Worse outcomes among hospitalized patients with severe vision impairment, blindness
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Patients with severe vision impairment or blindness admitted to U.S. hospitals in 2017 had worse clinical outcomes and greater resource utilization than other patients, according to a study in BMC Ophthalmology.
“Millions of Americans have vision impairment or are blind,” Ché Matthew Harris, MD, MS, and Scott Mitchell Wright, MD, of Johns Hopkins School of Medicine, wrote. “As rates continue to climb with the aging of the population, inpatient providers will encounter more patients with [severe vision impairment/blindness], and they will be expected to effectively manage this vulnerable population.”
Seeking to better understand clinical and resource utilization in patients with severe vision impairment/blindness (SVI/B) and whether obesity affects this population, Harris and Wright conducted a retrospective study using the 2017 National Inpatient Sample database.
According to results, of 35,769,613 hospitalized patients aged 18 years or older in the U.S., 37,200 had SVI/B. Compared with hospitalized patients without SVI/B, patients with SVI/B were older (mean age, 66.4 years vs. 57.9 years), less likely to be women (50% vs. 57.7%) and more likely to be insured by Medicare (75.7% vs. 49.2%).
Patients with SVI/B also had a greater comorbidity burden (Charlson comorbidity score of 3: 53.2% vs. 27.8%; P < .01), with higher rates of vascular and pulmonary comorbidities, and higher in-hospital mortality rates (3.9% vs. 2.2%; P < .01).
Further, investigators found that among patients with SVI/B, most were not obese (86.5%), although those who were had higher hospital charges compared to those without obesity (mean difference: $9,821; P = .02). However, “as the obesity epidemic continues to soar,” more SVI/B patients who are also obese will likely be hospitalized, the authors wrote.
“Patients with severe vision impairment or blindness have worse clinical outcomes and higher resources utilization when hospitalized compared to those without this disability,” Harris and Wright concluded. “Hospital-based health care providers should recognize this vulnerability and consider how to optimally care for and serve this group of patients.”
Perspective
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When I work with visually impaired patients, my goal is to answer this question: “How can I reduce visual barriers and improve your quality of life?” We know that blindness has been associated with a higher rate of cognitive and physical comorbidities that may lead to hospitalization. As optometrists, offering low vision care can combat aspects of this by providing patients greater independence and quality of life. However, what are the effects of visual impairment for those who do end up being admitted into the hospital?
This U.S.-based retrospective study by Harris and Wright suggest that SVI/B are associated with higher likelihood of adverse outcomes upon hospitalization. This includes increased length of hospital stay, lower odds of returning home after hospital discharge and, perhaps most importantly, a higher rate of in-hospital mortality.
Does this change how we practice? No. Eye care clinicians should continue to provide low vision care in-office or refer to low vision organizations if needed. However, inpatient providers from other disciplines may benefit from understanding how SVI/B can impact patients during their hospital stay. Only with multidisciplinary care and comanagement can our patients thrive.
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