Glasses and contact lenses are not the only things that can help people with poor vision. Insight discovers there is more that can be done when a patient is living with permanent vision loss, if the professionals allow theirs to be opened to the help available.
Pop quiz – you’re an optometrist in a busy practice. You have a patient whose sight has deteriorated so much that they are defined as low vision or blind. You have performed all of the tests, prescribed glasses but now realise you have done all you can to save what sight they have left.
What’s your next step? Does your responsibility to that person end when they leave the store?
Optometrist Mr Michael Peter says the answer is no.
Peter, optometry director of two Specsavers stores in rural western Victoria – Horsham and Stawell – says that not only does an optometrist’s responsibility extend beyond the test room, there are simple, effective ways to extend that support in ways that can improve the patient’s quality of life, and make the most of their remaining sight.
That’s about coming to terms with the limitations of what can be done and then working with support and rehabilitation organisations like Vision Australia as an extension of care.
Peter understands the frustration and emotion that can come with realising there is little more you can do to help a patient with deteriorating eyesight.
“I think there’s a sense of failure,” he says, “and I can feel quite frustrated with not being able to improve people’s vision and dealing with the emotions as well.”
He believes up to 10-15% of his patients could be classified as low vision or blind, living with a degenerative condition that is not correctible by glasses or contact lenses.
That’s on top of the many other ocular ailments they deal with in their busy rural practices.
“We see a lot of pathology, so we are sort of the first port of call where we have to deal with a lot of diabetic retinopathy, a lot of macular degeneration, dry eye, cataract.
“We also see your infective cases, do a lot of foreign body removals, even retinal detachments.”
His optometrists do have the support of ophthalmologists in Ballarat and Bendigo, but when a patient’s eyesight has become so bad that there is little more he or his staff can do, Peter looks elsewhere for support.
As part of his consultation, he’ll talk with the patient about the help and information available from Vision Australia and other support agencies.
“I have a discussion with them about how they are coping at home: Do they have help? Are they living alone? And based on that, you can make that decision about whether they need further assistance – all in the interests of ensuring their safety.
“Once you get their consent you can make a referral, and that’s pretty easy these days.”
Using the Oculo patient reporting system, he can refer the patient to Vision Australia; those without Oculo can do this directly on the organisation’s easy-to-navigate website.
“I just fill in the patient’s details, I give a description of why I’m referring them and what their condition is, and then I add the actual report that I wrote up on Oculo. And then Vision Australia contacts the patient, and they take it from there.”
As part of that ongoing support, he will normally get an email back to say that Vision Australia has contacted the patient and also about the progress made.
He says that support becomes an extension of the follow-up consultations he has with the patients, most of whom are happy to get help navigating their homes and their communities with failing eyesight.
“I’ve got one older patient, she lives rurally, and she lives on her own, and the biggest help they could give her was actually within the home – how to navigate safely around the house, in the kitchen or laundry, with magnifiers and other daily living aids. This extends to learning how to navigate outside the home and travelling around the community safely and things like that. She was happy about it.”
The irony is that it’s not just the patients who live with the limitations of low vision.
Peter admits that many optometrists, even his own team members, don’t fully understand the support that organisations like Vision Australia can provide.
“That elderly woman, she didn’t know she could be eligible for certain disability support funding or access services and products that organisations like Vision Australia offer that could be helpful for her.
“I think there’s awareness of Vision Australia,” he says, “but the attitude [among optometrists] is that they can only help with visual aids.
“It’s about more than just visual support. Vision Australia gives people access to mobility training, emotional and wellbeing support, an array of daily living aids (not just magnifiers), connection to social and recreational groups, information services like library and radio, all those sort of things – it’s a wider spectrum than just vision.”
That’s where Mr Nabill Jacob comes in.
The senior orthoptist is the clinical relationship manager at Vision Australia and a key part of that role is helping the ophthalmic sector better understand the support available to them and their low vision and blind patients.
He too has witnessed some of the misconceptions in the community about what Vision Australia does, the support it provides, even who it represents.
“I realised as a clinician that ongoing low vision care of patients tends to be a little bit back of mind for eye healthcare practitioners,” he says.
“Often, I’m at a conference and I’ll have a prominent health practitioner come up to me and ask me, ‘you only work with children, right?’ Or ‘you only do mobility training’.
“So, there’s a lot of misunderstanding as to what we do,” says Jacob.
What Vision Australia does offer is a comprehensive range of programs and products for all ages and stages in life, be it someone born blind or someone with low vision as they age.
In addition to its core allied health services such as occupational therapy and orthoptic low vision assessments, it can assist young children to develop life skills, help someone find or keep a job, provide a comprehensive range of accessible technology products, peer support programs, mobility training, including Seeing Eye Dogs, as well as information services such as a dedicated library and radio network.
Jacob says Vision Australia is this country’s leading blindness and low vision agency, with over a century of service and advocacy to the blindness community – seeing close to 40,000 people per annum.
And it’s keen and ready to take on more.
That’s why it has been working with Specsavers since September 2023 to deliver a more holistic approach for its many low vision and blind patients.
Specsavers says it realised its optometrists could be further supporting patients with low vision.
“Specsavers responded with open arms,” says Jacob.
It has become an education and awareness-led partnership, with Vision Australia and its services being highlighted in a growing number of Specsavers stores through their “morning team huddles” that have become commonplace across their store network before doors open.
“We go out for about 20 minutes to talk to them about the low vision referral process, the services we offer, and how it can help their patients. The in-practice team also have an opportunity to ask questions.
“We’re involved with the annual Specsavers Clinical Conference. We exhibit there. We’ve also seen a number of their team members coming into a Vision Australia office and spending half a day with us to better understand what it is we do.”
That ongoing engagement has helped grow awareness within one company, but Jacob sees an opportunity to help others understand, while also helping more low vision and blind people.
“We estimate over half of the estimated 450,000 people in Australia with low vision or blindness are going without support, either unaware or reluctant to seek help,” he says.
Which is why he’s keen to work with other optometry and ophthalmology practices and businesses. Independent or corporate, it does not matter.
To help make that happen and the process as easy as possible, Vision Australia has cut down barriers and simplified the referral process, including signing up to Oculo, which is used by a large number of ophthalmic practices around the country.
Vision Australia is keen on more meaningful relationships with patients and practices – not just a last, passing thought as the person leaves the store.
“We want the practitioner to actually make the referral, not to give them a phone number or suggest to the patient or their loved one that they self-refer,” says Jacob.
“We want it done in the clinic, before they leave, when risk factors or injuries are identified, or they’ve just been diagnosed with a progressive condition, or they’ve just lost their driver’s licence.”
As optometrist Peter points out, that’s easy enough to do as part of the normal consultation.
But, more importantly, it’s part of the ongoing responsibility of eye health professionals to the patients under their care.
“When their vision goes and they have deteriorating sight, we as optometrists need to know that they’re OK out in the community and at home as well,” he says.
More reading
Vision Australia: Blind, low vision children need more support to start school year strong
Specsavers, Vision Australia stepping up for patients with low vision
Vision Australia in new low vision partnership
