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Refractive error, of course, is extremely common in nursing home residents. In the over 50 age group, nearly all residents will be presbyopic. Myopia, hyperopia, and astigmatism are quite common in all age groups. Proper correction can improve the visual acuities significantly. Studies have found that 20-40 percent of residents showed marked improvement in visual acuities after a complete eye examination. The optometric consultant is responsible for providing refractive and dispensing services or for arranging for them. The simple service of routine adjustment of eyeglasses is welcomed by both the staff and the residents. It is important to have this service available. Primary eye care services include the provision of postoperative care to residents. Nursing home residents will require these important services just as clinic-based patients do. With proper portable equipment these important services can be provided to residents without transporting them to the optometrist's office or the office of the surgeon. Postoperative care of residents after cataract extraction requires objective assessment of the cornea, anterior chamber, conjunctiva, the implant, the vitreous, retina, and intraocular pressure. This along with a detailed case history, visual acuity measurement, and review of medicines constitutes a postoperative visit. These services are convenient and cost effective if they can be provided within the facility. The postoperative course of YAG capsulotomies, laser photocoagulation, and glaucoma surgeries, among others, can be followed as well.
The vast majority of nursing home residents will not have had a vision examination for a number of years. Studies have estimated that visual impairment can be significantly reduced by the provision of appropriate optical devices. Eyeglasses represent the majority of optical prescribing needs within the nursing home. The majority of nursing home residents will be dually covered under both Medicare and Medicaid. Many state Medicaid programs have provisions for eyeglasses. Therefore, it is important to understand the provisions for eyeglasses under the individual state Medicaid program. If the resident is not covered under the Medicaid program for eyeglasses, the family or guardian should be informed regarding the resident's need for eyeglasses. It is often helpful if the family or guardian is approached through a familiar nursing home contact such as the social worker. The social worker is often more familiar with the level of family support for the resident than any other individual and can be an invaluable contact in working with the family. Once spectacles are prescribed, making sure that the spectacles stay with and are used by the resident is a challenge. Lost glasses are an extremely common nursing home problem. All spectacles provided to nursing home residents should be etched or labeled in some way for identification.Contact lenses within the nursing facility present a unique challenge. Aphakia or penetrating keratoplasty probably represent the most common conditions requiring contact lenses. The cognitive ability of the resident and his or her manual dexterity to handle and care for the lenses are key factors. If the resident is unable to care for lenses, nursing staff will need to be trained for the task.
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