1. Underwriting Eye Disorders
Philippine Society of Insurance Medicine
Updates

2. Eye Exam Eye Exam – valuable information about the client.
Classification:
Purely local disorders of the eyes (conjunctivitis and other infections, ocular injuries, )
Manifestations of systemic disease (Diabetes Mellitus, hypertension, SLE, RA, Dermatomyositis, Hyperthyroidism)

3. 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.

4. Blindness (MIRA) Total blindness Life CI TPD WPD ADB
Unilateral Excl Excl Excl
Bilateral Excl Excl Excl Excl
Partial blindness – Reduction of Visual Acuity
Mild
Moderate Excl Excl Excl Excl

5. 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

6. 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)

7. 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.)

8. Eye Report What should it contain?
a) Nature and cause of the visual impairment
b) Severity of the condition
c) Both

9. 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.

10. Hypertensive Retinopathy
Positive Features:
Grade I – II
Well controlled BP
Negative Features:
Grade II – IV
Poorly controlled blood pressure
Impaired vision

11. 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

12. Hypertensive Retinopathy (MIRA Underwriting Guidelines)
Life CI TPD WP ADB
Grade
Grade
Grade Excl Dec Dec
Grade Dec Dec Dec Dec Dec

13. 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

14. Prevention of Hypertensive Retinopathy
The most important element is the achievement
of satisfactory blood pressure control.

15. 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.)

16. 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.

17. Diabetic Retinopathy (MIRA)
Life CI TPD WP ADB
Visual impairment Dec Dec Dec Dec Dec
caused by diabetic
retinopathy

18. Diabetic Retinopathy (Brackenridge)
Basic Ratings for NIDDM:
31 – 40 yrs old
41 and above
Additional Ratings for retinopathy
Mild (microaneurysms)
Moderate (exudative)
Severe (proliferative)

19. Diabetic Retinopathy (Brackenridge)
Proteinuria
Trace
+3 and up Decline
Smoker – additional +50

20. 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

21. 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.

22. Uveitis Life CI TPD WPD ADB Present 0 Excl Excl Excl 1
In history

23. 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

24. Cataract Lens opacity, usually age-related Diabetic causes
Others: trauma, systemic steroid use, congenital, occupational
Life CI TPD WPD ADB
Operated Excl Excl Excl
Unoperated Excl Excl Excl

25. Thank you.