Where: The University of Chicago Medical Center, a 568-bed academic medical center that is part of the University of Chicago Medicine.
The issue: Testing and correcting the vision of inpatients.
It seems like a basic assumption: “For quality of life and even safety reasons, patients should be able to see in the hospital,” said hospitalist Valerie Press, MD, MPH, FACP. But she and her colleagues recently found that more than one-third of their inpatients could not see well enough to pass a vision screening that tested their functional sight (that is, sight with their corrective lenses on, if applicable). That means these patients probably struggle with vision-related tasks in the hospital, such as reading discharge forms. Delirium and falls are also associated with vision problems, said Dr. Press, an assistant professor in the section of hospital medicine at the University of Chicago.
How it works
In an effort to correct this problem, research assistants tested patients' vision using Snellen pocket charts. Patients who were found to have insufficient vision, who were not already wearing corrective lenses, and who had no documented blindness or medically severe vision loss then tried out nonprescription “readers”—which can be as inexpensive as $8—with sequential fitting until vision was corrected.
Funding didn't allow for patients to keep the readers, so they were also instructed on how to access vision care and how to obtain readers (if effective) after discharge. “We give patients toothbrushes and socks in the hospital; we should be able to provide patients with the ability to improve their vision,” Dr. Press said.
In most cases, the readers effectively corrected eligible participants' vision, according to results published in the May Journal of Hospital Medicine. Of the 116 patients eligible for readers, the glasses worked for 95 (82%) of them. Most participants' (70%) vision was corrected using the 2 lowest-calibration readers, and the other 12% did best with higher-strength lenses. Although patients 65 years of age and older were more likely to have insufficient vision, 28% of those under 65 did, too.
How patients benefit
The anecdotal results from patients were unsurprisingly positive. “What started happening with our patients as we started doing this is they were like, ‘Oh my goodness. Can I keep these readers? I can finally see the menu!’” Dr. Press said. A lot of patients don't always recognize that they have failing vision, she noted.
“In terms of the vision screening, knowing why our patients are failing can help us do the interventions, whether it's to bring their own glasses in or help get them more vision care,” she said. “And as part of the study, we are trying to make those connections, so we work very closely with the primary team to let them know if their patients did not pass the vision screening test, and the primary care team can help them get appointments to have follow-up vision care.”
Although readers can be very inexpensive, and the screening can be brief, finding the time and money to move this intervention into practice is a challenge. “But if we can prove that it's very brief and there's great uptake in interest by the providers, whether it's nurses or another staff member, then the value should be quite great,” said Dr. Press. “A lot of folks talk about how it takes 10 to 20 years to translate a discovery into actual practice, and I think that something that's this accessible for change—something very simple but important—could hopefully move along that spectrum much more quickly.”
A pilot grant is now allowing Dr. Press and her team to examine patients with diabetes—who are at high risk for medical eye disease—in the hospital and determine if they're more or less likely to fail the vision screening test. “You could actually hypothesize in either direction: You could say patients with diabetes are actually interacting with vision care more often because they know they're at risk, in which case, in general, they should have lower rates of the failed vision screening,” she said. “But you could also say they're more likely to have eye problems in the first place, and some of them don't get that care.”
This project will also provide readers to these inpatients and examine their efficacy, although Dr. Press said they will not necessarily benefit patients with diabetes, who often have medical eye disease that might not be corrected by readers. “This is multi-faceted, so we're assessing: What do patients know about diabetes and diabetes eye disease? What's their self-efficacy?” she said. The team will begin to flesh out best practices for incorporating vision screening into patient care, Dr. Press said, including examining whether patients got referrals for vision care. This work has also sparked her interest in other areas that can affect patient comprehension, such as hearing and language, she said.
Words of wisdom
“More and more in the world of hospital medicine, we're recognizing that not just in the outpatient setting do you need to do preventive care,” Dr. Press said. “It's pretty easy to overlook vision unless you're thinking about it—unless you're looking for it.”