Transcript UW Eye Disorders - philippine society of insurance medicine

Underwriting Eye
Disorders
Philippine Society of Insurance
Medicine
Updates
Eye Exam
Eye Exam – valuable information about the client.
Classification:
1.
Purely local disorders of the eyes (conjunctivitis
and other infections, ocular injuries, )
2.
Manifestations of systemic disease (Diabetes
Mellitus, hypertension, SLE, RA, Dermatomyositis,
Hyperthyroidism)
Blindness
– Most important ocular medical impairment that merits
our underwriting attention.
– Most important factor to be considered in risk
assessment – its CAUSE. Mortality is increased when
blindness is due to diabetic and hypertensive
retinopathy and other causes where the primary
disease itself is subject to extra mortality, than those
that do not pose hazard to life, e.g. temporary ocular
inflammatory conditions.
Blindness (MIRA)
Total blindness
Life CI TPD WPD ADB
Unilateral
0 Excl Excl Excl
1
Bilateral
0 Excl Excl Excl Excl
Partial blindness – Reduction of Visual Acuity
Mild
0 0
1
1
1
Moderate
0 Excl Excl Excl Excl
Visual Acuity
Reduction of visual acuity is a combination of
reduced vision of both eyes.
Confirms eye function?
a) an optometrist
b) an optician
c) the agent
d) an ophthalmologist
e) the medical director
Optometrist
– is a healthcare professional who performs
routine eye examinations, administers primary
eye care and prescribes eye wear – eyeglasses
or contact lenses to improve vision.
– is an O.D. (doctor of optometry)
Ophthalmologist
– a specialist who has trained further or
specialized in the diagnosis and treatment
(medical or surgical) treatment of eye
disorders.
– is a medical doctor (M.D.)
Eye Report
What should it contain?
a) Nature and cause of the visual impairment
b) Severity of the condition
c) Both
Hypertensive Retinopathy
Poorly controlled hypertension can give rise to
hypertensive retinopathy (fundus
hypertonicus).
Grading – based on changes that occur in the
blood vessels at the back of the eye which are
correlated closely to the changes generally
observed in blood vessels.
Hypertensive Retinopathy
Positive Features:
Grade I – II
Well controlled BP
Negative Features:
Grade II – IV
Poorly controlled blood pressure
Impaired vision
Effect of hypertension on the retina
Retinal changes:
Grade 1 – mild narrowing or sclerosis of retina arteries
Grade 2 – moderate to marked narrowing/sclerosis w/
light reflex and A-V crossing changes
Grade 3 – w/ addtl. hemorrhages or cotton-wool spots
Grade 4 – w/ addtl. swelling of the optic disk or
papilledema
Hypertensive Retinopathy (MIRA
Underwriting Guidelines)
Life
Grade 1
0
CI
0
Grade 2
25
50
Grade 3
50
Grade 4
Dec
TPD
1
1.25
WP
1
ADB
1
1
1
50 + Excl Dec
Dec
1
Dec
Dec
Dec
Dec
Hypertensive Retinopathy
An asymptomatic 58 yr-old businesswoman, FA 5M,
hypertensive since 1998, BP = 140/90, w/ incidental finding of
mild retinal artery narrowing in the eyegrounds; Past hx =
adequately treated for papillary CA, thyroid, 20 yrs ago; no
recurrence of disease; CXR normal, ECG = LVH, 2-D echo
IVS = 11 mm, very minimal MR. Carotid doppler no stenosis;
Chol 215 mg/dl, taking felodipine, simvastatin and Aspilet.
What is your underwriting decision?
a) Accept as substandard risk
b) Postpone
c) Decline
d) Talk to the agent
Prevention of Hypertensive
Retinopathy
The most important element is the achievement
of satisfactory blood pressure control.
Diabetic Retinopathy
Long-term complications of diabetes – due to
accelerated vascular disease. Smaller vessels are
affected, most noticeable in the retina, called
RETINOPATHY – Initially, non-proliferative (small
vessels break and leak), and then proliferative (blood
vessels abnormally grow in the retina producing
scarring, leading to retinal detachment and loss of
vision.)
Diabetic Retinopathy
What do you need:
a) FME, MUR
b) Diabetes questionnaire
c) BEX (blood exam) – FBS, HbA1c, OGTT
where needed
Reminder: HbA1c is not recommended for the diagnosis
of diabetes; it is best used to monitor long term
control and prognosis of this disease.
Diabetic Retinopathy (MIRA)
Life CI TPD WP ADB
Visual impairment Dec Dec Dec Dec Dec
caused by diabetic
retinopathy
Diabetic Retinopathy (Brackenridge)
Basic Ratings for NIDDM:
31 – 40 yrs old
+100
41 and above
+50
Additional Ratings for retinopathy
Mild (microaneurysms)
0
Moderate (exudative)
+50
Severe (proliferative)
+100
Diabetic Retinopathy (Brackenridge)
Proteinuria
Trace
0
+1
+50
+2
+100
+3 and up Decline
Smoker – additional +50
Diabetic Retinopathy
60 yr-old male executive, nicotine addict 10 sticks/day
FA 2M, diabetic for the past 10 yrs, has irreg. intake
of Euglucon, sees “floaters”, eyegrounds show some
microaneurysms and exudates; last ff up with his
endocrinologist 2 yrs ago. HbA1c = 9.4; FBS = 118
mg%. MUR shows +2 proteinuria, ECG – normal
What is your underwriting action?
a) accept as highly substandard risk
b) postpone
c) decline
d) talk to the agent
Prevention of Diabetic Retinopathy
If the incidence and severity of diabetic
complications are to be avoided, it is
imperative that blood sugar level be
maintained within
normal levels.
Uveitis
Life CI TPD WPD ADB
Present
0
Excl Excl Excl
1
In history
0
0
1
1
1
Glaucoma
Causes: Uveitis, intraocular trauma, use of
steroid eye drops, rubeosis in diabetes
MIRA Guidelines
W/ visual impairment – Standard, ADB
W/o visual impairment
stable – standard, w/ CI, ADB
unstable – standard, ADB
Cataract
•
•
•
Lens opacity, usually age-related
Diabetic causes
Others: trauma, systemic steroid use,
congenital, occupational
Operated
Unoperated
Life CI TPD WPD ADB
0 Excl Excl Excl
1
0 Excl Excl Excl
1
Thank you.