management 

Category I: Patients with No Risk Factors 

At the time of each comprehensive medical eye evaluation, the ophthalmologist will reassess the patient to determine the appropriate follow-up interval.
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Adults with no signs or risk factors for eye disease should receive a comprehensive medical eye evaluation at age 40 if they have not previously received one.
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Interim evaluations, such as screenings, refractions, or less extensive evaluations, are indicated to address episodic minor problems and complaints, or for patient reassurance.
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Category II: Patients with Risk Factors 

The ophthalmologist determines an appropriate follow-up interval for each patient based on the presence of early symptoms and signs, risk factors, the onset of ocular disease, and the potential rate of progression of a given disease.
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Category III: Conditions that Require Intervention 

The ophthalmologist should ensure that the patient is informed of relevant examination findings and the need for further evaluation, testing, treatment, or follow-up. (G, S) Also, relevant ophthalmic findings should be shared with the patient's primary care physician or other specialists, as appropriate.
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For a patient with systemic abnormalities, the ophthalmologist may advise further evaluation or referral, as appropriate.
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Vision rehabilitation attempts to restore as much functional ability as possible, and patients with reduced visual function may be referred for vision rehabilitation and social services.
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Provider and Setting 

Of all health care providers, the ophthalmologist, as a physician with full medical training, best combines a thorough understanding of ocular pathology and disease processes; familiarity with systemic disorders that have ocular manifestations; and clinical skills and experience in ocular diagnosis, treatment, and medical decision making. This makes the ophthalmologist the most qualified professional to perform and oversee a comprehensive medical eye evaluation.

Frequently, and appropriately, specific testing and data collection are conducted by trained personnel working under the ophthalmologist's supervision.

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The ophthalmologist evaluates and integrates the findings of the comprehensive ophthalmic examination with all aspects of the patient's health status and social situation in determining an appropriate course of action.
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Recommendation Grading

Overview

Title

Comprehensive Adult Medical Eye Evaluation Preferred Practice Pattern

Authoring Organization

Publication Month/Year

November 12, 2020

Last Updated Month/Year

February 7, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Long term care

Intended Users

Optometrist, optician, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis

Diseases/Conditions (MeSH)

D014785 - Vision, Ocular

Keywords

cataract, open-angle glaucoma, ocular diseases, primary angle closure glaucoma, adult medical eye evaluation, Diabetes-Related Ocular Disease

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
169
Literature Search Start Date
February 1, 2020
Literature Search End Date
June 1, 2020