On the ground
Coronavirus: on the ground in Gateshead
Low vision optometrist Stephanie Cairns on supporting those with sight loss during the pandemic
As the coronavirus (COVID-19) pandemic transforms the way optometrists practise, OT is sharing the experiences of optometrists across the UK and beyond. If you, or a colleague, is interested in sharing your story please get in touch by email.
My clinical work all but stopped during lockdown. I have continued as a clinical adviser to the low vision clinic at Sight Services, a sight loss charity supporting people in Gateshead and South Tyneside. When COVID-19 kicked off we made a decision early on to suspend the low vision clinics. The average age of our clients is around 78, often living with multiple health conditions, so they are a high-risk group.
Sight Service is funded to offer an integrated service which combines support, rehabilitation and a low vision service. During lockdown, the support side of the charity integrated with the local authority response, providing assistance to those over the age of 60 who were vulnerable.
I have been there in the background as an adviser if there is a specific question or client that I could help with. We have been able to continue to replace broken magnifiers or provide extra equipment as required out of the low vision budget. I’m now triaging those who would have been due a two-year review appointment during lockdown and offering a modified remote low vision consultation where suitable. Hopefully we’ll be able to offer face-to-face appointments to those who would like one soon.
The local eye department has a backlog of people who were due to be seen, so I expect new referrals via this route to be quiet for a while. We expect to be busier in October or November when referrals to the low vision clinic following certification of visual impairment registration start to pick up. However, we also received referrals directly from primary care optical practice and GPs, so potentially these may start flooding in earlier.
As well as providing equipment, sight loss charities can help with things like benefit claims, supporting people at work or getting them back into work. In normal times they would also run support and activity groups to help break down social isolation. Our team have been increasing their social media presence to try and get people engaged.
Before COVID-19, I worked a flexible week, but it averaged as two days at Sight Service for the low vision clinic, two days as a locum in primary care, and approximately one day on my local optical committee (LOC) duties. In the first few months, there was a lot of LOC work because there were so many queries about what was going on.
The idea of everything stopping was quite anxiety-inducing. Our LOC had started sending out a newsletter every six months or so, but we ended up producing six newsletters in the three months since the outbreak changed primary care optical practice forever. We pulled together any local updates alongside the national guidance. We’ve also relaunched our website.
I have been working in low vision for around nine years. Low vision is an area that is misunderstood and there is not enough support for people who have visual impairment within the clinical setting. In hospital, low vision is often only offered if the person reports they are struggling, something people often don’t like to admit, or offered around the point of registration.
In primary care, there is no funding for it in most places. Being able to provide support at an earlier stage before people are registered as sight impaired is very rewarding but requires referrals from optical practices, GPs, adult social care, and community NHS teams such as physiotherapists and occupational therapists, amongst others.
Poor vision has a big impact on other parts of a person’s life. It can affect whether someone can cook properly, whether they can shop properly and whether they can get out to go for a walk or socialise with their friends. There are many issues that are not just whether you can read black letters on a letter chart. When you can support someone with their functional everyday living – I find that really rewarding. I like having a chat and the patients like having a chat with me.
Sometimes, for people who have trouble with their eyesight, all they need is for someone to listen to them. Within a GOS sight test, you don’t have time for that. Maybe with longer appointment times due to social distancing we will have time to talk to patients about how they are managing at home and not just about their glasses. My professional sphere is wider because I work with people who are involved in adult social care and local authorities. That has helped my LOC work.
COVID-19 started aggressively in London and took a little while to spread further north. It gave our area a little bit more time to prepare. The lockdown still came as a shock though. I don’t think our optical practices had been expecting a lockdown, let alone the uncertainty about ongoing financial funding.
I also worry that during this period people who are living with sight loss will not have been automatically been directed for any support. We’ve had a trickle of new referrals as the eye clinic liaison officers have continued to work remotely, but there will have been people who were missed. While the HES were figuring out how they could close down routine services, they wouldn't necessarily have directed patients to the eye clinic liaison officers (ECLOs).
What motivates me to advocate for low vision services is that I see too many people who haven’t had the support early enough. They have been struggling on for two, three, four or five years before realising that there is help available. People who should have directed them for support haven’t done the signposting.
I see too many people who haven’t had the support early enough. They have been struggling on for two, three, four or five years before realising that there is help available
Some conditions were becoming less common before COVID-19. We weren’t seeing as many diabetic retinopathy cases coming through the low vision clinics because of retinal screening. I can envisage that we will have a period where cases increase. Lockdown may have affected how well people manage their diabetes, and it meant screening was suspended.
I’m not sure when we will be ready to offer face-to-face low vision services again. I can’t see us being properly back up and running until the autumn. The people who we support are probably not going to be comfortable coming and seeing us until then.
I would recommend that optometrists and dispensing opticians start directing people with low vision issues directly to their local ECLO. They are still working and can refer them through to the support they need. Also, in the long term consider making a dual referral; one to your local low vision clinic and another for support via the ECLO. Then the support process can be started within a shorter time scale.
There is a big cohort of people who hear that ‘nothing can be done’, and they don’t come back for regular eye care after that. I do think that primary care has a bigger role to play. Maybe something positive that will come out of COVID-19 is that we will achieve system reform. If there is more monitoring of medically stable eye conditions in primary care then we will be in a better position to pick up the people who are living with visual impairment that affects their daily life. We could help them ourselves rather than relying on the hospital eye service. We would be in a much better place to use our knowledge in a way that goes beyond glasses prescriptions.
• As told to Selina Powell.