Visual impairment and chronic disease: A community approach to self-management for a population disproportionately affected by diabetes and eye disease

Background: The incidence of diabetes and its complications are disproportionately higher in Hispanics. The severity and progression of diabetic retinopathy is also greater within this population. When chronic illness and eye disease occur concomitantly, the patient's ability to manage the disease and its complications are profoundly affected. Our objective was to identify patients with diagnosed diabetic retinopathy and assess whether, through vision rehabilitation therapy, providing them with assistive devices and strategies would increase adherence to a self-management plan.

Methods: This feasibility/demonstration project combined clinical and rehabilitative services at a community health center (CHC) serving a population that is 95% Hispanic. Diabetic patients diagnosed with retinopathy and acuity of 20/60 or worse were identified. Diabetic education, counseling, low vision exams and vision rehabilitation therapy were provided over 20 months.

Results: 56 Hispanic patients with diabetes participated. Documented baseline hemoglobin A1c's revealed that 80% of patients had uncontrolled diabetes (A1c of 9 or greater). All patients received low vision exams and required vision rehabilitation therapy. 65% participated in specially-designed bilingual education and support groups. Participants' A1c values significantly decreased over time. The utilization of Spanish language materials and audio CDs, talking glucometers, magnifiers, tactile markings and other visual aids contributed to an increase in compliance with healthcare recommendations.

Conclusions: Our results suggest that visual impairment can affect a patient's ability to follow care plans and manage disease. Hispanics and other minorities with a higher rate of eye disease and chronic illness would benefit from programs that combine medical interventions and rehabilitation therapy.