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Formal registration of visual impairment in people with diabetic retinopathy significantly underestimates the scale of the problem: a retrospective cohort study at a tertiary care eye hospital service in the UK
  1. Abraham Olvera-Barrios1,2,
  2. Amit V Mishra1,
  3. Roy Schwartz1,3,
  4. Mumina Khatun1,
  5. Michael Seltene1,
  6. Celestine Rutkowska1,
  7. Alicja R Rudnicka4,
  8. Christopher G Owen4,
  9. Adnan Tufail1,2,
  10. Catherine A Egan1,2
  1. 1Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2Institute of Ophthalmology, University College London, London, UK
  3. 3Institute of Health Informatics, University College London, London, UK
  4. 4Population Health Research Institute, St George's, University of London, London, UK
  1. Correspondence to Dr Abraham Olvera-Barrios, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK; dr.olvera.a{at}


Aims To analyse the prevalence of visual impairment (VI), compare it to certification of visual impairment (CVI) and analyse VI associations in patients with diabetic retinopathy (DR).

Methods Retrospective cohort study, which included 8007 patients with DR referred from the English diabetic eye screening programme to a tertiary referral eye hospital. Main outcome measure was VI, defined as vision in the best eye of <6/24. We conducted a multivariable logistic regression for VI as primary outcome of interest, controlling for age, sex, type of diabetes, baseline DR grade, ethnicity and index of multiple deprivation (IMD).

Results Mean age was 64.5 (SD 13.6) years; 61% of patients were men; and 31% of South Asian ethnicity. There were 68 patients with CVI during the study period, and 84% (272/325) of patients with VI did not have CVI after a mean follow-up of 1.87 (SD ±0.86) years. Older age showed a positive association with VI (OR per decade rise 1.88, 95% CI 1.70 to 2.08; p=1.8×10–34). Men had a lower risk of VI (OR 0.62, 95% CI 0.50 to 0.79, p=6.0×10–5), and less deprivation had a graded inverse association with VI (OR per IMD category increase 0.83, 95% CI 0.74 to 0.93, p value for linear trend 0.002).

Conclusion The majority of people with vision impairment are not registered at the point of care, which could translate to underestimation of diabetes-related VI and all-cause VI at a national level if replicated at other centres. Further work is needed to explore rates of VI and uptake of registration.

  • Epidemiology
  • Public health
  • Retina
  • Macula
  • Neovascularisation

Data availability statement

Data are available upon reasonable request. The data that support the findings from this study are available from Moorfields Eye Hospital upon reasonable request.

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Data availability statement

Data are available upon reasonable request. The data that support the findings from this study are available from Moorfields Eye Hospital upon reasonable request.

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  • Contributors AO-B, ARR, CGO and CAE designed the study. AO-B, RS, MS, MK and CR undertook data management and processing. AO-B undertook data analysis, and ARR, CGO, CAE and AT provided statistical advice. AO-B and AVM wrote the first draft of the report, which was critically appraised by all authors. CAE: Guarantor.

  • Funding This work was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology (support to AT and CE), and the Mexican Council of Science and Technology (grant #2018-000009-01EXTF-00573 to AO-B). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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