Bedside Ophthalmic Screening in Diabetic Foot: Correlating Wagner Grade with Diabetic Retinopathy Severity and Visual Impairment

Abstract

Introduction: Diabetes mellitus is a systemic microvascular disorder with multi-organ involvement. Diabetic foot represents an advanced stage of systemic vascular compromise and is increasingly recognised as a surrogate marker of generalised microangiopathy. Diabetic retinopathy, another manifestation of microvascular disease, remains a leading cause of preventable blindness. Patients admitted with diabetic foot often have limited access to routine ophthalmic screening, providing a unique opportunity for bedside ocular evaluation.

Aims and Objectives: To describe ocular manifestations in patients admitted with diabetic foot and to assess whether severity of diabetic foot correlates with ocular microvascular disease.

Materials and Methods: This hospital-based descriptive observational study was conducted between November 2025 and January 2026. Eighty consecutive patients admitted under the Department of Surgery with diabetic foot and referred for bedside ophthalmology consultation were included. Systemic evaluation included duration of diabetes, glycaemic status, renal function, ankle–brachial index (ABI), and Wagner grading of diabetic foot. Ophthalmic evaluation comprised visual acuity assessment, lens status, dilated fundus examination with ETDRS grading of diabetic retinopathy, and assessment for macular edema. Duration since diagnosis of diabetic retinopathy and duration of foot ulcer were additionally recorded. Data were analysed descriptively.

Results: Eighty patients (mean age 58.6 ± 9.4 years) were evaluated; 52 (65%) were male. Hypertension was present in 45 (56%), chronic kidney disease in 14 (18%), and dyslipidaemia in 44 (55%). Diabetic retinopathy was detected in 51 (63.7%) patients; sight-threatening diabetic retinopathy (severe NPDR or PDR) was noted in 16 (20%). Macular edema was present in 14 (17.5%), with clinically significant macular edema in 9 (11.2%). Severe diabetic foot (Wagner grade ≥4) was observed in 20 (25%) patients. A higher proportion of sight-threatening diabetic retinopathy and macular edema was observed among patients with severe foot disease (90% vs 52.6% for retinopathy overall). Reduced visual acuity (<6/12 in at least one eye) was documented in 38 (47.5%) patients. Mean duration since diagnosis of diabetic retinopathy and mean duration of foot ulcer were longer in patients with advanced retinopathy.

Conclusions: A high prevalence of diabetic retinopathy and vision-threatening ocular disease was observed among patients admitted with diabetic foot. Increasing severity of diabetic foot tended to coincide with more advanced ocular microvascular disease. Bedside ophthalmic screening of hospitalised diabetic foot patients may facilitate early detection and timely referral for sight-saving interventions.