Feature, Orthoptics Australia

Low vision services and border restrictions

The logistical headaches associated with COVID-19 restrictions are most pronounced in border communities. Orthoptist MEAGAN ANDERSON discusses the impact it is having on low vision clients and clinicians.

As an orthoptist working on the New South Wales and Victorian border, I can only describe this as being a case of doing what you can, while you can.

The border community sees itself as one, albeit with separate driving laws and constant competition for which side has the best coffee; and the health impacts are starting to become more apparent with increasing restrictions and heightened anxiety to follow the rules and exercise common sense as much as we can.

Meagan Anderson.

The sometimes vaguely-worded border permits for both clients and clinicians – and increased travel times for local and surrounding areas attempting to access essential health services (which are usually only present on one side of the border) – have led many community members to effectively become “hermits”.

They are avoiding health services because it is proving just too difficult to access. The associated risks of developing further eye and general health complications are high and have been reported elsewhere.

As a low vision orthoptist, my role incorporates functional vision assessments, strategy and equipment recommendations, and counselling through vision loss. The rates of depression and anxiety skyrocket with any form of vision loss, more so in this current COVID-19 climate.

Trialling magnifiers and other reading devices is not appropriate via telehealth; for both the client’s (and clinician’s) peace of mind, a physical trial is required, particularly for funded equipment via the Department of Veteran’s Affairs or the NDIS.

The delivery, repairs and trial of devices, and the personal protective equipment (PPE) and increased time required to ensure our equipment and personnel do not inadvertently spread the virus, has become even more of a logistical nightmare in recent months.

Home visits are traditionally utilised because they provide better context of the client’s home and lighting environment and communication is easier when demonstrating strategies; for example, when watching television, and how to find and cut up food when the chopping board is in a dark corner of the kitchen.

This is especially useful for our more rural clients, as our region covers a 200km radius (100,000km2 area), and access to equipment is otherwise extremely limited. In a single comprehensive session we will often assess, set up and provide training on equipment.

The travel restrictions, and particularly the inability to physically attend aged- care facilities, has restricted our efficiency in this area, and a number of clients have refused our services purely because we are from the “border bubble”.

Telehealth has been utilised as much as possible, but only works when the person on the other end has enough vision to see how to use their phone and/or computer in the first place. Additionally, “black holes” in internet coverage still exist in many areas, with some relying on just a crackly landline phone.

Joint telehealth and shorter face-to-face appointments have been utilised to some effect. Telehealth sessions provide time to counsel on the medical and functional aspects of vision loss, providing an opportunity to discuss and encourage ongoing reviews with clients who may have been otherwise told “there was nothing more they could do” and had refused to have another check-up for several years.

Telehealth sessions have also provided an opportunity for clearer communication, strategies and training, ensuring they are as well supported as possible.

There have been other unexpected benefits via telehealth: one client in a particularly inaccessible area had a joint session via HealthDirect using the local nursing district; by explaining her inability to see her medication and daily glucose levels we were able to brainstorm strategies to ensure she would be supported as much as possible in both ocular and general health within her home environment.

The increased collaboration between our local low vision services, family members and friends (living locally and/or across the country), external health providers (especially hospital rehabilitation services and occupational therapists), and optometrists and ophthalmology clinics both during and outside appointments has become the largest benefit, from my point of view.

Many services previously unaware of the recent technological updates have had a crash course in equipment and software, particularly with clients with a visual and/or cognitive inability to read and are now stuck at home with nothing else to do.

It has been a hard few months, and will continue to be, but this period is making us all into more efficient clinicians.

ABOUT THE AUTHOR: Meagan Anderson is the Vision Australia Orthoptist in Albury (NSW) and Shepparton (VIC). She has a Bachelor of Health Sciences/Master of Clinical Vision Sciences degree (University of Sydney).