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I could not live without…

My Low Vision Service Wales LVA kit

Independent practice owner and low vision-accredited optometrist, Andrew Hobby, explains how his low vision aid kit is a must have in practice and on home visits

16 Sep 2018 by Emily McCormick

The Low Vision Service Wales (LVSW) began around 15 years ago. A key part of the wider Wales Eye Care Scheme (WECS), the idea was to make the supply of low vision aids (LVAs) to patients quicker and easier, whilst at the same time reducing the burden on the hospital eye clinics.

 At present there are over 180 accredited practitioners across Wales taking part in the LVSW. Most will have a full LVA kit, which ranges from simple magnifiers, typoscopes, task lights and UV shields to the latest electronic gadgets complete with multiple functions. Patients can be referred into the service by themselves, family, friends, doctors, social services or by their optometrist, and are seen within two weeks.

The low vision assessment

Each assessment can last an hour, with another appointment on collection to revisit use of the LVAs. During the session, what the patient most needs help with is discussed, for example reading, cooking, watching TV, paying bills etc.

A maximum of three LVAs are dispensed on the first occasion so that the patient doesn't feel swamped and end up not using any of them. The aids are supplied on an ‘on loan’ basis, with free repairs and replacements. The patients are then reviewed yearly to review their needs. Any aids that are in good condition but are no longer appropriate are returned to the scheme’s HQ in Carmarthen so that they can be refurbished and recycled.

"With the tsunami of technology in everyday life, the resistance to using the high-tech devices is gradually being eroded…The reverse contrast feature is usually the clincher"

Gaining accreditation 

Reaccreditation for practitioners takes place every three years via online lectures and a series of workshops, as well as peer review sessions at various locations throughout Wales. 

During these meetings I get to network with fellow practitioners, charities, support groups, LVA suppliers, patients and the sensory care teams from our area. Linking up with these groups is particularly beneficial as we are able to refer patients directly to social services, GPs or other care providers if we feel they need further assistance. The WOPEC training days cover a wide spectrum of related topics including recognising signs of depression, risk of falls and cerebral visual impairment.

To qualify for an assessment, a patient’s vision has to be equal to or less than 6/12 or N6 with a +4.00 add. This may sound like a low threshold, but I find it is a real strength of the service. N6 at a push in a well-lit consulting room does not equal comfortably reading a newspaper at home or, more importantly, the pint on a packet of tablets. 

Furthermore, unfortunately, a dry age-related macular degeneration sufferer is often at the start of a gradual deterioration. If they can use a relatively low powered LVA at this point, there is more chance of adapting to the greater magnification but small field aids further down the line. 

Inevitably the majority of users are older patients. However, we do have some from the school and working populations. Most are very receptive to the idea of using LVAs, but it is always worthwhile explaining why the appointment is not about ‘just giving me a stronger pair of specs.’ Likewise demonstrating there is no magic magnifier that covers all eventualities is time well spent. 

With the tsunami of technology in everyday life, the resistance to using the high-tech devices is gradually being eroded. And the electronic devices are becoming ever more popular. The reverse contrast feature is usually the clincher.

Practitioner benefits

It is very satisfying being able to help someone continue with their favourite pastime and maintain their independence. The kit is very extensive filling a couple of medium sized cases, as well a double cupboard in the consulting room. It fast became a ‘must have’ on domiciliary visits. However, I soon learned to study the record cards before setting out and to take my own mini kit, containing just the aids most suitable for the patients I am seeing that day. It was either that, buy a bigger car or have a loyalty card with my osteopath. 

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