Multi-disciplinary care of the patient with low vision and eye care pathways

Question 1

what is a low vision service defined as

and who created this definition

Answer 1

‘’A Low Vision Service is a rehabilitative or habilitative process which provides a range of services for people with low vision to enable them to make best use of their eyesight and visual function to achieve maximum potential’’

Recommended Standards for Low Vision Services: Outcomes from the Low Vision Working Group, commissioned by the Eye Care Services Steering Group

Question 2

list 3 things that a low vision service is about

Answer 2

• Not just about prescribing glasses or magnifiers
• Should be multi disciplinary and multi agency
• Disorder, Impairment, Disability and Handicap

Question 3

what is the term disorder used to describe and give an example

Answer 3

the impact of the disease or injury at the level of the organs e.g. AMD

Question 4

what is the term impairment used to describe and give an example of this in AMD

Answer 4

the reduced functional performance as a result of the disease e.g. AMD = reduced va and cs

Question 5

what is the term disability used to describe and give an example of this in AMD

Answer 5

the consequences of the disease in terms of the effect of the impairment on the patient’s abilities e.g. AMD = reading difficulties and recognising faces

Question 6

what is the term handicap used to describe and give an example of this in AMD

Answer 6

describes the social consequences of the disease e.g. AMD = the patient may not go out because they cannot recognise their friends

Question 7

list the 11 services that the low vision service provision consists of

Answer 7

• Referral for diagnosis (of the eye cond) and surgical/medical treatment
• Referral to low vision services: low vision aids, best optical correction, assessment of functional vision (e.g. va and cs)
• Referral for annual eye examinations
• Information about the eye condition
• Registration as sight impaired and severely sight impaired
• Information about services
• Assessment of Needs and understanding the limitations
• Emotional Support
• Provision of daily living and mobility aids and training (home, school and work environments)
• Changes to the environment
• Continued Support

Question 8

why does the low vision service provision provide information about the eye condition

Answer 8

because the patient should understand the prognosis of their condition and how it will affect their life

Question 9

why does the low vision service provision provide information about other services

Answer 9

there may be other services within the community of the patient

Question 10

how does the low vision service provision provide emotional support

Answer 10

by referring the patient to counselling services if appropriate
because depression is common in VI

Question 11

how does the low vision service provision provide changes to the environment

Answer 11

social services will come to the patient’s home e.g. look at their lighting and suggest doing things to the house which will be better for the patient
or they can go to the child’s school

Question 12

why does the low vision service provision provide continues support

Answer 12

because the patient should have access to continued support incase their condition or lifestyle gets worse

Question 13

list 6 places in the UK that a low vision provision service can take place and the % of patients that go to each location

Answer 13

• Mostly hospital based (65%)

Other location include

• Social Services Departments ( 6%)
• Voluntary Organisations (E.g. RNIB) (10%)
• Optometry practices (15%)
• Specialist Teachers (3%)
• University Eye Clinics (1%)

Question 14

list the 2 different typical low vision pathway options for an adult

Answer 14

1) 
High Street Optometrist (will refer their findings e.g. AMD)
GP
Hospital LV Clinic
Social Services

2)
GP (px can go directly to)
Hospital LV clinic
Social Services

Question 15

what is the disadvantage to the current low vision pathways for an adult

Answer 15

Waiting lists are often very long both for LV clinics and Social Services

Can sometimes take up to a year (to get px to be seen in the hospital)

from the optom to the GP - can take about a week
at the hospital, the px is then provided with LV aids
from hospital to social services - can take weeks-months

Question 16

what is the typical low vision pathway for a child

and how does this compare to an adult’s and why

Answer 16

GP, refers to…
Hes - Child Development Unit (paediatrician, educational psychologist, physiotherapist, occupational therapist, social worker) Other appropriate sources of help depending on what the child has

4 stage code of practice

Children who get referred to the Hes, tend to stay at the Hes where they get services and help from the LV unit.
Also because they’re known to have a visual impairment, they get help from SENCO

They get a Statement of Needs (VI children typically have this)

A child’s low vision pathway is more simpler and shorter waiting list and get more help and a lot faster than an adult, because visual impairment in children tends to get identified quite early on

Question 17

who are SENCO and how are they there to help VI children

Answer 17

Special Educational Needs Co-ordinator

Help VI children’s educational needs who can request assessments from outside specialists

Question 18

as well as SENCO, who else can request assessments from outside specialists for children in school

Answer 18

the local education authority

Question 19

which type of children get put into mainstream schools and which type of children get put into socialist schools

Answer 19

• Mainstream schools = if the child only has a VI and no other problem
• Specialist schools = if the child is severely visually impaired or has got other problems too

Question 20

give 3 reasons why it is important for there to be low vision pathways available

Answer 20

• 13% of SI & SSI people of working age and 17% SI & SSI people of retirement age: No access to low vision services in the year following certification.
• For people certified in the previous year these figures increase to 44% and 55% respectively.
• Many are not aware of the services offered (e.g. free LV aids under the NHS etc)

Question 21

what happens in the 1st stage of the Proposed Low Vision Pathway: Department of Health (2003)

Answer 21

1. patient is referred to the low vision service (LVS)

• referral may be from secondary care, GP, social worker, rehabilitation officer, community nurse, OT etc or may be self referral
• patient may have an LVI, RVI or CVI

px should be able to refer themselves into this service as well
px does not need to be registered to access the service and don’t need to have a LV leaflet or referral of visual impairment

• all patients are contacted by LVS within 10 working days and an appointment should be arranged

Question 22

what happens in the 2nd stage of the Proposed Low Vision Pathway: Department of Health (2003)

Answer 22

2. Patient attends LVS
   - it must be ensured that theres good co-operation between health, social care and the voluntary sector, so the px gets the help they’re entitled to
   - LV service should consist of a full sight test
   - px should be given information on their eye condition, what they’re entitled to and information about local services, counselling and advice on employment or education
   - they should have access to LV aids and advice on lighting and home adaptations needed and be able to get them through social services
   - patient should be referred to other areas of health and social care, including certification if needed

Question 23

what happens in the 3rd stage of the Proposed Low Vision Pathway: Department of Health (2003)

Answer 23

3. Patient has follow up visits as needed
   - visits may take place in the patient’s home or elsewhere
   - visits will be by appropriate member of the LV team

This is called the enhanced service pathway, which is present in some on the UK, but not widely implemented

Question 24

list the 6 advantages of the low vision pathway

Answer 24

• reduce unnecessary referrals to the hospital low vision service
• reduce patient anxiety and increase capacity within the overburdened hospital clinic
• provide a more cost effective service with a greater number of patients being managed within the primary care setting
• high quality low vision assessment, information and clinical support, and
• where appropriate, low vision aids (LVAs), daily living aids and follow-up in a community setting in a convenient location for them
• provide accredited theoretical training which supports the pathway

Question 25

explain how the welsh low vision scheme works

Answer 25

Accredited Optometrists provide the service in the community

Accreditation via Cardiff University

No charge for the appointment

LVA are issued free of cost on loan

Vision passport

Referral via GP/Optometrist/Social Services/Community Services/Ophthalmologist

Or px can self refer for a Lv appointment

Question 26

what is an advantage of the welsh low vision scheme and what is a disadvantage

Answer 26

Advantage:
much more closer to home, not a long waiting list, is a good service and is cost effective way of providing LV services

Disadvantage:
not all can access the service because they need an ambulance for minority of the patients who’s lv services that need to take place in hospital

Question 27

list the 13 Personnel Involved in Low Vision Services and their roles

Answer 27

• Carers: help to look after VI people, bring them to apps etc
• Dispensing Opticians: can do a special course and then start dispensing LV aids course through ABDO
• General Practitioners: important role = referring patients into the hospital LV service provision and referring patients for counselling and emotional support
• Occupational Therapists
• Ophthalmic Nurses: in hospitals, help dispense LV aids
• Ophthalmologists: for diagnosis and management
• Optometrists: for diagnosis and help with providing LV aids and refraction
• Orthoptists: in hospitals, provide LV aids and emotional support
• Rehabilitation Workers/Officers: work within the community and social services. they go to people’s houses and see if theres any way to modify the environment and house and provide orientation and mobility training
• Social Workers: help give advice about benefits
• Voluntary Workers: ork in hospitals or for charities, help support VI people
• Eye Care Liaison Officers (ECLOs): work within hospital and main role = to act as a bridge between hospital and social care. some hospitals will have an eye care liaison officer.
• Specialist Teachers: work in schools with VI children and provide support. LV child in LV clinic may come with them as wants to see how best to help this child

Question 28

what is the aim of vision 2020 UK and what are their 7 objectives

Answer 28

Facilitates collaboration organisations within the UK, which focus on vision impairment

Objectives
To prevent avoidable blindness

To improve the quality of services to vision impaired people

To improve the training available to professionals providing advice and services (so they feel more confident in providing services to VI patients)

To improve communication between organisations within the VI Sector

To improve the availability of information to vision impaired people (in accessible format)

To ensure that the voices of the vision impaired are heard when planning services and their opinions sought on key issues affecting their lives

To raise public awareness of the issues and problems relating to sight loss

Question 29

list 3 other countries which also have models of LV service provision

Answer 29

Sweden
Spain
United States of America