Enhanced eye services 

One in three people with a learning disability has a sight problem, yet a minority get regular and effective sight tests according to SeeAbility. This puts many people with learning disabilities at risk of unnecessary sight loss. Read on to find out what is happening to give people access to the eye care they need and how to improve eye care for people with learning disabilities in your locality.

There are estimated to be over a million people with a learning disability in England. They are more likely to have eye problems than the general population, yet many never have their eyes tested. Lots of people with a learning disability have unidentified sight problems, leading to reduced quality of life, sight loss which could have been prevented and increased dependency.

In parts of the UK, enhanced eye examination services are ensuring that people with a learning disability receive the eye care they require. These services offer longer appointments which are carried out by an optometrist with specialist training and equipment. This helps to overcome some of the eye care barriers faced by people with a learning disability such as communication difficulties and inaccessible testing methods. Improved access to appropriate eye care will lead to an increase in the quality of life for people with a learning disability and reduce future health and social care costs.

An enhanced eye examination scheme can fit in with the Directed Enhanced Service, a national scheme that rewards GPs for offering annual health checks to their patients who have a learning disability and are known to the local Learning Disability Team. When a person with a learning disability has their annual health check, the GP or Nurse will ask specific questions about their eye care but won’t provide a comprehensive eye test. People who are not getting regular eye care can be referred on to the local enhanced service to see their optometrist, as part of their Health Action Plan.

Wokingham Eye Care Project

Over the last few years the outcomes from annual health checks for people with learning disabilities in the Wokingham area have shown that people are not accessing eye care. A proposal was put before the local Partnership Board for funding for a pilot scheme to investigate the reasons for this.

Once funding was granted, the PCT approached SeeAbility to cooperate on the project. Mary Codling, primary healthcare lead nurse for learning disabilities in the PCT, and Stephen Kill from SeeAbility, formerly The Royal School for the Blind, visited opticians in the Wokingham area to discuss the project. Three practitioners were invited to take part. SeeAbility is helping develop training for the optometrists to help them become fully aware of issues that may arise for people with learning disabilities when attending for an eye test. The training looks at how to examine people who are unable to read, those who cannot articulate their views and those with communication difficulties.

The project will be promoted through posters and user-friendly leaflets to all people with learning disabilities, carers and organisations, informing them of the service. An awareness day about looking after your eyes is planned for service users.

As part of the pilot, the opticians will gather information about the number of people who attend their service, the length of time needed to conduct an eye test, whether specialist tests had to be used, any problems detected and whether a referral was made to hospital services.

Mary Codling says, “The response from the opticians has been positive. It is hoped that by raising awareness amongst opticians, services users, carers and other organisations the project will increase the uptake of people with learning disabilities accessing this service. We did not have concrete evidence to suggest a need for this service but it is hoped that the data arising from this project will show us what eye care people with learning disabilities need in the Wokingham area.”
If you want to offer this sort of service in your area, talk to the PCT about remuneration for examinations and specialist equipment. Find interested optometrists, and create specialist training. Consider how practitioners will gather information about the person, their needs and their health before the test, and how they will communicate findings from the examination. SeeAbility offers suitable forms, “ Telling the Optometrist about Me” and “ Feedback from the Optometrist about My Eye Test.”  Once you have practitioner recruitment and training in progress, you should also look at how to promote the service to people with learning disabilities, their carers, support staff and other professionals.

For an enhanced service to succeed there must be liaison between both eye care and learning disability professionals. If you want to take this forward in your area, contact and engage with:

• Learning Disability Partnership Board
• Learning Disability Health facilitation professionals
• Community Team for People with a Learning Disability
• Local Optical Committee (LOC)
• Local Optometric Adviser at the PCT/health board
• Local Low Vision Services Committee
• Commissioners of local eye care services

You can get support from SeeAbility, the Optical Confederation and the LOC Support Unit: the organisations are keen to see more enhanced eye test services set up across the country.

SeeAbility has also produced a " Best Practice Guide - Enhanced Eye Test for People with Learning Disabilities".

Resources

SeeAbility’s  Eye Care Hub provides adults with a learning disability, carers, eye care professionals and health and social care staff with a wealth of information about eye care and vision for people with learning disabilities. There are many Easy Read factsheets to look at and download such as “ Telling the Optometrist about Me” and “ Feedback from the Optometrist about My Eye Test.”  
 
For further information please contact:
Paula Spinks-Chamberlain, SeeAbility Director of Information and Advisory Services
SeeAbility House, Hook Road, Epsom, Surrey, KT19 8SQ
Telephone: 01372 755049 Email: p.spinks-chamberlain@seeability.org  

The Local Optical Committee Support Unit (LOCSU) is developing a model clinical pathway for People with Learning Disabilities which should make local commissioning much simpler.

Georgina Gordon, Head of Unit, Optical Confederation and LOC Support Unit
61 Southwark Street, London, SE1 0HL
Telephone: 020 7202 8151 Email: info@locsu.co.uk  
List of Learning Disability Partnership Boards: www.valuingpeople.gov.uk/dynamic/valuingpeople40.jsp  
Contact details for Local Optical Committees - www.loc-net.org.uk