Information resources for patients and carers. Updates to this care map. Considerations for meeting and guiding a person with low vision

Transcription

1 Care map information Information resources for patients and carers Updates to this care map Visual loss - clinical presentation Considerations for meeting and guiding a person with low vision Confirm diagnosis Refer to support service R Provide advice, information, and emotional support Referral from health to social care Refer to social care R Registration, assessment, and reablement Visual impairment rehabilitation programme Community care assessment Eligible for community care Ineligible for community care Community-based social care (statutory funding) Community-based services (no statutory funding) Monitoring and followup Page 1 of 7

2 1 Care map information Definitions: an impairment of visual function which causes restriction in a person's life, for which full remediation is not possible with conventional spectacles, contact lenses, or medical intervention [RCOphth] measures of visual function for sight-impaired [RCOphth]: visual acuity between 3/60 and 6/60 with a full visual field visual acuity of up to 6/24 with any of: moderate restriction of visual field media opacities aphakia 6/18 or better with either: gross field defect, eg hemianopia marked constriction of the field, eg glaucoma or retinitis pigmentosa measures of visual function for severely sight-impaired (blind) [RCOphth]: visual acuity less than 3/60 visual acuity between 3/60 and 6/60, but with a very contracted field of vision (unless this has been longstanding) visual acuity better than 6/60 with a very constricted visual field, especially in the lower part of the field, excluding people with visual acuity better than 6/18 with: Prevalence: homonymous hemianopia; or bi-temporal hemianopia about 346,000 people are registered as having a sight problem in England, Wales, and Scotland [RCOphth] around 2 million people self-define as having a sight problem [RCOphth] 18 per 10,000 children will have low vision before age 16 years [RCOphthChild] Prognosis: people with impaired vision are at greater risk of [AOA]: falling sustaining a hip fracture mortality earlier admission to a nursing home greater use of community services increased social isolation depression 3 Updates to this care map References: [UKSLP]. Vision Adult UK sight loss pathway. Vision London; [RCOpth] The Royal College of Ophthalmologists (RCOphth). Low Vision: The essential guide for all ophthalmologists. RCOphth: London; [AOA] American Optometric Association. Care of the patient with visual impairment (low vision rehabilitation). American Optometric Association: St. Louis, MO, US; [RCOphthChild] The Royal College of Ophthalmologists (RCOphth). Ophthalmic services for children. RCOphth: London; [CET1] General Optical Council. Paediatric low vision: Part 1 - Causes of vision impairment in children and young people, certification and registration. General Optical Council. London; [CET2] General Optical Council. Paediatric low vision: Paediatric low vision: Part 2 - The assessment. General Optical Council. London; Page 2 of 7

3 [CET3] General Optical Council. Paediatric low vision: Part 3 - Management of children and young people with vision impairment. General Optical Council. London; [CET4] General Optical Council. Paediatric low vision: Part 4 Interdisciplinary matters and support for children and young people with vision impairment. General Optical Council. London; Visual loss - clinical presentation Low vision is defined as vision impairment that is not corrected by standard eyeglasses, or by medical or surgical treatment [AOA]. Aspects of visual impairment may include [AOA]: visual acuity visual field contrast sensitivity loss glare 5 Considerations for meeting and guiding a person with low vision Meeting a person with a visual impairment [RCOphth]: check case notes for an indication of visual acuity actively seek the person out and approach them directly introduce yourself and explain where you are going if the patient requires help, offer to guide them give instructions on the way about where you are going Guiding a person with visual impairment [RCOphth]: always ask the person if they want help never grab their arm and pull them along give a verbal cue, or stand side-by-side so that the person can locate your upper arm and take a grip start moving, staying about one step ahead of the person, never pushing or dragging provide a commentary concerning any hazards as you walk if there is not enough room to pass through a space side-by-side, walk in front of the person, allowing them to rest their hand on your back on approaching a door, the person should be on the hinge side of the door, so they can take control of the door to allow the person to sit, place a guiding hand on the arm of the chair, allowing the person to follow your arm down to the arm of the chair before sitting 6 Confirm diagnosis Vision impairment specialists may be [UKSLP]: ophthalmologists optometrists with or without: higher qualification in low vision accreditation (in some areas) dispensing opticians with a diploma in low vision orthoptists ophthalmic nurses Low vision specialists may be used for further specialist interventions [UKSLP]. The vision impairment specialist should: undertake vision and eye health screening and assessment [UKSLP], including [AOA]: Page 3 of 7

4 comprehensive patient history visual acuity test, including: distance visual acuity consider using a LogMAR Distance Visual Acuity Chart [RCOphth] near visual acuity use a specialist chart, eg Bailey-Lovie near chart [RCOphth] contrast sensitivity consider using a Pelli-Robson letter chart refraction [RCOphth] ocular motility and binocular vision assessment [AOA] visual field assessment [RCOphth] treat eye conditions [UKSLP] sensitively confirm the diagnosis [RCOphth]: explain what the diagnosis is and what it means provide sufficient information, including written information 8 Provide advice, information, and emotional support Support services may include [UKSLP]: Eye Clinic Liaison Officer (ECLO) vision support service additional support: counsellors befrienders other community-based social care agencies Support should include: information about the patient's eye condition in accessible formats, eg[ukslp]: tape CD large print information about sight loss pathway [UKSLP] assistance with completion of Certificate of Vision Impairment (CVI) [UKSLP] referrals to statutory and voluntary sector services [UKSLP] signposting to local and national support services [UKSLP] reassurance that visual hallucinations (Charles Bonnet Syndrome) are common [AOA] 9 Referral from health to social care Register officers or front line duty staff [UKSLP]: require knowledge of: visual impairment sight loss pathway registration process should perform the following: take the referral explain the benefits of registration invite registration refer on for entry onto register database and for visual impairment assessment of need Page 4 of 7

5 11 Registration, assessment, and reablement A Rehabilitation Officer for Visual Impairment should: perform a visual impairment assessment of presenting need functional vision and eye health screening and assessment [UKSLP] provide further emotional support [UKSLP], consider assessment of cognitive/psychological status [AOA] provide more detailed information about the eye condition [UKSLP] teach core orientation and mobility [UKSLP] teach communication skills [UKSLP]: use of assistive technology: screen readers [UKSLP] voice recognition software [UKSLP] magnifiers with or without illumination [AOA] computer tablets [AOA] telescopic devices [AOA] lighting [AOA] braille [UKSLP] teach and enable independent living skills [UKSLP] offer interventions to maximise use of residual vision [UKSLP] refer to statutory and voluntary sector services [UKSLP] signpost local and national support services [UKSLP] consider including [UKSLP]: Guide Dogs mobility interventions, eg: guide dog My Guide scheme access technology trainers low vision therapists occupational therapist trained to work with people with sight loss dual sensory and complex needs specialists, eg guide communicators education and lifelong learning specialists vocational specialists community-based support services, eg social groups 12 Visual impairment rehabilitation programme Visual rehabilitation may include: reading rehabilitation [RCOphth] activities of daily living [AOA]: personal care home management financial management meal preparation [RCOphth] shopping [RCOphth] patient safety: taking medications [RCOphth] Page 5 of 7

6 monitoring blood glucose, if necessary [AOA] using a telephone [RCOphth] emergency evacuation plan [AOA] risk of falling [AOA] independent mobility [RCOphth] ambient light adaptation [RCOphth]: glare light and dark adaptation 13 Community care assessment Social workers (or rehabilitation officers in some areas) are responsible for [UKSLP]: community care assessment of eligible need resource allocation care management 16 Community-based social care (statutory funding) Social care supports will develop according to the choices and needs of the person, and may become very complex, encompassing [UKVS]: educational support employment support/vocational training community equipment housing adaptations use of a personal budget, where appropriate Page 6 of 7

7 Key Dates Published:, by Valid until: Evidence summary for Visual loss Page 7 of 7