2.2.1 Able to manage all px including those who have additional clinical or social needs

Question 1

What does the Disability & Equality Act (2010) state?

Answer 1

Patients should be treated equally and prevented from discrimination (e.g. in education,
employment, good service, facilities, transport).
For Optometrists:
* Provide the same level of care.
* Adapt your routine to accommodate a patient.
* Allow them to access the facility

Question 2

What are the different types of disabilities?

Answer 2

• Physical – Amputation, Motor Neuron Disease, Advanced MS
• Sensory – Blind or Deaf
• Intellectual – Dyslexic, Dementia, Down Syndrome
• Emotional – Anxiety or Depression
• Developmental – Autism

Question 3

What is the Low Vision Leaflet (LVL)?

Answer 3

Low Vision Leaflet is a self-referral to the eye clinic for eye assessment and determination of eligibility for RVI. Px fills out details, what they suffer with and specific concerns (e.g. cooking, crossing roads, coping at work etc.) and then this gets sent to visual impairment team who will facilitate patient care and support groups.

Question 4

What is Certificate of Visual Impairement (CVI) (Scotland)?

Answer 4

• need to refer px to get this
• consultant completes this and decides if px SI or SSI

Question 5

What is Registration of Visual Impairement (RVI) (England)?

Answer 5

• HES - before CVI is needed or where px has declined registration but wants advice
• If px presents to HES and not registered - hosp can write to social services to tell them they think px is struggling
• Voluntary and confidential

Question 6

What is the difference between certification and registration of visual impairment?

Answer 6

“certification” means receiving a medical document, usually called a Certificate of Vision Impairment (CVI), from an eye specialist confirming the level of sight loss
“registration” refers to the voluntary act of adding your name to a local council’s register of visually impaired people

Question 7

What happens at certification of Low Vision?

Answer 7

• Px needs to consent - can come off register if want
• Once certified, px registers with local services. Even those choosing not to be registered can recieve help
• Social services will conduct needs assesment to see what help px requires to remain independent (help w/ day to day tasks, keeping in touch with family, transport)
• Registration is routine referral

Question 8

What benefits does registration of Low Vision get the patient?

Answer 8

• 1/2 price TV licence
• NHS costs
• Council tax and allowances
• Leisure discount
• Free transport level of concessions depends on level of registration (SI/SSI) -> council gives card to prove entitlement
• Free transport

Question 9

What is the Access to Work Scheme in Scotland?

Answer 9

Allows individuals with low vision to receive financial support for assistive technology, like screen readers or magnification software, to help them maintain employment by providing necessary adaptations to their workplace or travel needs, essentially enabling them to perform their job effectively despite their visual impairment.

Question 10

What is the criteria to be registered SI (partially sighted)?

Answer 10

• VA of 3/60 to 6/60 (1.3 - 1.0) with full VF
• VA 6/60 to 6/24 (1.0 - 0.6) with moderate reduction in VF, cloudiness in parts of eye or lens removed and not replaced with implant
• VA of 6/18 or better (0.48) with significant VF defect e.g. whole 1/2 missing or lots of peripheral vision is missing

Question 11

What is the criteria to be registered SSI (blind)?

Answer 11

• VA <3/60 and full fields (<1.3)
• VA 3/60 - 6/60 (1.3 - 1.0) with severe decrease in VF (e.g. tunnel vision)
• VA of 6/60 (1.0) or above but with reduction in VF especially if lots missing in lower field

Question 12

What are the Class 1 Driving Standards? and VF requirements?

Answer 12

Class 1: All drivers to read in good daylight (with the aid of glasses or CL’s) a registration mark 79mm x 50mm from 20 metres OR 79mm x 57mm from 20.5 metres.
6/12 binoculary (0.3)

Class 1 Visual Field Requirements
* 120° horizontally with at least 50° to each side
* 20° above and below fixation
* No significant defects in central 20°

Question 13

What are the Class 2 driving standard? and VF requirements?

Answer 13

Class 2:
* Better eye must achieve VA 6/7.5 (0.1)
* ‘worse eye’ at least 6/60 (1.0)
* If corrected power limit +8.00D
Class 2 Visual Field Requirements
* 160° horizontally with at least 70° to each side 30° above and below fixation No
significant defects in central 30°

Question 14

What adaptations can you make to routine for px with visual impairment?

Answer 14

o LogMAR – Scored by letter (0.02 a letter)
o Bailey Lovie letters
o Pelli-Robson – Triplet of letters decreasing in contrast, test at 1m – each
letter is 0.05. lowest contrast where 2/3 seen determines CS. A score of 2.0
is normal while score below 1.5 suggest impairment.
o Larger fixation targets
o Autos/Ret
o Bracket
o Stenoscopic slit - determines cyl

Question 15

What adaptations can you make to routine for px with disability?

Answer 15

• accessible test room
• trial frame
• cyclo an adult
• dilate if adult px can’t stay still
• ophthalmoscopy over Volk
• Provide space for carer
• iCare/Perkins
• Confrontation and amsler
• Rely on objective over subjective (mental disability)
• Communication with appropriate carer/family member to highlight any concerns
  or needs of Px
• Remove obstacles
• Face the patient and speak clearly and concisely
• Use Kay’s Pictures or Tumbling Es