Domiciliary eye care and service recipients in the North West of England

Abstract

Very little research to date has been conducted within the field of domiciliary eye care in the United Kingdom. However, with the ageing population, this sector is likely to expand in the coming years. The programme of research presented in this thesis investigated the visual needs and demands of domiciliary eye care recipients by conducting a questionnaire based survey involving the housebound population; a retrospective review of sight test record cards examined their clinical characteristics compared to conventional practice-based patients, and determined the changes in self-reported visual function following cataract surgery using the VF-14 instrument. All research was conducted in the North West of England. The initial questionnaire survey obtained 412 responses and highlighted that domiciliary eye care recipients engage in similar leisure activities as the general population of comparable age. Watching television followed by reading were the most frequently-performed activities.Use of PC/ internet browsing was very limited amongst care home residents, but was a common leisure activity performed by almost 40 % of domiciliary patients residing in their own homes. The majority of respondents considered that provision of perfect vision would have a positive impact on their quality-of-life; however, poor vision was not cited as a cause for their housebound status. Many respondents (11.8 %) reported symptoms of tear film disorders,which could be amenable to treatment by mobile eye care practitioners. The retrospective review of sight test data (including 650 record cards) revealed that there was a greater prevalence of age-related macular degeneration and cataract in domiciliary eye care recipients, particularly amongst care home residents, resulting in a higher rate of visual impairment compared to conventional practice-based patients aged 70 and over. Cataract was the most common reason for referral to the Hospital Eye Service (37.9 % of referrals),indicating that many domiciliary patients are living with correctable visual impairments. Changes in self-reported visual function following cataract surgery were assessed using questionnaires (VF-14) administered pre- and post-operatively to domiciliary eye recipients (n= 52) and in-practice patients (n = 26). Despite having a limited range of daily activities due to their housebound status, domiciliary eye care patients demonstrated significant improvements in self-reported visual function after cataract surgery (median VF-14 score change for care-home patients was 23.4 [range 12.5-55.0, P <0.001]). The results indicate that where it is in the best interests of the patient, domiciliary optometrists should not be reluctant to refer housebound individuals for cataract surgery.