In this blog I'll discuss all the reasons someone should have glasses and the occasions when someone may be better without them.
One of the most common phrases I hear from relatives is, "my mum has dementia and she doesn't read so she won't need any reading glasses". There are two situations here. The patient isn't reading because they can't comprehend it due to their dementia or they aren't reading because they haven't got any glasses to read with and it's been assumed that's it's due to dementia. Either way, "reading glasses" is really just a term for glasses that help with ANY near task. Looking at family photos, reading birthday cards, card games, board games, and seeing their food to name a few. It can be difficult to get elderly people to eat enough food at the best of times. Maybe allowing them to see what their eating by wearing a pair of glasses may just help a little. Even if it doesn't, wouldn't you like to be able to see what you are eating or what someone is feeding you if you're not able to do it yourself?
It's a similar situation for distance glasses or "driving/tv glasses". Some opticians will name them after the tasks which most people use them for but in actual fact they are just glasses to help the person see everything in general life that is past about a meter. Seeing the faces of family members, the carers, doctors, nurses, anyone who comes to see them.
Often people with dementia can lash out of or become aggressive. One of these reasons could be that they don't recognise who is approaching them because they are blurry. So even if the patient doesn't drive or isn't interested in the television, it doesn't mean they should be living their whole life in a blur. If patients are able to walk and could be at risk of falls, this is another reason to correct their vision with glasses.
I had a patient once who was very short-sighted and her daughter was worried that she was forgetting who she was as she never recognised her when she came to visit. The actual reason was because she couldn't see past 10cm clearly. Her daughter walking in was just a blob of colours. Once she got her new glasses, it was no longer a problem and she wore them all the time.
When are glasses inappropriate?
There are a few situations when glasses won't help or may even be a danger to patient.
1. The patient had dense cataracts or end stage glaucoma or end stage macular degeneration (or any other eye condition that renders the patient unable to see). In these cases glasses will be of no benefit. However, in patients with dementia sometimes they think they can see ok and maybe they've worn glasses all their life. If a patient becomes distressed when their glasses are removed then let them keep them on, even if they aren't benefiting their sight. If their glasses break and they want to replace them, the easiest thing to do it to buy some cheap ready readers as they are just for the feeling of having glasses rather than the sight.
2. The patient doesn't need glasses for distance and doesn't settle down very often, i.e they constantly walk around and often get up even if someone asks them to sit down. In this case I wouldn't prescribe reading glasses in case the patient gets up and starts wandering when wearing them and is then risking falling due to their distance vision being blurred through the reading glasses. I would only prescribe reading glasses if there is someone who can stay with the person while eating or looking at photos and immediately take them off of they start to get up and wander off. The glasses shouldn't be left anywhere where the patient can help themselves and put them on.
3. The patient has one eye that is clear for distance and one that is clear for close. This is done artificially in some cataract patients. One cataract is removed and the eye is corrected for distance vision then when the second cataract is done, it is left clear for close to. Some people have this naturally in which case they have no need for glasses.
4. The patient constantly have their eyes closed.
5. Wearing glasses distresses the patient and they will just throw them off. In this case we should still reassess each year as their a attitude towards glasses will likely change as their dementia changes.
6. Very advanced dementia where a patient has no visual demands at all (not even looking at people who come in so showing any interest or response to photos etc)
Bifocals or varifocals?
I prescribe bifocals or varifocals for the majority of dementia patients who are none mobile. Having a bifocal means they have one pair of glasses which can be kept on to see general vision as well as close up without having to swap between taking glasses on and off or between 2 different pairs. Often the patient won't be cognitively able to take them on and off and put on a correct pair of glasses for a specific task, and also may not realise if they are sat watching tv in their reading glasses. Bifocal or varifocal glasses for patients who are none mobile won't increase risk of falls. I would only prescribe them for patients who walk if they are very stable or have always worn this type of glasses and haven't been falling in them.
A situation when mutifocal glasses are inappropriate is when a patient is bedbound and spends the majority of time lying flat in bed. If their tv is high up on the wall this might be ok. If it is level with the bed then the patient may be watching it at an angle where mutifocal glasses won't be appropriate. If the reading area is in the way then a single vision distance pair is more appropriate for watching tv and separate close glasses for near tasks. This doesn't mean they can't have a bifocal for when they are sat up on bed if they want one.
Dementia eye test
Levels of dementia vary greatly between patients even if they have the same type of dementia. Some can read the chart and carry out a normal eye test whereas some can't tell me what the can or can't see. We have specialist training and equipment that allows us to measure a patient prescription for glasses and that allows us to see the back of the eye to detect any eye problem that may reduce sight. This allows us to know whether glasses would actually benefit the wearer or whether their eyes are too damaged to benefit from glasses correction. I'll do a separate blog post all about the dementia eye test so keep an eye out if you'd like more information.
The simple answer is yes! If you need one then you can! For most people this is a free service funded by the NHS. So many people are unaware that this service exists but it definitely does! If you are entitled to a free eye test at an opticians but you are unable to get out on your own due to physical or mental health constraints, you will be entitled to a free eye test at home too. This includes (but is not limited to) people over 60, people with diabetes and people with glaucoma in their immediate family. There is a link to the full list of who is entitled to a free eye test here.
If you are not entitled to a free eye test then you can still have one at home. Our private fee at Freedom Eyecare Nottingham is £45 and that includes the eye test, glasses fitting and a full aftercare service including any adjustments. This is reduced to £25 if you buy glasses from us. We also provide low vision assessments free for anyone who still struggles to see, even with glasses on, perhaps due to cataracts or macular degeneration.
If you are in hospital, unfortunately the NHS will not fund your eye test until you are home. However, we can provide a discounted private eye test at £25 should you wish to have one done whilst still in hospital. If you lose or break your glasses in hospital and your eye test is in date, we can come out for free to help you to choose some new glasses.
Below are some of reasons people may require a home eye test:
If you're unable to get to an opticians unaccompanied for any reason, then we can come to you.
Here at Freedom Eyecare Nottingham, home eye tests is all we do. If you want to book an eye test for someone but they are not able to communicate, we are still able to test their eyes. Many people with autism, advanced dementia or have suffered a stroke are unable to tell us what they can see or answer any questions about which lenses are better or worse. We have specialist training and equipment that allows us to measure someone's eyes for glasses and to see into their eyes so we know how well they will or won't be be able to see with glasses, even if they can't communicate. When an optician looks into your eyes with an ophthalmoscope, they are not only able to check the health of the eyes but can also detect and monitor other health problems such as diabetes, high blood pressure and even increased pressure in the brain.
For relatives of people with advanced dementia or autism there can be a worry about unpredictable or challenging behaviour. If an eye test is booked but cannot be finished for any reason, we can come back another day. We are experienced in testing people with these conditions and always allow plenty of time for each patient, up to an hour if necessary so there is no rushing around and we can try and make the eye test as easy as possible for each patient.
At Freedom Eyecare Nottingham, we are an independent optician and specialise in home visits. Our patients can benefit with very competitive cost of glasses starting from as little as £49 which includes glasses frames and hard coated lenses. We have a whole range of glasses which we subsidise for patients who are entitled to an NHS voucher so that there is nothing to pay for this range. We also have a range of tough, flexible frames and plenty of other glasses to browse through that patients can put an NHS voucher towards. We can make tv glasses, reading glasses, computer glasses, bifocals, varifocals, sunglasses, glasses that change in the sun, anti glare, anti scratch, you name it and we will try our best to provide it.
If you need help or have any questions about home eye tests, please give us a call on 01157866320. We cover all of Nottinghamshire and can provide eye tests further afield if needed. There are only two of us in the team so if we are both out testing eyes, please leave a message and one of us will get back to you as soon as possible. If you'd rather email us you can contact Info@freedomeyecare.co.uk.
About the author:
Stephanie is one to the optometrist directors at Freedom Eyecare Nottingham. She and her business partner Ann Hamilton set up Freedom Eyecare when they realised they wanted more flexibility and control over their working hours in order to look after their families. Stephanie and Ann decided they wanted to provide a more personal, friendly service to people who need eye tests at home. Stephanie loves what she does and has a wealth of experience in independent practises, multiples and hospital optometry. Home visits are her passion and she loves the variation that comes with each day
We have experienced one of the hottest summers in history and now as we enter October, the nights are drawing in and the temperature is getting cooler. It now won’t be long before we are having to put the heating on and brace ourselves in the cold and wintery conditions on our daily commute and everyday activities. Take a moment to think about the elderly who may live on their own and have limited mobility. A trip outside to the shops in the winter and snow may not seem too difficult for most of us, but anyone who has a physical disability or impaired mobility, such a task is very daunting and possibly dangerous.
With the NHS reporting an increase of admissions to A and E as a result of falls in the winter, it is understandable how many would be hesitant in going out to have their eyes tested. If a problem with their eyes or vision occurred suddenly, many would worry how they would get to someone to check their eyes. Some people may be fortunate to live near relatives or friends who are able to take them to the opticians, however some may not live near relatives or have anyone who are able to help them. I have spoken to a few patients who explain they feel almost like a burden and would rather not inconvenience anyone. Often many will suffer in silence, but as with any medical condition, the earlier things are detected, the better outcome it can be.
For friends and relatives who work full time they may struggle to get the time off to take their elderly relatives to various health care appointments especially if they have numerous conditions. Sometimes the physical difficulty, tiredness and subsequent stress may be too much for some for both the patient and their carer or relative.
Fortunately there is a solution! Did you know that you can have your eye test done in the comfort of your home if you have any condition that limits your ability to go to an optician unassisted? You can get an NHS eye test at home for free if you qualify for an NHS eye test. Below is a list of who is able to get an NHS eye test.
You qualify for a free NHS funded sight test if:
Ann Hamilton (left) and Stephanie Lipsey-Liu (right) Freedom Eyecare Nottingham's home visiting optometrists.
Stephanie and I created Freedom Eyecare Nottingham, a home visiting opticians service. We are based in Nottingham and we cover all of Nottinghamshire. Set up by myself and Stephanie, we are both optometrists who have worked in hospitals, high street and independent practices who love doing what we do. My late grandma was the reason why I wanted to provide domiciliary eye care. She was house bound in the last four years of her life, but she valued her vision greatly. Although she wasn’t able to get out, she still enjoyed the everyday activities such as watching TV, reading a book and bird watching. It also enabled her to maintain a sense of independence. That is the most important and rewarding part of our job, helping people see better to enjoy life.
The eye test is just like at the opticians (including the ‘puffy eye machine!’). We perform a full and comprehensive eye examination including the glaucoma check. We also bring glasses should you need to change them, our range vary from free NHS ones to designer glasses. We believe in quality and affordability and have a great range of glasses to choose from, we never pressure sell as we never take any money up front, unless you wish to leave deposit and allow a cooling off period should you change your mind. A summary of the order is given at the end of the eye test so the customer knows what they have ordered and that is often required if there is a power of attorney.
We do understand there can be times where the patient needs to be referred for treatment and we are able to refer just like a in-store optician for treatment such as cataracts and wet macular degeneration. For people who are sight-impaired we also provide free low vision assessments and have a wide range of magnifiers and adjustable lighting.
Essentially, we provide a complete eye care service at the comfort of your home. Not surprisingly, not many people are aware that such NHS services exist! If you know anyone who would benefit from having an eye test at the comfort of their own home, please visit www.freedomeyecare.co.uk or call 0115 7866320.