Routine eye exams are an important part of overall health, as they can help detect many conditions, including diabetes and heart disease. A traditional eye exam includes dilating the patient’s pupils, which allows the doctor to examine the retina, blood vessels, and optic nerve. As technology has evolved, retinal imaging has replaced dilation for a variety of reasons. Despite its benefits, there are some drawbacks, and many vision plans don’t cover retinal imaging.
Benefits Of Retinal Imaging
Retinal imaging technology captures images of the layers of the retina. These images can be stored within electronic medical records (EMRs) for future comparison. As it’s non-invasive, it allows patients to avoid dilation drops, which can cause an uncomfortable stinging sensation. Rather than waiting 30 minutes for dilation drops to work, the doctor can view the eye immediately, helping the office to operate more efficiently and reducing the amount of time spent with each patient. Imaging also reduces recovery time, as dilation causes blurry vision and light sensitivity for up to 24 hours — and even up to 72 hours in people with light-colored eyes — which can cause significant disruption for the patient.
Disadvantages Of Retinal Imaging
Retinal imaging has some distinct disadvantages as well. Dilation allows a clearer view of the retina as opposed to retinal imaging. Some conditions, such as glaucoma, can only be detected by dilation. Imaging also does not capture the entire retina — as even the best retinal imaging technology only captures 82% of the retina at one time and only allows the doctor to view up to 200 degrees of the eye, compared to 240 degrees when dilation is used.
Another drawback is the high cost of imaging equipment and testing. Patients without coverage for retinal imaging must pay out of pocket for this type of exam. Also, there’s no Current Procedural Terminology (CPT®) code for the retinal imaging test, making it challenging for an eye doctor to submit a claim for the service to the vision carrier or administrator.
Insurance Coverage For Retinal Imaging
Retinal imaging is not covered by vision insurance plans the way that dilation is. Why? It is considered “healthy eye imaging,” which is not covered under most vision plans. On the other hand, dilation is considered diagnostic imaging when completed as part of a routine eye exam.
Does Your Vision Plan Cover Retinal Imaging?
As an employer, consider adding retinal imaging to your vision plan, either as part of your annual vision exam benefits or as a covered procedure with a reduced copay.
If your vision plan doesn’t cover retinal imaging, encourage your employees to contact their optometrist’s office ahead of their next appointment to learn what the out-of-pocket cost may be for retinal imaging. That way, they can make informed decisions about whether to have the procedure or opt for traditional dilation instead.
Retinal imaging poses an option for low-risk patients who are seeking routine or preventive eye care. There will still be a need for full eye dilation, but generally not for those who see an eye doctor routinely. Both procedures have valid reasons to be covered by vision plans, especially considering that retinal imaging saves time and resources when used in appropriate situations.