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Principles of examining patients with learning disabilities

When examining a patient with learning disabilities you must:
  1. 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
  2. seek their consent to get a briefing from a relative or carer, if necessary.
If the patient is unable to consent, refer for advice to the section on Consent.
Encourage the patient to attend with a relative or carer if they are unlikely to be able to give full and accurate details, history and the reason for visit.
When examining a patient with learning disabilities you should:
  1. encourage the patient to visit your premises before their eye examination to help them become familiar and comfortable with the environment
  2. encourage the patient and carer to complete SeeAbility’s ‘Telling the optometrist about me’ form55  and bring it to the eye examination
  3. 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
  4. find out about any recent signs, symptoms or behavioural changes that might be relevant
  5. ask to refer to the patient’s health action plan or communication passport, if they have one
  6. be prepared to spend longer on the examination and to arrange repeat visits to obtain full and valid results
  7. use an objective measure of accommodative function (e.g. dynamic retinoscopy) to determine the accuracy of the patient’s accommodation
  8. attempt visual field assessment, even if only by using confrontation techniques
  9. use cycloplegic examination, if necessary, to determine the full refractive error
  10. use mydriasis, if necessary, to internally examine the eye
  11. give clear information to the patient or their carer about the effects of eye drops
  12. record any reasons for limitations on the examination and results obtained
  13. 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.
When you communicate with a patient with learning disabilities you should:
  1. talk directly to the patient, rather than their carer
  2. take time to speak clearly
  3. explain what you are doing in plain English
  4. warn the patient before you touch them
  5. explain and show them the equipment you are using.
You must provide information to patients in a way that they understand. 56,57 In England, the Accessible Information Standard applies to NHS patients, including those using General Ophthalmic Services (GOS), who have information or communication support needs relating to a learning disability, sensory loss or other impairment. GOS contractors need to ensure that patients receive information in a suitable, accessible format, unless the provision of this would be at disproportionate or unreasonable cost. The Optical Confederation produces guidance on this,58 and SeeAbility provides information in ‘Easy Read’ factsheets.59  Practitioners in the other UK nations should also make the information they produce accessible.