Background: One in five hospitalized patients has diabetes. Despite guideline recommendations for regular outpatient vision care, studies show gaps in outpatient vision assessments. The hospital setting may be an opportunity to identify patients with diabetes who may need further vision care after discharge, but few studies have evaluated vision status among inpatients with diabetes. Our study aimed to identify the prevalence of insufficient vision among inpatients with diabetes and evaluate their level of empowerment in managing their disease.
Methods: The Vision in Senior Inpatients: Outcomes and Needs (VISION) study is an ongoing, prospective, observational study of adult (≥18 years), English-speaking, cognitively intact general inpatients (IRB #9967). Trained research assistants measured visual acuity using a pocket Snellen chart (insufficient vision defined as worse than 20/40 in both eyes). Participants completed a survey about access to, and need for, vision care. Participants with diabetes were identified by medical record and self-report; a subset completed the Diabetes Empowerment Scale-Short Form (DES-SF). Wilcoxon Mann-Whitney U tests and χ2 tests were used to analyze the data.
Results: From June 2012- April 2015, 1908 participants were enrolled. The majority were female (55%, 1058/1908) and African American (76%, 1448/1908). One-third (592/1908) had diabetes. Those with, versus without, diabetes were more likely to be older (58 vs. 51 years, p<0.001). Insufficient vision was found in almost half of participants (852/1908), and was significantly more prevalent in those with (vs without) diabetes (58%, 343/592 vs 39%, 509/1316; p<0.001). Excluding those with self-reported eye disease, participants with diabetes were still more likely to have insufficient vision (54%, 254/470 vs 36%, 417/1159; p<0.001). Of note, over ¼ of those with diabetes were wearing their corrective lenses, but still had insufficient vision (26%, 154/592). Participants with insufficient vision (vs. sufficient) were more likely to be of older (63 vs 51 years, p<0.001) and score lower on the DES (4.38/5, IQR 3.5-4.75 vs 4.5/5, IQR 4-4.75; p=0.03).
Conclusions: Nearly 3 out of 5 inpatients with diabetes had poor visual acuity, and 1 of 4 were wearing corrective lenses, but still failed the vision screening. Despite the high prevalence of insufficient vision, most participants with diabetes self-reported regular eye exams. These findings suggest that self-reported attainment of vision care and wearing of corrective lenses may be inadequate markers of sufficient visual acuity during hospitalization or adherence to recommended guidelines of care. Therefore, the hospital setting may be an important point of care to identify vision care needs and to intervene to ensure that patients receive their guideline recommended diabetes-related vision care. Further work should evaluate interventions to improve inpatient screening and referrals for improved diabetes-related vision care.