- Patients need not be registered as sight impaired or severely sight impaired to benefit from low vision services.
- You should assess all patients according to their needs.
- You should follow local protocols for the assessment, referral and management of patients with low vision.
- You should consider the patient’s need for emotional support and social care.
- Low vision assessment and management is multidisciplinary.
- Low vision assessment is rarely a one-off process.
- You should refer the patient if you do not have sufficient expertise to assess a patient with low vision.
- The supply of spectacles or contact lenses to patients who are registered as sight impaired or severely sight impaired must be carried out by, or under the supervision of, an optometrist, dispensing optician or doctor.
References
33 Clinical Council for Eye Health Commissioning (2017) Low vision, habilitation and rehabilitation framework for adults and children [Accessed 18 Nov 2020]- needs. Some patients may have a personal care plan or low vision passport that would assist in this assessment
- visual acuity, including use of distance and near logMAR charts. If these are not available you may be able to use conventional charts to achieve meaningful results
- contrast sensitivity
- glare function
- central visual function using, for example, Amsler charts and appropriate colour vision tests
- visual field. You should:
- repeat field assessments, where necessary and possible, to obtain a meaningful result, and
- be aware of the limitations of static screening equipment particularly in cases of severe sight loss. If you do not have access to a conventional kinetic test, such as Goldmann, you should use confrontation type tests and Amsler charts for central vision to give practical advice to the patient
- binocular and accommodative status, where appropriate, for example in phakic children with low vision.
References
34 Equality Act 2010. [Accessed 18 Nov2020]35 General Optical Council (2016) Standards of Practice for Optometrists and Dispensing Opticians para 2.1. [Accessed 18 Nov 2020]
36 General Optical Council (2019) ~Standards for Optical Businesses para 1.3.1. [Accessed 18 Nov 2020]
- their visual function relating to visual acuity and contrast sensitivity levels; you:
- should explain this to the patient in relation to both threshold and sustained visual function
- should differentiate between clinical measurements and practical ability
- may need to demonstrate how to make adaptations to every day practical tasks such as reading door signs, mobile phone screens, newspapers, timetables and packets
- illumination as well as the use of specific tints and glare shields and non-optical devices
- the effects of the condition affecting their vision
- the benefits and disadvantages of low vision devices.
- the most common eye conditions that cause low vision
- support services, such as talking books, holidays, safety at home, lighting and travel.
- older people
- children
- people whose first language is not English
- carers
- people who live alone
- people with other sensory impairment or learning difficulties
- people in, or seeking, employment.
References
37 Department of Health (2018) Registering vision impairment as a disability [Accessed 18 Nov 2020]- the tasks the device has been issued for
- how to use the device, including:
- how far the device should be held from the eye and the object
- which spectacles, if any, to use with it
- any specific advice on lighting
- the initial programme of low vision training, including:
- reading or skill practice
- aftercare
- what post-supply support is available
- care, storage and cleaning of the device, including maintenance of batteries and integral lamps if appropriate.
References
38 Opticians Act 1989 s27(1)(b) [Accessed 18 Nov 2020]39 Council Directive 93/42/EEC concerning medical devices [1993] OJ L169/1. [Accessed 18 Nov 2020]
40 Association of British Dispensing Opticians. Advice and Guidelines for Dispensing Opticians: paras 2.19-2.23. [Accessed 18 Nov 2020]
Certification of people as visually impaired, including the benefits of certification, and links to guidance notes [Accessed 18 Nov 2020]
Research has shown that depression is common in people with visual impairment. See Nollett CL, Bray N, Bunce C, et al. Depression in visual impairment trial (DEPVIT): a randomised clinical trial of depression treatments in people with low vision. Invest Ophthalmol Vis Sci. 2016;57:4247-4254
Clinical Council for Eye Health Commissioning (2018) Low Vision, Habilitation and Rehabilitation Framework for Adults and Children [Accessed 18 Nov 2020]
The College of Optometrists higher qualifications in low vision [Accessed 18 Nov 2020]
The College of Optometrists and Royal College of Ophthalmologists (2013) Commissioning Better Eye Care: Adults with low vision [Accessed 18 Nov 2020]
Diabetes UK [Accessed 18 Nov 2020]
Guide Dog [Accessed 18 Nov 2020]
International Glaucoma Association [Accessed 18 Nov 2020]
Look [Accessed 18 Nov 2020]
Macular Society [Accessed 18 Nov 2020]
NHS England guides to help staff support people with access needs [Accessed 18 Nov 2020].
National Institute for Health and Care Excellence (2013) Falls in Older People: Assessing Risk and Prevention. Clinical guideline 161. London: NICE [Accessed 18 Nov 2020]
Partially Sighted Society [Accessed 18 Nov 2020]
RNIB [Accessed 25 Nov 2018]
Ryan B, Woodhouse M, Sinclair A (2009) Low Vision, the Essential Guide for Optometrists. Guide Dogs for the Blind Association and College of Optometrists [Accessed 18 Nov 2020]
Visionary [Accessed 25 Nov 2018]
Wales Eye Care Services. LVSW-Low Vision [Accessed 18 Nov 2020]