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Tunde Peto, Rabia Bourkiza, Mala Subash, Joanna Da Costa, Dania Qatarneh, Catey Bunce; Sight impairment certification amongst patients attending diabetic retinopathy screening in East London. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5750.
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Despite increasing efforts to detect and treat diabetic retinopathy early, the incidence of certified visual impairment doubled between 1991 and 2001 in people over 65 years of age. Accurate data on blindness and sight registration is paramount in facilitating the delivery of social support to those who will benefit from it and at a social, economic and public health level is an important statistic for continual monitoring. Sight impairment for any reason has a major impact on the patients' ability of self-care and diabetes management. In this study we assessed the level of and barriers to sight impaired certification in the East London Borough of Tower Hamlets amongst patients attending the Diabetic Retinopathy Screening Service (DRSS).
All patients who attended DRSS between 1stApril 2009 and 31st of March 2010 and whose recorded best corrected visual acuity (BCVA) at DRSS fulfilled the requirements for sight impaired (SI) (<6/24) or severely sight impaired registration (SSI) (<6/60) in the UK were included in the cohort. An additional 24 patients whose family doctors reported them to be registered blind due to no perception of light (NPL) vision in either eye were re-examined to ascertain the reason for registration and their potential social and visual aids needs.
Altogether, 78 patients in the studied DRSS (population of 12879 patients with diabetes of whom 7234 screened during the study period) were identified with certifiable vision and were reviewed: 10 deceased in the past 12 months; 8 were known to be registered and 60 were not. Of these 60, 53 attended further assessment: 24 were found not to have poor vision any longer due to intervention in the meantime, 3 more were listed for cataract surgery; 10 were registered as SI/SSI and 16 were found to be eligible, but did not wish to be registered due to fear of social stigma, or believing that it would not provide any further benefits to them or their families. Five patients were registered due to diabetic eye disease.Of those 24 reported by the GP of NPL vision, only 4 had true NPL, the rest had usable vision. Only two of them were registered blind due to diabetes.
Our data show that sight registration amongst patients with diabetes might be grossly underestimated and that patients with diabetes often have non-diabetes related visual loss. Not taking visual factors into account may result in inadequate service delivery and healthcare provision. We propose that data on certifiable visual impairment could serve, along with existing certification databases, as a resource for quality of care standards assessment and service provision for patients with diabetes, many of whom who have poor vision not necessarily related to diabetic eye disease.
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