Fear of visual loss in patients with diabetes: results of the Prevalence of Diabetic Eye Disease in Tayside, Scotland (P-DETS) study

Aims To describe the relationship between fear of visual loss and dependent variables (visual acuity, retinopathy treatment, severity of retinopathy) in community-based diabetic patients. Methods Subjects were identified from the Diabetes Audit and Research in Tayside, Scotland (DARTS) diabetes register. From a total of 4825 individuals known to have diabetes and who were resident in Dundee and Perth (population 216 204; diabetes prevalence 2.23%), 586 persons with diabetes were randomly selected. Participants completed a self-administered questionnaire in Likert grade format which incorporated two items addressing presence and intensity of fear of visual loss. Results Questionnaires were returned by 61.4% of the cohort. Fear of visual loss was 'often in mind' for 37% of respondents, and that fear was intense for 47.4%. Analysis by diabetes type revealed differences in reported fear of Type 1 and Type 2 patients in relation to disease and treatment variables. Linear regression highlighted the complexity of the issue with retinal status, acuity and treatment only partly explaining reported patient concern (r(2) range: 0.051-0.125 for presence of fear; 0.026-0.04 for intensity of fear, depending on diabetes type). Conclusions Fear of visual loss is preoccupying and intense for a substantial proportion of the diabetic population. Reasons for this are multiple and complex. Objective measures of visual impairment and retinal status are inadequate predictors of fear. Carers and researchers need to be mindful of this when approaching patients with diabetes.