Visual rehabilitation of patients with advanced diabetic retinopathy. A follow-up study at the Low Vision Clinic, Department of Ophthalmology, University of Linköping.

Seventy-nine patients with advanced diabetic retinopathy were subjected to a full range of low vision rehabilitation measures and followed for an average of 3.6 years at the Low Vision Clinic. They were provided with high power optical aids, followed by educational training in the use of such aids and of residual vision, including the utilization of peripheral retina by means of eccentric viewing technique in many cases (23%). Mean age was 52.7 years. Type I diabetes was diagnosed in 69 subjects and type II in 10 subjects. Proliferative retinopathy was present in 73 cases and background retinopathy in 6 cases. All subjects showed macular changes in varying degrees. (Another 36 patients participated in the first series of visits but could not be followed up, the main reason being that 31 of them died before follow-up. There were no major differences between the two groups regarding rehabilitation results.) The average power of the telescopes used for distance vision was 4.8 X, and the mean power of the aids used for reading and near vision, mainly increased near addition and hyperocular lenses, was 22.2 dioptres (5.6 X). The patients were also provided with aids for intermediate distance and for 'spot use'. The average number of series of visits was 2.7 and the number of 1 h training sessions 2.5 per series of visits. With aids and training, mean visual acuity improved from 0.17 to 0.73 on the first series of visits. After the last series of visits acuity was still as good as 0.64. Ability to read TV titles increased from 15.2% to 79.7% in the group and reached 64.6% after the last series of visits. The number of individuals able to read newspaper text increased from 1.3% to 97.5%. After the last series of visits the number was still as large as 86.1%. Of the individuals who had to stop working because of poor vision, 89% would have been able to return to work after rehabilitation. However, because of unemployment problems in the area, only 72% managed to return. It is quite obvious from the results that the presented methods, including high power aids and training sessions, are extremely successful in rehabilitation of patients with advanced diabetic retinopathy, provided that they have at least some residual vision. Dramatic improvements in visual performance were seen, allowing a life of much better quality than before.(ABSTRACT TRUNCATED AT 400 WORDS)