Welcome to Special Eyes Vision Services
A lot has been happening these last few months, and things are finally coming together. At this point, I thought it would be a good idea to talk a bit about the ‘why’ behind Special Eyes. There are lots and lots of optometry practices, but in creating this practice, I am aiming for something quite different, to service the needs of a very specific population. Here are some of the reasons for this venture.
Boy sitting in a wheelchair, he is smiling
Reason 1: I love working with people with complex needs
I have been working with children and adults with additional needs and complex disability for over 10 years now and I absolutely love it. Every single patient I see requires me to think on my feet and adapt my assessments, to ensure we can figure out what they can see, and what is challenging for them. One of the things I love most about my work is that it is not limited to health, and administering ‘tests’. That is absolutely an important part of what I do, BUT, equally important, is to gain an understanding of the functional impact of a person’s vision profile: I love the challenge of working out what someone can, and cannot see, and then explaining my findings to them, and to those who are involved in their care. I love the ‘ah-ha!’ moments, when a parent suddenly understands why their child always behaves a particular way when undertaking a particular task, or even why they, the parents, always do something a particular way. As parents/carers, we learn to respond intuitively to the people we care for. Oftentimes, we don’t know why a particular thing works, we just know that when we do it a different way, the result is not as good. I have found, both from personal experience as a parent, and from years of working with parents of complex kids, that understanding ‘why’ is so powerful. It doesn’t change anything, but somehow also changes everything.
Reason 2: I think there is a real need for this service
Did you know that children with complex disability and special needs are 28 times more likely to have vision problems than their peers?
This statistic comes from research, which involved vision testing in special schools in the UK. Not only is this population of children at higher risk of having vision problems, but they are also much less likely to have accessed eyecare services. Researchers found that 46% of the children they tested had a visual deficiency, and in 12.5% of the children tested, visual deficiencies had not previously been detected. Almost half (44%) had no previous eyecare history, i.e. they had never had an eye test.
Adults with intellectual disability are 10 times more likely to have vision problems.
This statistic comes from research from the Royal National Institute for the Blind (RNIB) in the UK, who found that nearly 1 in 10 adults in this population are blind/partially sighted, and 6 out of 10 required glasses to see clearly. Again, this study reported that this population experienced difficulties accessing regular eye health examinations.
Here’s the most critical part:
Both of these groups seem to encounter significant barriers to accessing eyecare. To date, there has not really been any research to conclusively identify the barriers faced by people with complex disability, so we can only speculate as to the reasons, but part of it could be a lack of expertise among healthcare professionals, regarding how to adjust standardised assessments for people who are unable to read a letter chart, or discern whether ‘one or two’ is clearer. Another part could be a lack of access to appropriate assessments. We have different tests for people who can’t tell us verbally what they can see, but these are not part of the standard equipment in eye healthcare settings. Even accessing the healthcare setting itself can be tricky. My lengthy search for a suitable premises, one that is fully Person With Disability (PWD) compliant, opened my eyes to just how difficult it is to find premises that are fully accessible to people with disabilities.
Reason 3: Identification is the first step
As previously stated, I have worked in low vision for many years. I have met lots of children and adults with varying levels of vision impairment. The creation of the NDIS has afforded access to many very worthwhile services for people with visual impairment, BUT only if their visual impairment has been identified. Those significant barriers we talked about in the the last paragraph not only prohibit access to equitable eye healthcare, they also prevent people from accessing the funded disability support that could really help them with daily functioning.
Reason 4: Small adjustments can be life-changing
So many times, while working in paediatric low vision, I would recommend small adjustments that could have a huge impact on a person’s life. If we don’t fully understand a person’s vision profile, then there are some very significant bits of the puzzle missing, because we know that around 80% of our learning comes from vision.
Maybe a non speaking/minimally verbal child needs glasses to see their environment clearly, if nobody identifies this is the case, their vision may not develop as well as it should, and this will form a real barrier to their learning about their world.
Maybe the child who keeps walking into things isn’t clumsy, maybe they actually have a lower field defect meaning they can’t see things below eye level. Lots of physiotherapy work to address gross motor skills won’t help with their vision impairment. We need to know they have a vision impairment. If the vision impairment is identified, we can teach them compensatory strategies, so they can get themselves around safely.
A child with Down syndrome might not be able to accurately focus on things that are close to them. If this is identified, we can provide glasses to compensate, so they can see their toys and people’s faces and the pictures and letters in story books when you read to them.
Maybe a child/adult with cerebral palsy has a weakness on their left side, but has anyone established whether or not they can see things on that side? What if their communication system has been positioned on that side? Is everyone concluding that learning to use this communication system, be it, PODDs, PECS or a switch/button is beyond their capabilities? If we have properly assessed the person’s functional vision, we would realise that relocating the system to the other side would make it visually more accessible.
Of course, there may be a physical reason why this is not going to work, and this is where collaboration is crucial, because figuring out how to provide a communication system that is viable for this person may involve their speech pathologist, their physio, and their optometrist. But if we all collaborate, we likely can find a way.
I hope I’ve got most things right, but I am happy to make further adjustments…
In setting up this new service, I hope to provide equitable access to good eye healthcare. My premises is fully PWD compliant, quiet, and easy to access. I will work with you to accommodate your needs, or the needs of the person you are supporting. I have put a lot of thought into what would make an optometry practice accessible, but I am always happy to adjust things further as needed: just let us know what would help, whether it’s coming to check out the practice 3 times before venturing into the test room, bringing your OT along to the appointment, or that we perform the whole eye test through the medium of nursery rhymes. You will find social stories on our website, one for children, and another for adults with intellectual disability. We can gather information in advance of your child’s appointment if concentration span is a concern, or we can perform the assessments over a couple of visits. Let us know what would work best.
I can’t wait to welcome you to my new practice. If you want to learn more, please get in touch.