Dementia and the eye examination

Tips for making the eye examination easier and more successful for you, your practice, and for patients with dementia.

Improve your confidence in examining people with dementia

Prepare for the appointment

  • Ask practice staff to inform you if a patient with dementia is booked.
  • Speak with carer or care worker in advance.
  • Establish ‘best’ time of day and environment (practice or domiciliary) for appointment.

Involve an informed carer or care worker at every stage of the examination

  • Before the appointment, assess level of cognitive impairment, capacity and cooperation whenever possible.
  • During the examination to provide reassurance.
  • If a care worker, check how well they know the person with dementia.

Be patient and concentrate on communication

Have a flexible approach to the examination 

  • Adapt your routine to cognitive ability of patient and concentrate on objective tests.
  • Each of four key tests (retinoscopy, subjective, direct ophthalmoscopy, tonometry) was possible in over 80% of people with dementia in the PrOVIDe research study.

Choose suitable equipment

  • Computerised test chart is best as can be used at any distance, can present single letters or symbols, and can be used without a mirror (some people with dementia find mirrors disturbing).

Consider consent and capacity

  • Read our College’s Guidance for professional practice on consent.
  • Try using the PLUMB method to remember:

    P – Presumption of capacity.
    L - Least restrictive interventions, where possible.
    U - Unwise decisions do not necessarily indicate a lack of capacity and people with capacity have a right to make unwise, harmful or even fatal decisions.
    M - Maximising capacity.
    B - Best Interests of the person.

Take care when prescribing

  • Keep the same prescription and lens types wherever possible.
  • It may also be advisable to keep the same type and colour of frame as previously.
  • Remember that people with dementia are at increased risk of falling.
  • Label glasses, with name, purpose and date prescribed.

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