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

• Become an Alzheimer’s Society ‘Dementia Friend’ by attending a face-to-face session or accessing online training to find out more about dementia and the small ways you can help make a difference.
• Read the College’s Guidance for professional practice, particularly A95 on examining patients with cognitive impairment.
• Take a look at the dementia resources on our website.
• Shadow someone with experience.

• 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.

• 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.

• Smile as much as you can during the examination to be reassuring.
• Allow more time for the examination.
• Showing frustration increases agitation which reduces cooperation.
• Use Docet videos and the section on Communication in the College’s Guidance for professional practice.

• 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.

• 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).

• 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.

• 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.