Meeting the eye health needs of vulnerable adults during COVID-19

The Optical Confederation’s Domiciliary Eyecare Committee (DEC) has produced guidance for health and care providers to support the provision of eye care to “extremely clinically vulnerable” and “clinically vulnerable” adults, as well as those unable to leave their homes due to physical or mental ill-health or disability during the coronavirus (COVID-19) outbreak.

The committee has called for governments, the NHS, local authorities and care home providers to work with domiciliary eye care providers to ensure that the clinically vulnerable, and extremely clinically vulnerable patients, “are not denied the eye and vision care they need in these very challenging times.”

In a statement, the committee noted that under COVID-19 measures, the UK health systems have identified shielded populations of “extremely clinically vulnerable adults” of approximately 2.5 million people. It is estimated there could be over twice as many “clinically vulnerable” adults who have been advised to isolate or may have chosen to do so.

We must not fail the most vulnerable in society by denying them the eye care they need to stay fit and well

“Nevertheless, the eye health needs of both groups, as well as those unable to leave home for non-COVID reasons, continue and have, arguably, become even more crucial during this period of social isolation,” the statement reads. “A condition which may have been safe to postpone ten weeks ago may now have become acute, especially for chronic eye diseases which may not be immediately obvious to patients or carers or ongoing conditions which need regular support.”

More than two million people in the UK live with sight loss severe enough to significantly impact their daily lives, the statement highlights, with around 79% of these over the age of 64. One in every three people aged 85 and over are living with sight loss.

The committee emphasised that vision and eye health problems can exacerbate the effects of isolation, and impact on other conditions such as cognitive impairment and dementia.

Co-chair of the DEC, Gordon Ilett, commented: “Vision and healthy eyes are critical to people who cannot leave home, who may have other long-term conditions or who are isolating. Eye disease is insidious and can be catastrophic. We must not fail the most vulnerable in society by denying them the eye care they need to stay fit and well.”

The committee has said that with more now known about the disease and how it is spread, as well as measures such as personal protective equipment, and infection prevention and control, care could be safely provided in private homes and care-home settings using ‘remote-first’ and ‘safety first’ principles and based on assessed risk for each patient and location.

To support the provision of eye care to shielding, isolating and domiciliary patients, the committee has published guidance for health and care providers, which links to government and public health advice, as well as guidance produced by various optical bodies.

Recognising that suspending all but remote care “was the correct public health response” in the first phase of the pandemic, the committee suggests, “We also know that the virus will be around for some time and possibly for the whole lifetime of some vulnerable patients.”

“This means that the balance of risk has now shifted,” the guidance continues, with a focus now on meeting individual eye care needs based on principles of informed consent and respecting the risks and “protected characteristics” of each patient.

The guidance highlights that the groups advised to self-isolate or shield may change over time and in response to local risk levels, adding that the provision of eye care will need to respond to these changes, “based on local public health advice and clinical judgement about risk and benefits to the patient and risk to others in the same premises.”