Diabetic eye exams are a small part of a much larger quality conversation. They sit at the intersection of diabetes care, eye health, prevention, health equity, and care coordination. That is why a recent policy debate over Medicare Advantage Star Ratings deserves attention from anyone working in vision care.
In 2025, the Centers for Medicare and Medicaid Services proposed removing the diabetic eye exam measure from the Medicare Advantage Star Ratings program. After public comment and stakeholder engagement, CMS retained the measure in the 2026 final rule.
A recent Cureus policy commentary argues that this decision matters because quality measures do more than track performance. They signal what health systems should prioritize. Keeping the diabetic eye exam measure helps preserve visibility for preventive vision care within chronic disease management.
Why the diabetic eye exam measure matters
The diabetic eye exam measure assesses whether Medicare Advantage beneficiaries with diabetes receive recommended diabetic eye examinations within specified time intervals. In practical terms, it helps keep eye care connected to diabetes management rather than treating vision as a separate or optional concern.
That connection is important because diabetic retinopathy remains a major cause of preventable vision loss. The commentary notes that in 2021, an estimated 9.60 million people in the United States had diabetic retinopathy, including 1.84 million with vision-threatening diabetic retinopathy. It also cites projections suggesting diabetic retinopathy may affect 16.0 million Americans aged 40 years or older by 2050.
Those numbers are not just clinical statistics. They represent people whose independence, mobility, work, mental health, and quality of life may be affected when diabetic eye disease is not detected and managed in time.
Measurement is not the whole solution
The Cureus commentary is careful on one important point: it does not claim that the Star Ratings measure alone has substantially increased diabetic eye exam completion rates. That distinction matters.
Quality measures can create accountability, but they do not automatically solve access problems. People still face barriers such as transportation, cost, fragmented referrals, limited appointment availability, language access, health literacy challenges, and difficulty navigating multiple care settings.
The value of the diabetic eye exam measure is that it keeps those barriers visible. If a measure is removed because it is difficult to achieve, the underlying problem does not disappear. It may simply become less visible within quality improvement programs.
A prevention issue, not just a reporting issue
Diabetes is managed across multiple systems: primary care, endocrinology, ophthalmology, optometry, health plans, community programs, and sometimes retina specialists. Diabetic eye care depends on coordination across those systems.
That makes the measure challenging. A primary care team may identify the need for an eye exam but not directly deliver the service. A health plan may send reminders but still depend on local access and patient follow-through. An eye care provider may complete an exam, but the result may not flow back to the patient’s broader care team.
These challenges can frustrate quality reporting. Still, they are exactly why the measure is important. It points to the need for stronger referral pathways, patient navigation, data sharing, and closed-loop follow-up.
Health equity is central to the debate
The decision to retain the diabetic eye exam measure also has equity implications. The commentary notes that vision loss from diabetic retinopathy disproportionately affects underserved communities and that disparities are seen in diabetic eye care utilization.
Among Medicare Part B fee-for-service beneficiaries with diabetes, only 54.1% received an eye examination in 2017, with lower rates among Black and Hispanic beneficiaries than among White beneficiaries. The article also discusses more recent multicenter U.S. data showing that some racial and rural groups were less likely to receive guideline-recommended diabetic eye care.
These disparities are shaped by real-world barriers. Transportation, geographic access, cost, insurance coverage, language access, food insecurity, housing insecurity, and mental health burden can all affect whether a patient receives diabetic eye care.
Without measurement, health systems may have less incentive to identify and address those gaps. Retaining the measure keeps attention on the populations most likely to be missed.
Modernizing the measure should be the next step
Keeping the diabetic eye exam measure does not mean the current system is perfect. The commentary argues that preservation should lead to modernization.
That includes recognizing newer care models such as teleophthalmology, teleretinal screening, community health center programs, mobile screening, and integration within primary care settings. These approaches can expand access to early detection, especially in underserved areas.
But the article also makes an important distinction. Retinal screening is not the same as a comprehensive diabetic eye examination. Screening can identify patients who may need further evaluation, but it does not replace diagnosis, treatment planning, or long-term management by eye care professionals.
That means quality programs should not stop at image capture or screening completion. The stronger goal is closed-loop care: screening, referral when needed, comprehensive examination, treatment when indicated, and documented follow-up.
What this means for eye care and health system leaders
The policy lesson is straightforward. Difficult measures often reveal difficult systems. Removing a measure may make reporting easier, but it can also reduce accountability for services that matter to patients.
For eye care professionals, the retained measure reinforces the importance of communication with primary care teams and health plans. For health systems, it supports investment in referral tracking, outreach, and follow-up workflows. For payers, it highlights the role of navigation, data integration, and access support.
Good-Lite does not provide diabetic retinal screening or treatment services. Still, the broader message aligns with the company’s role in supporting accurate, accessible vision assessment across clinical and community settings. In eye care, measurement is often the starting point for better decisions. Whether the setting is a diabetic eye exam, low vision evaluation, acuity testing, or a school screening program, reliable processes help connect people to the care they need.
A signal that prevention still counts
CMS’s decision to retain the diabetic eye exam measure is more than a technical update to Medicare Advantage Star Ratings. It is a signal that preventive eye care should remain part of chronic disease management.
The harder work comes next. Health systems need to improve access, strengthen coordination, close referral loops, and measure whether preventive services are reaching the people most at risk.
For patients with diabetes, the goal is not simply to complete a metric. The goal is to reduce avoidable vision loss and preserve independence for as long as possible. Keeping the diabetic eye exam measure visible helps keep that goal on the table.
