- Patients with learning disabilities may have additional ocular conditions and other health problems.
- You should use tests and procedures that are appropriate to the patient’s needs.
- You must follow the guidance on consent when discussing the patient’s condition with a relative or carer.
- When you communicate with the patient, you should talk directly to them rather than their carer.
- If possible, in advance of the appointment, you should discuss with the patient and their relative or carer what adjustments may be needed to help them understand information and participate in the examination.
- You should provide the patient and their relative or carer with a written, as well as a verbal, report.
References
41 Mencap Learning disability explained [Accessed 18 Nov 2018]- unknown aetiology
- prematurity
- chromosomal disorders
- Down’s syndrome
- Fragile-X syndrome
- cerebral palsy
- genetic disorders
- metabolic disorders
- iatrogenic disorders
References
42 Royal College of Ophthalmologists (2015) Eye care services for adults with learning disabilities [Accessed 18 Nov 2020]- amblyopia
- blepharitis – common in people with Down’s syndrome
- cataract
- concomitant strabismus
- cortical visual impairment
- entropion – common in people with Down’s syndrome
- field defects
- high refractive error
- impaired accommodation
- keratoconus
- nystagmus
- reduced vision.
References
43 Emerson E, Robertson J (2011) The estimated prevalence of visual impairment among people with learning difficulties in the UK. London: RNIB [Accessed 25 Nov 2020]- make reasonable adjustments to the patient’s eye care, for example by using a range of tests and procedures that are appropriate to the needs of the patient
- seek their consent to get a briefing from a relative or carer, if necessary.
- encourage the patient to visit your premises before their eye examination to help them become familiar and comfortable with the environment
- encourage the patient and carer to complete SeeAbility’s ‘Telling the optometrist about me’ form44 and bring it to the eye examination
- find out how the patient likes to communicate and how their disabilities affect them, including if they are particularly sensitive to touch, lights and sounds
- find out about any recent signs, symptoms or behavioural changes that might be relevant
- ask to refer to the patient’s health action plan or communication passport, if they have one
- be prepared to spend longer on the examination and to arrange repeat visits to obtain full and valid results
- use an objective measure of accommodative function (e.g. dynamic retinoscopy) to determine the accuracy of the patient’s accommodation
- attempt visual field assessment, even if only by using confrontation techniques
- use cycloplegic examination, if necessary, to determine the full refractive error
- use mydriasis, if necessary, to internally examine the eye
- give clear information to the patient or their carer about the effects of eye drops
- record any reasons for limitations on the examination and results obtained
- consider whether you need to refer the patient for further tests, for example examination under anaesthetic, or electrophysiological tests. If you decide that you do, you should involve learning disability health professionals for advice about access to health care and treatment.
- talk directly to the patient, rather than their carer
- take time to speak clearly
- explain what you are doing in plain English
- warn the patient before you touch them
- explain and show them the equipment you are using.
References
44 SeeAbility (2016) Having an Eye Test (and scroll down to download the ‘Telling the optometrist about me’ form) [Accessed 5 July 2021]45 General Optical Council (2019) Standards of Practice for Optometrists and Dispensing Opticians para 2.1 [Accessed 18 Nov 2020]
46 General Optical Council (2019) Standards for Optical Businesses para 1.3 [Accessed 5 Dec 2019]
47 FODONHS Accessible Information Standard [Accessed 18 Nov 2020]
48 SeeAbility (2016) Having an eye test [Accessed 5 July 2021]
- reasons why results of the examination may be limited
- details of referral to another practitioner
- information on agencies that may be able to provide further advice or support
- advice on wearing spectacles, copied, with the patient’s consent, to other relevant professionals involved in their care and to staff at a college or day centre that the patient attends.
References
49 SeeAbility. After the eye test: Feedback from my optometrist [Accessed 5 July 2021]50 SeeAbility. The results of your child’s eye test form [Accessed 6 Oct 2021]
References
51 SeeAbility Wearing glasses [Accessed 5 July 2021]British Institute of Learning Disabilities [Accessed 18 Nov 2020]
Department of Health (2013) Learning disabilities good practice project [Accessed 18 Nov 2020]
General Medical Council. Learning disabilities [Accessed 18 Nov 2020]
NHS England guides to help staff support people with access needs [Accessed 18 Nov 2020].
Public Health England: Eyecare and people with learning disabilities: making reasonable adjustments [Accessed 18 Nov 2020]
Royal College of Ophthalmologists (2011) The management of visual problems in people with learning disabilities [Accessed 18 Nov 2020]
Royal College of Ophthalmologists (2015) Eye care for adults with learning disabilities [Accessed 18 Nov 2020]
The Scottish Accessible Information Forum provides information and training on how to produce accessible information [Accessed 18 Nov 2020]
SeeAbility has various resources on eye health, sight tests, wearing glasses, eye conditions and eye operations that are useful to the optometrist, the patient and their carers [Accessed 18 Nov 2020][
SeeAbility, Find an optometrist database [Accessed 18 Nov 2020]
SeeAbility has information on eye tests for children and young people with learning disabilities. This includes downloadable forms [Accessed 5 July 2021]
Turner S, Kill S, Emerson E (2013) Making reasonable adjustments to eye care services for people with learning disabilities. Learning Disabilities Observatory [Accessed 18 Nov 2020]
Ulster Vision Resources [Accessed 18 Nov 2020]