“The public’s perception of domiciliary has evolved”

One reason for this is that the number of beds in care homes has not increased much over the last 25 years, yet the number of people who would qualify for a home visit has more than doubled to over two million.

With this change in access to services, the expectations of customers has evolved too. As customers have experienced more sophisticated tests on the High Street, their desire to continue to receive the same level of care in their own home has increased their expectations of what is delivered as part of a domiciliary sight test. In addition, improved referral pathways have increased ophthalmology care for housebound individuals.

It is estimated that there will be over six million people in the UK who would consider themselves housebound by 2040. The challenge we have as a society is maintaining these individuals’ independence and maximising their quality of life. Poor sight is a significant contributing factor in the increased incidence of falls. It can also lead to feelings of isolation and depression, which in turn leads to increased rates of dementia. Sight loss also reduces physical activity and that in turn has a detrimental effect on a person’s quality of life, both physically and mentally. Regular eye exams are often missed by these individuals, yet many simply require an update in spectacle prescription, which could significantly improve their wellbeing.

Public perception

Over the years the public’s perception and awareness of domiciliary has evolved, and it continues to do so. Alongside this, more and more, as a profession, we recognise the important role we can play in supporting this growing group of individuals. However, performing an eye examination in a patient’s home or a care home is a very different environment compared to a High Street practice and presents many different challenges. This continues to make recruiting enough optometrists, into this area of the profession, a real struggle.

In my opinion, there are not enough optometrists, especially those with higher qualifications, currently providing domiciliary eye care. While this is partly due to the challenges of the working environment and transporting equipment, there is also the difficulty in obtaining further qualifications when you practice domiciliary.

Reflecting and demystifying

Practitioners, as well as patients, still have a number ofmisconceptions about the delivery of domiciliary eye care.

For optometrists, historically there was a perception that you would be seeing very frail individuals – both physically and mentally – in a care home setting, which may not have been the most appealing environment to work in. However, today the majority of domiciliary eye exams are carried out in individuals’ own homes.

As a domiciliary optometrist you have the possibility to serve individuals who are no longer able to access the High Street, and you have the opportunity to significantly improve their quality of life. In my experience, the regular positive feedbackI received from these people was always immensely rewarding.

As our population becomes more elderly and frail, the need for optometrists to offer domiciliary services will grow significantly in the years to come. The opportunity to offer additional ocular health care as more and more individuals struggle to attend ophthalmology appointments also means that we should be encouraging and enabling all of our domiciliary optometrists to upskill and obtain higher qualifications, so that we can best serve these people.

About the author

Paul Chapman-Hatchett has been a domiciliary optometrist for over two decades. He is an AOP Councillor representing domiciliary optometrists and in 2024 was elected to AOP Board.