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Low Vision Assessment and Rehabilitation

History

The patient, Dr. Cole, had a 19-year history of late-onset diabetes mellitus that had been treated with various combinations of oral hypoglycemic agents. He was 5 feet 11 inches tall and weighed 212 lbs (optimal weight for his height: 190 lbs).

His diabetes was controlled with Glucotrol® (glipizide) and Rezulin® (troglitazone). The presenting hemoglobin A1c blood analysis was 10.5%; this indicated poor diabetic control over the preceeding 3 months, with an average plasma glucose (blood sugar) of approximately 225 mg/dL. (The normal fasting level is less than 120 mg/dL.)

Diabetes management was changed to a 2200 calorie, six-feeding, diabetic diet and by replacing his oral medications with NPH insulin injections. There was no clinical/laboratory evidence of significant diabetic renal disease or of peripheral vascular disease. He had moderate diabetic peripheral neuropathy in his lower limbs causing numbness and early peripheral neuropathy involving his hands. His systemic blood pressure was moderately raised.

Dr. Cole was right eye dominant. He had noticed rapidly worsening vision over several months, particularly involving his right eye. There had been no noticeable response to a single laser treatment performed for macular edema two months previously. He was having increasing difficulties with his office paperwork, assessment of x-rays, and with driving in poor weather. Avocationally, he could still hunt using a gun scope to his left eye. He had purchased a hand magnifier to facilitate near-vision tasks. He was concerned about what he perceived was a bleak visual future.