Lecture 2, 3, 4 - LVA assessment + Reg Flashcards
- LVL Form (Low Vision Leaflet)
- Issued to patient by optometrist
- Self-referral form
- Access to social services
- Supplied by social services departments (SSD)
- RVI Form (Referral of Vision Impaired Patient)
- Issued by ophthalmology department; (e.g. ophthalmic nurses, junior doctors, orthoptists,
optometrists, dispensing opticians) - Application for access to social services
- CVI Form (Certificate of Vision Impairment)
- Certifies patient as blind, completed by consultant ophthalmologist
- Certifies patient as blind
- Information to census office
- Access to help is not dependent on registration
Paediatric CVI Form
- This is to be completed in addition to the standard form and contains details about the
disorder(s) resulting in visual impairment of the paediatric patient.
What is the registration process?
- Copies of the completed CVI are sent to local social services department, GP & Office of Population Censuses and Surveys for Research
- Social worker visits patient to discuss if they wish to be registered or need a community care assessment
- If there’s a long delay can be back dated
- Children registered blind after 4 years old unless obviously no sight
- Patient can then receive benefits of registration
Why should a patient get registered?
To determine funding & resource allocation it is important that accurate statistical information
about the number of blind & PS patients is available nationally & for each local authority area.
Estimates suggest that up to 50% of patients who are eligible are not registered.
Whats the benefits a registered patient can receive?
- Financial help (extra benefits and concessions e.g. income tax relief & VAT exemptions)
- 50% off TV license for blind, not PS!
- Free BT-directory enquiries service
- Free GOS sight test (England)
- Transport (free in some areas, disabled car badge)
- RNIB- talking books & many other very useful services
- British wireless for the Blind Fund- radios
Registration – Disadvantages and problems with the process*
- Health care & other professionals may not tell patients about registration and it is often done as a last resort by ophthalmologist
- Poor communication between professionals involved- ophthalmologists, social workers, optometrists etc.
- Long waiting times
- Not enough social workers - may not be trained in dealing with LV patients
- Budget cuts & lack of funding
Low Vision Aid Assessment: Difference between normal eye exam
- There is not one unique outcome or solution fot the Px (e.g. VA of 6/6)
Points to consider before you start low vision assessment:
- What does the patient want you to do (and is this possible)?
Px expectations may be too high or very low
Px may be distressed, disillusioned & tire easily
Poor motivation - The patient must agree with what you want them to do - they make the final choices!
What points can make LVA’s time consuming?
- Adjust your speed to the patient (e.g. Elderly, children) and avoid unnecessary tests/procedures
- Keep talking to the patient. Don’t use gestures which they might not see!
- Get all their current/past spectacles and magnifiers if possible
- Encourage carers/family to be present unless patient objects
- Px may have other disabilities e.g be prepared to cope with hearing loss as well
What general observations can be done from first contact with the Px?
- Are they bothered by bright light?
- Any physical infirmities, which restrict range of activities they need to undertake and limit
their visual requirements, but also restrict the ability to handle LVAs. - Do they look straight at you when talking, or use eccentric viewing?
- Can they navigate independently, or need to be guided? If guidance is required offer your arm and use the correct sighted guide technique.
How to correctly guide a VIP?
– VIP follows half a pace behind
– VIP takes guide’s arm slightly above elbow
– Change to holding wrist if space narrow (or guiding child)
– Crowds: in single file
How steps, doors and chairs are handled with a VIP:
Steps
– keep up a running commentary
– say if they go up or down
Doors
– VIP on same side as hinge
– Guide opens door and “hands it” to VIP
Chairs
– approach from behind and put VIPs hand in centre of back-rest, or
– approach from in front, and put their hand on arm-rest, or seat
– VIP stands with back of knees touching edge of seat before sitting
– Guide should say if there are any obstructions round the chair
Visual status questions during H&S:
- Distance and Near Vision (ability to read newspaper, watch TV etc)
- Mobility
- Everyday tasks (e.g. kitchen)
- Hobbies or interests
- Different lighting conditions
Some practitioners use questionnaires to assess visual status
Whats important about patients saying they cant see/read anything?
What they actually mean is they don’t enjoy reading, because it is difficult, but it is important to find out what size print they would be able to manage, as this is useful when calculating their magnification requirements
Ocular and General health history:
- Onset of impairment, duration and circumstances
− Stability of vision, difference between the eyes - Ocular condition if known
− Cause, duration & onset (sudden onset patient may be too upset for assessment)
− Stability & prognosis (deteriorating, improving or stable)
− Current, past & future treatment - General health and medication
- Physical infirmities (e.g. Arthritis or Parkinson’s - can’t hold hand magnifier.)
- Registration of vision impairment
Previous & Current Low Vision Aids history:
- Previous LVA assessments and previous LVAs used?
- Important: Have they previously tried LVAs that they didn’t find useful and Why?
- Current LVAs & spectacles used?
− Record VAs and details of currently used LVAs (e.g. power /magnification,
how old?, condition etc. )
This is important because if a px used to be able to read with a magnifier, but now can’t, their eye condition has deteriorated
Occupation & Education:
For patients of working age this is relevant as it will help you establish target VAs, required
working distances and magnification needs.
Patients Motivation & Expectations during history:
- What does the patient hope you can do for them?
- Is their expectation realistic?
- If their expectation is unrealistic try to let them down gently, but do not promise things
you can’t deliver!!
Patient motivation has major outcome, if a px is more positive and willing to try new things, they are more likely to succeed using them
Social Circumstances & Family history:
You may sometimes need to initiate a referral to social services/voluntary organisations:
* Live alone?
* Family & friends?
* Attitude of patient (angry, denial, confident, unconfident, depressed or accepting)
* Attitude of family (caring & supportive, over-helpful or uncaring)
Requirements & Priorities:
- Important to prioritise, unlikely solution for all problems
- Different LVAs will be required for different tasks, px may have many LVAs
Psychological Aspects
- patients must be willing to accept help
- Beware of patients that don’t want help because they dont want to be a burden
- Loss of vision is a form of bereavement, and the adaptation to loss is known as the Loss model
What are the 5 stages to the Loss Model
The Loss Model is probably most appropriate to sudden visual loss. The five stages are:
1) Denial & shock “It can’t be happening.”
2) Grief “I used to do such a lot, now I can’t do anything.”
3) Anger “Why ME? It’s not fair!”
4) Depression & apathy “I’m so sad, why bother? I’m sure you will not be able to help me”
5) Acceptance “It’s going to be OK.”
