Medical hypothesis, discovery & innovation in optometry

Abstract

Background: Visual impairment (VI) in patients with diabetes mellitus (DM) worsens as the disease progresses. Therefore, quality of life (QOL) may also be affected. Furthermore, in the absence of macular involvement, some patients may benefit from visual intervention. However, not many Malaysians with known DM had their eyes screened or used correctable spectacles. Consequently, the QOL and VI status of patients with DM in Malaysia remain unclear. This study was aimed at determining the impact of optometric intervention on the QOL and VI status of adults with type II DM.
Methods: This was a quasi-self-controlled, experimental study involving adults with known type II DM. We conducted face-to-face interviews using the low vision quality-of-life questionnaire (LVQOL). The habitual visual acuity (VA) of all participants was recorded. All participants underwent fundus photography to grade diabetic retinopathy (DR) in both eyes. Correctable VA was determined following subjective refraction when the best-corrected distance visual acuity (BCDVA) was 6 /9 and better. After a 3-week adaptation to the prescribed refractive error correction, LVQOL was repeated via a phone interview.
Results: A total of 47 participants with type II DM, including 16 (34%) men and 31 (66%) women, with a mean (standard deviation [SD]) age of 49.0 (7.9) years were recruited. The age range was 32 – 59 years, and the baseline mean (SD) habitual binocular VA was 0.52 (0.31) decimal. Only 15% (n = 7 patients) of the participants had their vision tested and wore glasses; however, some were uncomfortable with the current corrections. All patients had undercorrected or uncorrected refractive errors, namely, hyperopic astigmatism (47%), myopic astigmatism (38%), hyperopia (6%), myopia (4%), and antimetropia (4%). Among the 47 participants, 89% (n = 42) had uncorrected presbyopia. The mean (SD) LVQOL score at baseline was 91.9 (17.3), which improved significantly with visual intervention to 122.8 (3.2) (P < 0.05). Refractive error corrections significantly improved the VI status (P < 0.05), as all participants achieved a BCDVA of 6 / 9 and better.
Conclusions: Our findings indicate that optometric intervention is effective in improving the LVQOL and VI status of adults with type II DM. Further clinical optometric studies on type II DM with DR with a longer follow-up should be carried out to understand the clinical characteristics of this cohort and the impact of meticulous refractions on QOL in providing better services in the future.