Andy Connell works as an optometrist in Edinburgh and has put together five top tips this #WorldSightDay for working with people with learning disability and visual impairment.
He says: ‘I provided domiciliary eye care before moving to independent practice with Jack Brown Eyecare in 2013. I’ve been fortunate in my career to have had lots of opportunities to test and support people with more complex visual needs. It is a part of our work that I feel comfortable with.
‘I realise others in the profession might feel a bit out of their comfort zone, but these hints are really straightforward, and can make all the difference when dealing with patients with particular needs.’
1. Allow plenty of time
This may seem obvious, but with most clinician’s diaries being managed by reception staff, it’s important that the reception team are able to recognise situations where more complex appointments need additional time.
This is easier when appointments are made in person but often, especially in the current climate with COVID-19, appointments are made either by phone or online.
Having experienced staff, adept at getting the relevant information or asking new patients to complete a pre-booking form covering any additional needs, allow you to plan accordingly.
2. Have access to the necessary information
Often with patients with visual impairment, there is a corresponding complex history. It is important that this information is available at the time of the appointment.
Again, empowering reception staff to recognise these situations and prompt patients to attend with all of their glasses or visual aids, previous prescriptions, medical information, referral letters and a list of medications for example, enables you to quickly and efficiently get up to speed. Then you can concentrate fully on the task in hand on the day.
3. The eye test starts before the consulting room
Typically, we call the next patient, introduce ourselves and then lead the way to the consulting room.
When meeting someone with visual impairment for first time, these first two minutes may contain valuable insights into your patient’s world, noting whether:
- they have attended alone or required a chaperone
- they are able to recognise you approaching or are listening for a name being called
- a low vision aid is used to navigate through the waiting room
- how they hold their head.
Taking these things into account means that you can ensure that your initial lifestyle questioning and expectations are appropriate to the level of ability.
4. Communication
Communication and rapport are key to any successful relationship. In every consultation the first few minutes tends to set the tone for the rest of the visit and this is possibly even more important in the context of visual impairment.
I think it is human nature, especially in a situation where we may be out with our comfort zone, to speak too quickly.
In the current circumstances wearing masks, this can be quite a barrier. Listening is key. With visual impairment, the actual ‘testing time’ can be comparatively brief as many of the routine tests may not be applicable depending on the level of vision.
I can think of at least one patient, who attends routinely, knowing that the test is mainly a retinal exam in order to rule out active pathology or significant change out with normal expectations.
At each visit she stresses the importance of this opportunity to speak to a health care professional as there may be a new service that would be relevant to her and she appreciates having her glasses refitted or serviced and values our opinion regarding wear and tear.
Although the glasses are mainly cosmetic now, it is clearly important to her that they are well maintained and replaced as needed.
5. Thinking outside the box
Our raison d’être is to examine the eyes to looking for problems with vision, signs of injury and offer clinical advice, prescribe specs or contact lenses, but in the situation where there is already pre-existing visual impairment there’s an opportunity to go beyond this remit.
As part of the eye test, we can dig a bit deeper into the lifestyle questioning: how do you like to spend your spare time? For example, I like to watch Netflix series. What sort of device are you using? If it is a TV, what size, how far away are you sitting?
Often people are sitting a standard distance of 3m incorrectly thinking that closer may damage their vision further when sitting closer may in turn enhance the experience depending on the level of vision.
If we have a working knowledge of low vision aids for example, we may be able to prevent someone from using their finger to gauge when their tea cup is filled as there is a device for that, or for example, in Lanarkshire recently there were taster sessions for blind golf which might have been an opportunity to try a new experience.
I feel that this group of patients present us with a unique opportunity, with a little extra consideration and effective provision, to make a real world difference. In time, as the relationship between eye care provider and patient grows and develops, we have the opportunity to provide the highest level of care which extends past just providing an eye health assessment and glasses.