Visual Function Competency 3.8

Competency 3.8: An understanding of the special examination needs of patients with learning and other disabilities

This competency deals with the trainee’s ability to adapt  the eye examination to meet he needs of a patient with learning disabilities or a disability that may mean a more routine examination is not suitable.

Best Form Evidence

This competency will most likely be assessed with a real Patient Record.

The Assessor will expect you to be able to demonstrate both your ability and flexibility to adapt your routine depending upon the patient’s needs.  He or she may give examples of a case or situation and ask you to discuss those adaptations you feel that may be required.  In addition, you should consider any legal obligations to the patient when performing the examination.  For example a full eye examination is still required and if you are unable to complete the tests then action and advice should be taken; several visits may be required to complete a thorough examination.

For this competency you should be able to demonstrate at least one Patient Record: of a patient with a ‘physical or intellectual impairment.’

Examples may include:

  • Patient with cerebral palsy
  • Patient with severe deafness
  • Patient with severe dyslexia
  • Patient with Down’s syndrome

Points to Consider:

  • How would you check visual fields?
    • E.g. Peripheral fields / confrontation using carer to attract attention with a toy
  • Assessment of VA
    • E.g. Cardiff acuity cards, Kays Pictures,  Preferential Looking
    • Can the patient read / recognise letters?
    • Does crowding have a detrimental / beneficial effect?
  • Does the patient have any interests that may help retain attention?
    • e.g. use of bright colours, toy cars etc
  • Barrett / Mohindra method retinoscopy may be useful
  • Would a cycloplegic examination be useful / detrimental?
  • What is the best method of communication?
    • A parent or carer may help as long as they do not interfere with the accuracy of results
  • What is the patients learning age?
    • McClure Near Vision Test Type
  • Are there multiple disabilities?
  • Are there any mobility issues?
  • Consider appropriate dispensing
    • A designer frame with glass lenses may not be suitable for a child with aggressive behaviour
    • E.g. no point prescribing NV for N5 if they need an intermediate prescrption for TV at a 1m viewing distance
  • How would you check binocular vision status?

Unacceptable evidence

Though trainees may have limited experience of examining this group of patients the Assessor will still expect there to be adequate knowledge and understanding of how to conduct an appropriate test should the situation arise.

Trainees should also remember that eye problems frequently are found in those with learning and other related disabilities, and should demonstrate they have investigated for these thoroughly.

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