An understanding of eye care needs is important to help people of all levels of ability to enjoy a good quality of life. People with learning difficulties are particularly prone to eye problems; unfortunately they frequently go through their lives unnecessarily handicapped because of a lack of appropriate eye care. Carers may not be sufficiently aware of clients’ sight problems. Regular eye care may require medication for eye infections or in-growing lashes, as well as sight testing and possible prescriptions for glasses. Sight may be damaged or lost through lack of diagnosis and treatment. For many people with learning difficulties, their focusing ability (to see near objects in detail) deteriorates at a younger age than other people. Unidentified visual impairment, or even the need for glasses, may exacerbate levels of frustration and challenging behaviour.
EYE HEALTH CHECKS AND SIGHT TESTING
Optometrists provide valuable eye health checks, as well as establishing whether a person may need glasses. No one is too disabled to have such tests. Where people cannot cooperate, there are sight tests which record an individual’s reflexes and involuntary eye movements. Because people with learning difficulties are more likely to need glasses than the ‘general population’, they should have regular eye examinations.
Preparation is important before a person with learning difficulties attends for sight testing. The optometrist should be given as much information as possible—knowledge of the individual and their daily living routines, medical history, medications, methods of communicating, special needs, likes and dislikes, and whether the person is over-compliant (apt to answer ‘yes’ to every question). The appointment should be planned at a time of day when the service user will be able to function at his/her best, and they should be accompanied by someone who knows them well. To allay a service user’s anxieties in unfamiliar situations, it is useful to ‘practise’ some of the sight testing procedures beforehand—reduced light levels, special seating, having light shone into the eye, close face-to-face contact, eye drops, focusing on something in the distance, ‘tracking’ a light, matching pictures or letters (if the person is unable to identify letters verbally).
Most people, even those believed to be totally blind, have some sight which they can be helped to use in their daily lives. ‘Low-vision techniques’ can assist people with limited sight to greater independence. The quality of lighting is important—some people need a lot of light and others prefer reduced lighting. Many people with low vision find it hard to see things that are poorly contrasted with the background, or where there is ‘visual clutter’. Most people with low vision see larger things more easily, but people with ‘tunnel vision’ may prefer looking at small things which are within their frame of vision. Magnifiers and other low-vision aids have many uses, not just for reading. People can often be trained to use their eyes more effectively, even with low vision.
The National Council for the Blind of Ireland provides a Low Vision Clinic at its headquarters in Dublin (45 Whitworth Road, Drumcondra). The service offers assessment, monitoring of the condition causing the visual impairment and training in the use of low-vision aids. Patients may be referred to the Clinic from optometrsits, hospital eye departments and social workers. The choice of appropriate visual aids will be influenced by the cause of the vision reduction, the person’s needs, age and temperament and any accompanying disability.
People have a right to the best treatment available, and decisions involving surgery must not be prejudiced by the fact that someone has a learning difficulty. In some cases, medical staff may be less inclined to refer patients with severe disabilities to eye-care specialists for corrective surgery; the first consideration must be whether an operation will improve a person’s quality of life or prevent deterioration. The area of consent to treatment is complex; the confidence of individuals with learning disabilities may be gained by providing a full explanation of the proposed procedures and reassurance that the hospital stay will be for a very short period.
With modern techniques, eye surgery now rarely involves more than a few days’ stay in hospital. However, nurses can rarely offer special individual care, and persons with learning difficulties may need additional carer support during their hospitalisation. It may be possible to arrange for pre-operative procedures to be completed on an outpatient basis, or by the general practitioner.
The above article was compiled from materials provided by the Multiple Disability Team of the Royal National Institute for the Blind (RNIB) in the UK. This service provides information and advice to individuals, staff, carers and advocates. They also organise study days and courses, and they publish Focus Factsheets, a series of leaflets for staff working with people with visual and learning disabilities. Details of these publications are included in the list of health resources on page 00).