Refractive Error in the Geriatric Population

An 88-year-old African-American male is sent by his primary care physician for retinal evaluation for diabetic retinopathy. He has had worsening diabetes control requiring insulin therapy. He moved to the area after the death of his wife, who had been his primary caregiver, and is currently living with his daughter. He has not seen an eye care professional in the last 12 years. His past medical history is significant for diabetes and hypertension, both diagnosed at the time of a stroke 5 years previously and both currently controlled. A diabetic nurse is working with the patient on diabetic nutrition and insulin administration, but has doubts if the patient can see well enough to accurately draw up his own insulin.