Diabetic Low Vision Protocols
Specific Functional Needs of the Diabetic
Visually impaired diabetics have specific functional needs that must be addressed in the low vision examination. Many of these are crucial to their health and safety. Diabetics must see to fill insulin syringes and take oral medications. They need to see to test their blood sugar and to read labels on food containers to monitor their intake of carbohydrates. Diabetics may have neuropathies affecting their feet. If patients are unable to see to examine their feet and toes, care by their physician, podiatrist or family may be needed to monitor the health of their feet.
The Diabetic Low Vision Protocols
We utilize a set of Diabetic Low Vision Protocols developed at the Low Vision Clinic at John Hopkins to evaluate the functional vision of each diabetic patient.
Vision or Adaptive Steps Addressed During the Low Vision Exam:
Seeing to fill insulin syringes
Reading labels on medication bottles
Seeing to test blood sugar
Reading food nutritional labels
Seeing to perform foot care
Decreasing Glare (Especially Post Laser)
Testing for adequate visual field for night driving (Post Laser)
Educating on vision changes due to blood sugar fluctuations
Increasing awareness of decreased contrast sensitivity
Glare and Loss of Contrast Sensitivity
Glare and loss of contrast sensitivity may become problems in patients with diabetic retinopathy, especially after pan-retinal photocoagulation. Laser is crucial to saving the vision of diabetic, but patients often complain of a "fuzzy glare" after laser, which responds well to light amber filters. Because many diabetics experience color vision loss along the yellow-blue axis, they are able to benefit from the contrast enhancement of amber filters with less awareness of the yellow-amber color than those with normal color vision. Safety in night driving must also be addressed due to reduced side vision after PRP laser.
Low Vision Aids and Adaptive Devices
From simple magnifiers to closed circuit television systems, a wide range of low vision aids are available to aid the visually impaired diabetic. In addition to low vision aids, a number of adaptive devices may aid the visually impaired diabetic. These include talking glucometers, needle funnel guides to aid in inserting the needle in the insulin bottle and automatic insulin loaders.