What EED is
EED stands for Eye Exam for Patients with Diabetes. It is the HEDIS measure, maintained by NCQA, that reports the percentage of members 18 to 75 with diabetes who had a retinal or dilated eye exam performed by an eye care professional, meaning an optometrist or ophthalmologist.
The measure exists because diabetic retinopathy is a leading cause of preventable blindness, and an annual retinal exam catches it early. A negative exam, one showing no retinopathy, in the year before the measurement year can also satisfy the measure, recognizing that a clear retina does not need re-checking every twelve months.
Why EED matters
EED is a clinical quality measure in Medicare Star Ratings, so its rate contributes to the quality bonus payments CMS pays Medicare Advantage plans. It is also one of the diabetes measures where the care happens outside the primary care relationship, which makes it operationally distinct.
The exam is performed by an eye care professional, who frequently is not in the plan's medical claims flow the way a PCP is. The result, and whether retinopathy was present, has to be captured from that provider, so EED is as much a data-sourcing problem as a member-engagement one.
How EED is scored
The denominator is members 18 to 75 with a diagnosis of diabetes. The numerator is those with a retinal or dilated eye exam by an eye care professional in the measurement year, or a negative retinal exam in the prior year.
The exam has to be retinal. A routine vision check for glasses does not satisfy the measure. Retinal imaging read by an eye care professional, including some store-and-forward teleretinal programs, is accepted.
Exclusions include bilateral eye enucleation (surgical removal of both eyes), hospice enrollment or services, and, for members 66 and older, frailty with advanced illness.
Common mistakes teams make with EED
- Counting a vision exam as a retinal exam. A check for glasses is not a retinal or dilated exam and does not satisfy EED. Only the retinal exam by an eye care professional counts.
- Not sourcing the optometry result. The eye care provider is usually outside the plan's medical claims flow, so the exam happens but the result never reaches the plan, leaving a closed-in-reality gap open on paper.
- Ignoring the prior-year negative. A negative retinal exam last year still counts. Re-contacting those members wastes outreach that genuinely open members need.
- Overlooking teleretinal options. In-office retinal imaging read remotely can close many gaps for members who will not schedule a separate eye appointment.
How Pelica handles EED
Pelica's Quality and Stars Copilot tracks EED on one canonical record, reconciles eye-care results that sit outside the medical claims flow so a completed exam closes the gap, and prioritizes members with no qualifying exam in the current or prior year, routing them to in-office teleretinal imaging or an eye-care referral. Across Pelica deployments, customers lift gap closure by 41% with no new headcount.
Related terms
EED sits inside the HEDIS and Stars diabetes framework. See KED for the diabetic kidney measure, GSD for glycemic status, and cut points for how a completion rate becomes a star.