Providing domiciliary eye care during the pandemic

As the owner of a small domiciliary eye care business, which I run with my wife, we had been closely following developments over the emergence of the virus. We go on domiciliary visits together, and I remember us talking about what changes we should introduce before entering people’s homes. Our safety and that of our children and our patients was at the forefront of these discussions.

It soon became apparent in the weeks leading up to 23 March that our patients were beginning to feel uneasy over visits to their home. Whilst we had taken the decision to start cancelling routine appointments, patients were also requesting to postpone their eye examinations. At the time it felt quite surreal, as it was a virus which medical experts and the scientific community were still learning about.

When the national lockdown was announced, it partly came as a relief, even though we were fully aware that the announcement would impact our business and livelihood. The guidance issued by the College of Optometrists provided us with the clarity we needed to advise our patients.

As a mobile business, we do not have premises like a High Street opticians, and were therefore ineligible for grants provided by local authorities at the time. Fortunately, NHS England agreed to pay all NHS contractors a monthly payment based on average claims submitted prior to the pandemic. This was a huge relief and helped to keep the business afloat, during uncertain times.

During this period we stopped sending out reminders and paused any advertising we had booked. However, whilst we were not offering routine eye care, we were always available for telephone triage and we continued to provide essential and emergency eye care.

We also repaired and provided replacement spectacles. Repairs would be carried out on the doorstep and we delivered spectacles by hand.

When you think about an Amazon delivery driver who puts your package on the doorstep, rings the bell and leaves, we could not do that due to the age and capabilities of our patient base. We had to carefully consider how and where we left things. We would put the spectacles in a carrier bag and tie them to the door at arm height so they were reachable.

I would wait to make sure they were collected and then call to make sure the patient was inside safely before I left. This was at the time when we were all queuing outside supermarkets, socially distanced, just to purchase food and essentials.

Looking back, we have come a long way since the early days of the pandemic. Vaccines and COVID-19 tests are now available and we understand much more about the virus. It is easy to forget just what it was like during the first lockdown. The one thing I can recall is feeling quite uncertain as to when visits would resume. We also had the challenge, like many families, of homeschooling our two children and looking after my parents, who were shielding in their own home.

We had to carefully consider how and where we left things. We would put the spectacles in a carrier bag and tie them to the door at arm height so they were reachable

Business impact

The pandemic, and the subsequent restrictions on routine eye care, has meant that over the last two years we have had to adapt. As a small business, we are still recovering.

Pre-pandemic, we received new patients through word of mouth, referrals from other health and social care professionals, and advertising. During the pandemic, the frequency of health and social care professionals entering homes either decreased or paused. We stopped advertising for over a year. This did impact on the amount of new referrals we were receiving.

The changing nature of local restrictions and the tier system did affect the momentum of our business, and at times it was difficult to get going again. However, I love seeing and supporting our patients. Being a domiciliary optometrist has never felt like a job, and whilst it has been tough, I’m optimistic for the future.

We have really turned a positive corner in the last six to 12 months. We have started to advertise again and are receiving calls from new patients. We are sending recalls again, and old patients are getting in touch to request home visits. We are also rebuilding our network with other health and social care professionals as many past relationships have dissolved as people have moved on. I am confident about the business in 2022.

The new normal

As a business operating today in the current new normal, we have noticed more requests for eye care at home from younger adults, particularly those with mental health problems. Prior to the pandemic, a lot of these younger adults would have been unaware that they could have their eyes examined at home. We have noticed that public awareness of domiciliary eye care has grown. This is certainly a positive that has come out of the pandemic.

We have also seen an increase in referrals from High Street opticians who are perhaps struggling with their own patient backlog due to the pandemic, and can no longer balance this with offering domiciliary eye care. Furthermore, we have observed GP receptionists encouraging patients to contact their local opticians for eye care-related issues, and that includes domiciliary eye care.

We are living longer, and we want to stay in our homes for as long as we can. I think domiciliary optometrists have an important role enabling people to do just that and ensuring their ocular health and vision remains the best it can

Improving awareness

The vast majority of optometrists in the profession will have never experienced domiciliary work before, or perhaps had a bad experience in a care home many years ago. However, the sector has advanced greatly over the last decade and the equipment available to domiciliary optometrists is so much better now.

Domiciliary optometrists only see a handful of patients a day and there is less commercial pressure associated with the role. We have iPads with efficient sight test charts – using these applications, you can enter the distance from the patient and it will scale the letters up and down accordingly. We also have portable slit lamps and visual field screeners that help obtain a more detailed examination. I would recommend that all optometrists who have not worked in domiciliary before, to shadow someone to see what it is really like.

I believe there will be an increase in demand for domiciliary eye care in the future. We are living longer, and we want to stay in our homes for as long as we can. I think domiciliary optometrists have an important role enabling people to do just that and ensuring their ocular health and vision remains the best it can.

About the author

Harjinder Sunda is a domiciliary optometrist and owner of Eye Clinic at Home

• As told to Emily McCormick.