Patients may be confined to a wheelchair for many different reasons. It may be permanent or temporary, recent or longstanding. You should ask the patient why he or she is in the wheelchair and for how long.

Practices should ensure that wheelchair users have access to the instruments that are needed for their examination, such as a slit lamp, tonometer and visual field screener. Where this is not possible a comparable alternative must be made available.

You should ask the patient if they are able to transfer to the consulting room chair. The level of disability is not necessarily a guide as to whether a patient will be willing or able to do this. You should explain that you will be able to examine the patient in their wheelchair, but that they will be able to have more tests done if they can transfer to the consulting room chair. If the patient agrees to transfer you should:

1. ask the patient what the best position is for their wheelchair to help the patient to transfer out of it
2. lock the consulting room chair in position
3. ask the patient if they would like you to lift the armrests and/or footrest on the consulting room chair out of the way
4. ask the patient what help, if any, they would like
5. tell the patient that they transfer to the consulting room chair at their own risk.

If the patient remains in their wheelchair, positioned in front of the consulting room chair you should:

1. make sure that when you are talking to the patient you are able to look them in the eyes, rather than speaking to the patient from behind
2. make the necessary adjustments to ensure the patient can see the letter chart in the mirror. This may be by:
   • asking the patient, still in their wheelchair, to sit on a thick cushion to raise them up
   • tilting the mirror downwards, or
   • having a separate mirror on a stand that you bring into the consulting room
3. record the distance at which the test was conducted, for example 5/6 rather than 6/6
4. adjust the prescription that you find to take into account the reduced distance of the patient from the test chart. 

You should make clear notes of the adjustments that you made to your examination technique. This will help any follow-on optometrist understand what worked for this particular patient.