Case studies to illustrate issues relating to spectacle fitting for children and adults with special needs.
Jeff age 48 has mild learning disability. He attended his high street optometrist for a sight test. His distance vision was good but he was struggling with near tasks such as doing jigsaws and seeing buttons on his clothes to dress himself. His optometrist prescribed him some glasses for near vision tasks. When he collected his glasses, the member of shop staff did not explain clearly to the patient and carer which tasks the glasses should be used for. The carer had recently attended an event which explained how important it was that clients wear glasses they have been given. As a result he worked hard with Jeff persuading him to wear them all day. Jeff really disliked them as they blurred his vision for the distance and made him unstable when walking. Jeff told his carer how useless the glasses were. The carer then decided not to bother taking any of his other clients for glasses tests as he felt that is was a waste of time for people with learning disability.
Jeanie age 32 has severe and multiple disabilities. She has worn glasses since childhood without any problems. A carer took her to a new optometry practice who prescribed a new pair of glasses. Unfortunately the member of staff who chose the frames had not considered the position of her frames when in her wheelchair. When the carer collected the glasses, the shop assistant did not notice that the position of the neck support on Jeanie wheelchair caused her glasses to be pushed forward. Jeanie found the glasses uncomfortable and became frustrated at not being able to see well through them. The carers felt she was happier without the glasses and discarded them, leaving Jeanie with uncorrected vision.
Alan age 46 has moderate learning disability. He has worn glasses for a few years and his carers notice an improvement in his independence when he wears them. He was represcribedbifocal glasses by his optometrist. However, when the order was placed, the staff member did not appreciate the need for a large lower reading segment, and ordered a typical small “half moon” segment for the bifocals. Alan has difficult with his neck position and so when the new glasses were collected, he could not tilt his head into the correct position to “find” the near segment. Alan stopped trying after a few days.As a result, he could not see the food on his plate clearly and became disinterested at meal times. Carers commented on his increasing caring needs and loss of independence as he now needed feeding by a staff member.
Annie age 18 has moderate learning disability and hearing impairment. She has worn hearing aids since childhood but some days they irritate her especially when she is outside around traffic and she leaves them out. She had never been tested for glasses. As part of transition to adult services, the learning disability health team arranged for her to see an optometrist. On the day of the test, the carer decided to leave the hearing aids at home so Annie was not distressed on her way to the opticians. No one asked about hearing aids when the glasses frames were being chosen, and they weren’t taken on the day the glasses were collected and fitted. As a result, Annie could not comfortably wear her glasses at the same time as her hearing aids. The carers had to then choose whether Annie should have clear vision or good hearing for any given activity, rather than affording her the chance to have both at once.