Eye care case study: adults with learning disabilities in South Devon
Published 27 January 2020
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Eye care for adults with learning disabilities in South Devon
In Torbay, a pilot study investigated whether people with learning disabilities were accessing the eye care they needed. For further information see the pilot study report. The study confirmed the importance of an orthoptist with an extended role to coordinate local services to improve access to eye care for people with learning disabilities in South Devon. The changes to the system were made and the extended role incorporates 3 main areas:
Raising awareness
People with learning disabilities are encouraged to access primary care and visit their local optometrist wherever possible. A leaflet using Total Communication techniques called Getting My Eyes Checked was produced and is distributed widely within the local area including to learning disability teams, GP surgeries and at health promotion events.
The orthoptist visits further education departments in all local special schools to talk to young people (at the point of transition from child to adult services) about what happens when they have an eye test and gives them a copy of the leaflet. Children being monitored by the orthoptist in special school are automatically referred onto our adult service at the appropriate time.
Provision of a strong multi-disciplinary team is key. This includes local Primary Care Liaison Nurses (PCLN), representatives from the Local Optical Committee, Sensory Teams and nurses from the eye clinic who provide desensitisation sessions. The Orthoptist chairs a service review meeting twice a year to reinforce multi-disciplinary links and set actions for the next 6-month period in order to maintain smooth links between the hospital and community eye care pathways.
Desensitisation
Most people with learning disabilities were not accessing eye appointments because they or their carers felt they would be unable to co-operate with eye tests. Defined pathways have been established for desensitisation with the aim that everyone gets the reasonable adjustments they require. Identifying lead nurses for desensitisation in the eye clinic and eye surgery unit has allowed the provision of specialised, tailored desensitisation for those people with severe learning disabilities and or autism.
Referrals are received from PCLNs, Ophthalmologists and our local diabetic eye screening provider, meaning that people who previously were unable to get their eyes checked are now receiving the eye treatments they need. Access to diabetic eye screening has increased from 45% prior to our service to 93% in 2018.
Home visits
The pilot study identified a small group (approximately 13%) of people with severe learning disabilities where accessing primary services was not appropriate. The orthoptist is now able to offer these people a home visit for an eye check. Carers can be provided with practical advice about a person’s functional vision and it is possible to arrange follow up appointments with the consultants at the hospital eye clinic or their local optometrist.
Reasonable adjustments ensure that a double appointment slot can be arranged at a convenient time, preferably at the end or beginning of a clinic when it is less busy, and by doing a home eye check in advance it provides the consultant with information prior to the consultation and also reduces the time needed on the day of the appointment.
For further information please contact [email protected]