by Dr Bibhuti Bhusan, Opthamilogist on July 8

Many Persons with Intellectual and Developmental Disabilities (PIDD) would benefit from glasses to help them perform activities of daily living

It is a statutory requirement under the Rights of Persons with Disabilities Act, 2016The appropriate Government and the local authorities shall take measures and make schemes or programmes to promote healthcare and prevent the occurrence of disabilities and for the said purpose shall—

a) undertake or cause to be undertaken surveys, investigations and research concerning the cause of occurrence of disabilities;

b) promote various methods for preventing disabilities;

c) screen all the children at least once in a year for the purpose of identifying “at-risk” cases;

d) provide facilities for training to the staff at the primary health centres;

Some of the signs and symptoms of visual loss in a Persons with Intellectual and Developmental Disabilities (PIDD).

Recognising and identifying visual impairment is the first key stage in accessing services. This can be difficult as some patients with IDD may have impaired communication abilities and be unable to attend regular eye checks.

Some of the signs and symptoms of visual loss in a Persons with Intellectual and Developmental Disabilities (PIDD).

Causes of Visual Impairment in Persons with Intellectual and Developmental Disabilities (PIDD)

• Refractive surgery

• Amblyopia

• Strabismus

• Congenital cataract

• Acquired cataract

• Nystagmus

• Corneal problems

• Optic pathway abnormalities

• Perceptive and interpretive problems

Signs and symptoms of visual loss in PIDD

Behaviours associated with sight loss in PIDD include:

• Anxiety in unfamiliar situations

• Unwillingness to venture out of their immediate environment

• Hesitancy on steps, at pavement edges or in poorly lit areas

• Depression

• Anger of frustration

• Eye poking or rubbing

• Reduction in social or domestic skills in participation

• Loss of interest in family, friends, TV or social activities

• Undue alarm at unfamiliar noises or when approached

• Self-injurious behaviour

Undertaking a traditional Snellen acuity test will not be appropriate for many patients with IDD. Employing the skills of an orthoptist is often useful to assess vision using forced choice preferential looking techniques or picture/letter matching tests. Other measures such as contrast sensitivity can be useful in demonstrating reduction in visual function.

A functional visual assessment may also be useful in determining how the patient uses their vision day to day, and establish if there has been a change in visual function to support the diagnosis of onset of ocular pathology.

Planning a clinic appointment

Ophthalmologists should be proactive in identifying PIDD who attend clinic in order to ensure they receive an appropriate level of care. This is most effective if done when triaging referrals so adequate preparation can be offered to the patient and their carer, which will in turn make the hospital visit go more smoothly and efficiently.

Reasonable adjustments which can be made to facilitate access to eye clinic for patient with a IDD.

Making the appointment

• Administration staff should be made aware that changes can be made

• Where a patient is known to have ID/DD and visual impairment, alternative methods of communication with the patient other than postal letter should be considered.

• Early appointment when clinic less busy

• Particular time of day to suit carer/patient depending on cooperation

• Kept waiting as little as possible (notes passed straight to doctor or nurse)

• Visit to the department prior to appointment

• Split visits (to have VA, to see doctor) to reduce time in eye clinic

• No eye drops or do eye drops at home first

Patient information

• Hospital providing information on what sort of tests might be included in visit to clinic so patient can be prepared

• Carer providing information about patient medical condition and patient’s visual function

• Carer and patient to inform doctor of patient attitude to being touched, communication etc

Arriving at clinic

• Reception staff aware of adjustments which can be made

• Nursing staff alerted as patient checks in – quiet area available, if referral had not indicated a intellectual disability, autism, learning disability, decision made about type of vision test suitable

• Medical staff alerted so can prioritise patient and minimise wait, get equipment together, adjust room so suitable for patient

Visual assessment

• Snellen, Kays, matching

• Orthoptic colleagues to assess vision

• Functional assessment - Why is there concern about vision? (see later)

Examining the patient

• Explain what is going to happen

• Warn patient before turning lights off

• Warning patient before they are touched

• Inventive ways of achieving what is needed

• Alternative ways of checking eye pressure

• Minimal use of eye drops/appropriate preparation

Providing feedback/communication

• Provide information leaflet/easy read information

• Consider another appointment to come back and ask more questions