Referral thresholds for an integrated learning disability eye care pathway: a consensus approach.

INTRODUCTION: Local Optometric Support Unit (LOCSU) have published their refreshed clinical pathway for eye care for people with a learning disability. The document sets out the adjustments to practice that a community optometrist might make in order to provide optimal care for a person with learning disability attending a primary eye care assessment. The pathway specifically points to the need to retain patients in primary care where appropriate and 'reduce the number of people with learning disability who are inappropriately referred into the Hospital Eye Service (HES).' Pivotal to this refreshed pathway is the integration with secondary care, with local arrangements to facilitate referral and hospital management where appropriate. There are few ophthalmologists nationally who frequently encounter patients with a learning disability in their hospital practice and knowing where to start when creating referral criteria or KPIs may create a barrier to services becoming established. In order to address this gap in experience, we set about developing a set of consensus statements regarding referral thresholds for ocular conditions commonly encountered in adults with learning disability. METHOD: A series of video interviews were undertaken with eye health professionals with a range of experience in eye care for people with learning disability. Each contributor commented on the usability and clarity of each element of the referral criteria. In addition, each contributor was asked to express the overriding principles by which they make decisions regarding referral thresholds for patients with learning disability. These were collated into the final document which was circulated and agreed by all participants. RESULTS: A table setting out referral thresholds for commonly encountered eye conditions in adults with learning disabilities is presented. CONCLUSION: We have presented a succinct set of consensus statements relating referral thresholds for common presentations of visual problems in adults with learning disability in the UK distilled from the collective experience of a group of eye health professionals. The intention was not to present a comprehensive review of management of each condition. Rather, the consensus statements may form the starting point from which each area could develop locally agreed criteria, as is suggested by the LOCSU pathway guidance.

Effect of training on attitudes and expertise of optometrists towards people with intellectual disabilities.

PURPOSE: To determine whether participation in an educational programme, which comprised both lectures and supervised patient contacts, did more to improve the attitudes, expertise, knowledge and confidence of optometrists and student optometrists towards people with intellectual disabilities (ID) compared with receiving didactic lectures only. METHODS: Optometrists and student optometrists were invited to take part in vision screening. A series of lectures were provided followed by supervised practice for a minimum of 2 days. A questionnaire was administered before the commencement of the training, and afterwards, in order to assess the impact of the training. The results were compared with a group of control subjects who received similar lectures without the clinical experience. RESULTS: For both groups there were statistically significant improvements in self-reported knowledge of ophthalmic complications of ID, confidence in working with people with ID, and there was a significantly reduced perceived need for further training after the courses. There was a significantly better result for the group experiencing patient contact particularly in respect of self-reported attitudes towards people with ID. Confidence in dealing with people with ID was related to the number of such patients seen over the last year. CONCLUSIONS: Training incorporating clinical experience, and using real patients, is particularly effective, although there is still benefit in providing lecture type courses. It is recommended that, whenever possible, courses are provided that offer hands-on experience with real patients. There is a need for further research using validated attitudinal scales to investigate the attitudes of optometrists to people with ID.