The COVID-19 Pandemic has affected our health in a myriad of different ways. According to the REACT-2 Study, for example, over two million people in the UK may have suffered from Long Covid.
But, COVID-19 has also taken a huge toll on our eyes. Exactly how much is impossible to quantify. However, to mark National Eye Health Awareness Week 2021, a recent report commissioned by Deloitte Access Economics says nearly 3,000 people on these shores have lost their vision during the Pandemic. Part of the reason is the number of NHS eye appointments that were cancelled during the crisis. The Deloitte Access Economics study says that there were 4.3 million fewer eyes tests carried out in the pandemic. That’s 23 percent fewer examinations than normal.
COVID-19 has been particularly unkind on service users in social care, who rely on regular eye tests. As a disabilities specialist and a Registered Nurse, while I am not an expert in eye health, I’ve worked with a range of different age group, across a raft of settings for over 21 years.During this unprecedented crisis, I’ve witnessed first-hand the challenges that Registered Managers face to ensure that those they support receive the best eye care possible.
An inability to visit an optician during lockdown, or for an optician to conduct a home appointment for those confined to a residential home, has proved devastating for a multitude of service users. In some cases, but not all, it has led to “delayed identification and treatment for eye disease” as the Deloitte Access Economics study points out.
But it is not just elderly people in residential care whose eye health may have deteriorated during the lockdown. Statistics published by the RNIB show that one in ten people with learning disabilities also have “significant eye loss”, while six out of ten need glasses.[Office2]
It is vital, therefore, that Registered Managers are able to seek out the support that service users need. I can foresee a number of obstacles on the horizon, however. Currently, albeit at a local level, I am working with a GP federation to establish all of the staff in a surgery – or working with it – that are responsible for visiting care homes.
While I don’t have any data to share, the first major barrier, will inevitably come on November 11 when any optician visiting a care home will need to provide evidence to the Registered Manager that they have been fully vaccinated against COVID-19. The problem is that across the UK, nobody seems to know how many opticians have received both vaccinations, and I think it’s something that will only be established when the new legislation comes into force. While I don’t wish to make any predictions, I do think it is likely that the pool of opticians currently able to visit care homes will decrease. By how much, however, is the million dollar question.
To overcome this potential issue, there are a number of action points that Registered Managers can take. They can check care plans to see when service users last had an eye test. ]From a best practice perspective, if eye appointments are held annually and a service user is due a test after November 11, frontline managers could arrange the test to take place before November 11.
But, there are many service users who suffer from complex eye conditions, which require regular hospital check-ups with experienced ophthalmologists. Again, with a government consultation currently taking place, which will determine whether all health and care staff should be vaccinated against COVID-19 and flu this year, there are any known unknowns as to whether NHS eye appointments will be affected. In the event that they might be, Registered Managers, should have a contingency plan in place, which would help them and the service users they care for cope with any shortfall in appointments.
When eye check-ups have been cancelled or postponed, frontline teams should also closely monitor service users for any tell-tale signs that their eye-sight might be worsening. Has the individual suddenly begun to suffer trips, slips or falls, for instance? Can they read their book or magazine, or recognise the birds in the care home garden? Have they experienced pain, nausea, cloudy or blurred vision? Care and support workers need to note and collate this information in service plans and report any major issues to a local GP straight away.
But it isn’t quite as simple as that. Why? Well, take a person living with dementia, for example. They may not be able to communicate or even notice a change in their prescription. Therefore, it is up to professional carers to observe them closely and try to pick up on any subtle differences, record and log them in care plans and keep in regular contact with eye health professionals.
In different settings, carrying out such evaluations isn’t always easy – particularly in domiciliary care. Home care appointments, while extremely thorough, are often short. In a quarter of an hour or half an hour slot a professional domiciliary carer often only has time to meet a service user’s basic needs. However, that said, an experienced and well trained professional who carries out daily visits should be able to detect if something is not quite right with a person’s eyesight. If they do detect a problem, there are several specialist opticians that are set-up to carry out eye tests in a home environment that Registered managers can contact.
For those with learning disabilities, the challenges are slightly different. Many are able to visit an optician, but sometimes are nervous about having their eyes tested, especially if a test involves applying eye drops, which can be uncomfortable. There are a number of approaches, however, that care and support workers can take to make this experience more comfortable for service users. They can mentally prepare them for an appointment by gently talking to them daily – starting a couple of weeks in advance – about the eye appointment and possibly showing them pictures of the optician, their practice, the equipment that will be used and even the shop front on the high street, where the eye exam will take place.
This, and the other examples that I have mentioned, serve to remind us of the invaluable role that frontline care staff play in helping service users to best maintain eye health. They may not be opticians or ophthalmologists, but they add great value. in National Eye Awareness Week, perhaps we should recognise and thank them for their unheralded work which so often goes under the radar.