May 2025 - Teaching students skills of interaction with patients with learning disabilities

An optometrist’s role is varied, working with patients of all ages with a range of needs. All consultations and treatment plans therefore need to be tailored to specific patient needs to ensure they receive the attention they deserve. “People with learning disabilities are at a greatly increased risk of sight problems at any age. Adults with learning disabilities are 10 times more likely to have serious sight problems than other adults and children are 28 times more likely.” [1] It is therefore essential that optometry and ophthalmic dispensing learners develop a critical understanding of strategies to be used in the diagnosis, management and care of patients with learning disabilities, to ensure positive clinical outcomes. 

According to Public Health England, a person with learning disabilities may have:

  • A significantly reduced ability to understand new or complex information and to learn new skills
  • A reduced ability to cope independently

These will have started before adulthood, with a lasting effect on development. This doesn’t include people with conditions such as dyslexia, in which they have a difficulty with one type of skill but not a wider intellectual impairment.[2]

The General Optical Council's requirements for Approved Qualifications in Optometry or Dispensing Optics Outcomes O.12 and O.21 places an obligation on optometrists and dispensing opticians to manage desired health outcomes of patients, taking into consideration any relevant medical history and adapt their communication approach to meet the needs of patients and carers.

Professor Maggie Woodhouse, who has recently retired from Cardiff University, where she specialised in eye care for children and adults with disabilities in the School of Optometry and Vision Sciences gives her thoughts and advice on how optometry and ophthalmic dispensing learners can interact with patients with learning disabilities. 

Children and adults with learning disabilities are known to be at much higher risk of eye and vision problems – up to 28 times higher. This section of the population needs optometry more than the rest of us, yet are under-served in terms of eye care. Many optometrists feel less than confident in seeing patients with learning disabilities. To help build that confidence, the ideal approach is to spend time shadowing an optometrist who is comfortable in this specialism. In the meantime, here are some pointers to remember:

  • Consider familiarisation visits to the practice so that the patient can become familiar the environment before their appointment
  • Think about your practice appointment system and consider booking extra time or making the appointment, and time for dispensing and fitting, at a quiet time
  • Avoid pre-screening. Most patients will prefer to see just one person, the optometrist, rather than be confused by being pushed from pillar to post
  • Learners must remember to always speak to their patient, NOT to the carer, even if their patient cannot answer
  • It is important that learners Do NOT judge the cognitive ability of their patient by their speech or lack of speech. Many patients can understand speech better than they can respond, and people with no speech at all may be able to understand you perfectly
  • Emphasise to learners the necessity to use appropriate terminology. It is NOT a disabled adult or a Down’s child, it is an adult with disability, a child with Down’s syndrome and so on. Always put the person first
  • Autistic patients prefer identity first language i.e., autistic person rather than a person with autism and this should be used unless you are advised otherwise
  • Reinforce to learners that if they are examining an adult, treat him or her like an adult; do not patronise
  • Learners must be aware of their own body language. If they feel nervous and act it, they will signal this to the patient and carer, who then cannot have confidence in their optometrist or dispensing optician. To help learners build confidence in their body language, see the tips in February 2024's Topic of the month 
  • If optometry and ophthalmic dispensing learners are seeing a child, encourage them to seat the parent close to the child so that they can support. Make it clear to parent or carer that you value their input; they know your patient better than you and can help explain or encourage. Last month's feature on communicating with children gives some valuable tips
  • Patients with a learning disability may have hearing deficits or poor auditory processing. Highlight the importance to learners of speaking clearly, in short sentences, with simple words, and use gestures or signing throughout
  • Learners must try to avoid negatives. If, for example, you say “don’t move your head” your patient with auditory issues may hear “move head”. If you say “keep your head still”, he or she may hear “head still”, which will have the desired effect
  • Learners should always explain their findings to their patient and carer, and always follow-up with written advice. Especially for an adult, the accompanying carer may be just one of a group supporting the patient, and learners cannot rely on that person to relay information to others. The advice can be in the form of a pre-prepared leaflet, or an individual letter
  • Every patient is an individual. Take time at the outset to get to know your patient a little, so that you can adjust your approach and examination to suit
  • Remind learners that patients with learning disabilities often have other conditions and may have a history of medical interventions. They may be very apprehensive of an eye test
  • Learners must SHOW their patient what they are going to do before they do it. Remind them to always ask their consent before they do anything
  • Never tell a patient that they have got something wrong. Many patients with learning disabilities are as self-aware as you and I, and know that they are not good at things. It is not appropriate to remind them of that. Always finish a task on a good note, providing something that your patient CAN do
  • Learners should aim to be flexible in their examination. What works for one patient may not work for another. Tailor your examination order and process to your individual patient. This is what make seeing patients with learning disabilities so enjoyable – no routine!
  • Have a choice of tests available – different acuity tests for example. Use one that the patient can easily do. The worst you can do is try letters and fail, then switch to pictures. This will damage your patient’s self-esteem, and they may not want to do anything else for you
  • Avoid Hi-Tec equipment that many patients will be disturbed by or will be unable to use
  • Very few patients with learning disabilities can understand subjective refraction – learners should not attempt it
  • Remind learners that if their patient is showing signs of distress, stop the examination. Patients should not be pushed beyond their tolerance. Learners must be prepared to make another appointment to complete the examination

Practical Learning

Opportunities for optometry and ophthalmic dispensing learners to meet and communicate with patients with diverse intellectual disabilities is relatively limited so specialist teaching is extremely valuable. Practical learning can involve:

  • Workshops - Cambridge University has worked with professionally trained actors with intellectual disabilities to develop an interprofessional workshop that sought to provide authentic communication skills training to enable healthcare students to communicate effectively with patients of all abilities
  • Scenarios - create group discussions amongst learners to talk through various scenarios and how they would approach them. Encourage learners to share their experiences of communicating with patients with learning disabilities
  • Shadow other healthcare professionals to see how they work with patients with learning disabilities
  • Communication - encourage learners to develop confidence in their communication and adapt it accordingly. For instance, make use of visual aids, diagrams, props, sign language or interpreters. Emphasise the importance of active listening to learners as it helps to ensure clear understanding and that the patient feels heard and respected
  • Ophthalmic dispensing learners should role play spectacle fitting. In particular, taking into consideration time to look at frame styles, handling frames and trying them on. As ABDO recommends, the use of toys or demonstrating on a carer can be helpful
  • There is often a range of eye care professionals who treat people with learning disabilities so where possible, learners should have exposure to various healthcare professionals. This could be through shadowing and gaining experience of working in multi disciplinary teams
  • Lifelong learning - encourage learners to keep up to date with current guidelines and skills and to attend learning disability awareness training to enhance their skills of interaction with patients with diverse intellectual disabilities

Professor Maggie Woodhouse

Professor Maggie Woodhouse has recently retired from Cardiff University, where she specialised in eye care for children and adults with disabilities in the School of Optometry and Vision Sciences. Maggie ran the School's Special Assessment Clinic and headed the Down's Syndrome Vision Research Unit. Her work resulted in the award of an OBE in 2014, AOP Lifetime Achievement in 2015, Queen's Anniversary Prize for Research in 2018 and College of Optometrists Life Fellowship in 2024. Although officially retired, Maggie is still involved with postgraduate courses and training sessions for professionals and parents. Not one to give up her clinical work, Maggie now runs an occasional clinic in practice, which keeps her in touch with special needs optometry.

Keep updated 

If you would like to be kept up to date with the work of SPOKE, please email spokehub@college-optometrists.org to be added to our Advisory Review Group. Similarly, please email with your views of Topic of the month or any suggested themes you would like to see covered. 

References and Bibliography 

[1] SeeAbility (2016) Delivering an equal right to sight   Eye care messages

[2] Public Health England, 27 January 2020 Eye care and people with learning disabilities: making reasonable adjustments

Boardman L, Bernal J, Hollins S. Communicating with people with intellectual disabilities: a guide for general psychiatrists. Advances in Psychiatric Treatment. 2014;20(1):27-36. doi:10.1192/apt.bp.110.008664

Leung TW. Empowering students to bridge basic and clinical sciences by creating innovative optometric tools. Med Educ. 2025; 59(5): 562-563. 

Metcalf E, Colgate R. Communication skills training for healthcare students working with people with intellectual disabilities. BJPsych Advances. 2019;25(2):74-77. doi:10.1192/bja.2018.57

Moy.A, OD, FAAO, CPCO Mar 13, 2023 Best Eye Exam Practices for Patients with IDDs

Opticare Clinical Guide, September 26, 2023 Managing Patients with Special Needs

Searle.J, 12 August 2024, Optometry Students, Preparing for Real Patients: A Guide for Optometry Students

Sideris.T, September 11, 2024 How Do You Adapt Your Practice to Accommodate Patients With Special Needs? Optometry Magazine

Wan, K., Lau, K.H., Wong, H.Y. et al. Fostering holistic eye care for children with special educational needs: an interprofessional education program bridging optometry and education. BMC Med Educ 24, 1340 (2024). 

Acuity, The College of Optometrists, 1 November 2023, How to support neurodiverse people in practice

Acuity, The College of Optometrists, 5 May 2023, A visual fixation: Simon Berry MCOptom

Acuity, The College of Optometrists, 30 November 2018, Supporting optometrists with disabilities - College of Optometrists

Association of British Dispensing Opticians, People with Learning Disabilities (PWLD) – Quality Standards for Dispensing Opticians (Guidelines)

Children with additional needs - Course: Top tips for paediatric patients with additional needs

Equality Act 2010, UK Public General ACTS, www.legislation.gov.uk

National Autistic Society, How to talk and write about autism

Public Health England, 27 January 2020, Eye care and people with learning disabilities: making reasonable adjustments

Primary Eyecare Services, Learning Disabilities Easy Eye Care                         

The College of Optometrists, Guidance for Professional Practice December 2023 Examining patients with learning disabilities

The College of Optometrists, Guidance for Professional Practice December 2023 Examining autistic patients

The College of Optometrists, Guidance for Professional Practice December 2023 Examining patients with specific learning difficulties 

The College of Optometrists, September 2022, Case on ensuring accessibility for autistic patients

The College of Optometrists CPD, 31 December 2025 Top tips for paediatric patients with additional needs

The College of Optometrists CPD, 31 December 2025 Communicating with patients with special needs