What to do when sight

loss occurs?

Helen May

RNIB Eye Health Advisor

Optometrist

Sight Loss Prevention Team

Introduction

Who are RNIB?

• UK charity

• Patient Voice organisation

RNIB Priorities:

• Prevention of unnecessary sight loss

• Supporting independent living

• Creating an inclusive society

Sight Loss Prevention

Reducing preventable sight loss is a key priority

• Public Health

• Commissioning eye and supporting services

• Addressing health inequalities

• Collaborative working

• Evidence building - data and resources

Sight Loss Data Tool

• Local, regional, national data on diabetes

• No of people with diabetes and diabetic retinopathy

www.rnib.org.uk/aboutus/research/statistics/pages/sight-loss-data-tool.aspx

Sight Loss Prevention

Campaigns scoping work:

• Aware of delays in treatment/referrals

• Problems with capacity

• Implementation of NICE DMO guidance

• Advocate for patients to access timely treatment

• Support clinicians and professionals

• Confidential and anonymous

Sight loss & health inequalities evidence

Community Engagement Projects

Community Engagement Projects (CEP)

DRS Barriers:

• Difficulty of managing all the appointments associated

with diabetes

• Limited understanding of how diabetes can cause

diabetic retinopathy

• Some confusion about the need for both DRS and eye

examinations

DRS Enablers/High satisfaction:

• timely notification of appointments

• minimal waiting time

• polite staff

CEP: Interventions

1. Increase uptake of DRS

• DRS reminder appointments sent via text message

2. Increase attendance at secondary care

• Targeted telephone reminders conducted by a

bilingual worker

3. Increase uptake of eye examinations.

• Health professionals providing key messages

• Community education campaign

4. Increase understanding of eye health and its

relationship to diabetes

• Implementation of a self-care tool for diabetic people

• Community engagement and awareness raising via eye

health champions and volunteers

Understanding diabetic eye conditions

Cyflyrau llygaid sy'n gysylltiedig â diabetes

Sight Loss in Diabetes

Reduction in the 'sharpness' of vision (visual acuity)

Loss of side or central vision (visual field)

Difficulties to detect contrast and seeing colours ('washed out')

• Face/Coin recognition

• Reading medicines & food

• Reading correspondence

(miss appointments/bills)

• Mobility difficulties

• Watching the TV

• Work

• Bus numbers

Impact of sight loss

• Emotional impact

• Loss of independence

• Lack of privacy

• Lack of support

• Reduced quality of life

• Risk to health

• Mobility

• Reading

• Falls

• Anxiety

• Social Isolation

Importance of Early Support

To help keep the patient safe, independent and reduce social isolation

Risk of depression in the elderly:

"Older people with sight loss are almost three times more

likely to experience depression than people with good

vision." (Evans, Fletcher and Wormald, 2007)

Important to acknowledge and treat otherwise all other

intervention may be of limited benefit

Where to now?

Help and support:

• Emotional support • Eye Clinic Liaison Officer (ECLO) • Emotional Support • Low Vision service • Rehabilitation services (social service) • Employment support • Education/children's service • Finance • Housing • Information and signposting • Local/national groups for people with visual impairment

Bigger, Brighter, Bolder

Making everything BIGGER: Easier to see

• Larger objects/larger print

• Magnifiers

• Moving closer to objects

BRIGHTER: Lighting

•Thomas Pocklington Trust

BOLDER: High Contrast

• Highlight Step edges

• Pencil v felt pen

Other considerations and aids

•Glare shields/ Hats with a brim

•White canes/ Mobility training

•Blister packs for medication

•Assistive gadgets

•Talking clocks, BP and blood sugar monitors

•Adaptations for insulin pens

•Talking books

•Assistive technology

•Kindles/iPads

•Befriending services

•Certification (CVI) and Registration

Certification and Registration

Certificate of visual impairment (CVI)

• Officially documents someone's vision loss

Registration

• CVI sent to the local authority and the patient is added

to the visual impairment register

Benefits:

• Access to local social services sensory team

• Access to work

• Travel discounts and support

• Reductions in council tax/Apply for other financial

benefits can be applied for

Importance of Certification

• Accessing social services sensory team and access to

work (Due to financial cuts)

• Enables the patient to become aware of the support

available to them

• Plan future health care services/social

services/education service provision

• Better understanding of eye care risk factors

• Does not reflected badly on the clinical success rating

of the hospital

• Delayed certification due to active treatment?

• Criteria for CVI states 'generally'

• LVL and RVI use?

Low Vision: Accessible DRS

Clinic:

• Layout of rooms

• Lighting of rooms

• Contrast of table edges

• Guiding into assessment room

Accessible information

• Appointment letter

• Results letter

Other:

• Signing consent forms Black felt pen

• Transport/Mobility

Action Mobile Resource Centre

• Information and signposting

• Daily living aids: talking clock, watches,

• Kitchen equipment, household products, DIY gadgets

• Daisy players for talking books

• Adaptive hard and software for computers

• CCTV magnifiers

Action Low Vision Centre (C&I)

Integrated low vision service for adults

Specialist clinic for people with learning disabilities

Rehabilitation (social services)

Low vision aids/Non optical aids

Direct links with:

• Emotional support

• Independent living coordinators

• Computer assistance

• Resource centre

• Other sight loss charities

• HES/GP

© RNIB 2011

Registered charity number 226227

Helen May

Eye Health Advisor

Telephone: 020 7391 2369

Email: Helen.May@rnib.org.uk

Website: www.rnib.org.uk/healthprofessionals

RNIB Helpline Number: 0303 123 9999

Action Low Vision Clinic: 020 7391 2241

Contact Details