Sanj Koasha, director and home-visiting optometrist discusses the challenges experienced seeing a patient in a very different environment to a test room – in sheltered housing where she has been bedbound for the last two years.
‘Can you imagine being confined to your bed, day after day, unable to care for your own needs? Seeing a TV, a book, a person’s face or even your own writing is a lifeline. Long term immobility in the home-visit patients that we see can be due to paralysis, severe stroke, late stage Alzheimer’s disease or Parkinson’s, or end of life palliative care, among other conditions.
As well as the reason that they are bedbound, additional complications of being immobile can be confusion, loss of independence, anxiety, depression, loss of muscular strength, pressure sores, or incontinence.
One such patient my customer service partner and I visited was a lady who had the skin of a 50 year-old but was in her 80s. She had been bedbound for two years. She was taking a lot of pain relief and explained that she felt very tired a lot of the time, due to her medicine and her fatal health condition. Her vision and ability to focus was therefore affected.
As with a lot of elderly patients that we see in their own homes, she had some cataract and early macular degeneration. When measured, her IOP was high but as she was clearly nervous with sweat on her forehead and not able to describe anything about her health condition, no comment was made and when tested again thirty minutes later, her IOP was normal. Reading these non-verbal signs is essential with some patients.
When it came to dispensing, due to the lady’s semi-prone position in the medical bed, the focal heights were set lower to take into account that she never sat upright and unable to use her existing varifocals to their full potential. We also dispensed distance specs so that if she was tired and wanted to lie back further she would be able to see the TV, which she said she spent the majority of the day doing.
Tinted lenses were discussed as the way her room was set up, she was always in direct sunlight during the day time and on a sunny day complained the sun was in her eyes and she was unable to move out of the way. A lot of patients in this situation prefer Reactions lenses so that if it is bright they feel more comfortable and the sunlight does not impact their vision.
By the time we were saying goodbye the lady was no longer nervous, she had told us about her seven great grand-children, how wonderful her late husband was and was even telling jokes, in between ordering two pairs of glasses, which I hope will help improve her quality of life considerably.
*Library image used. All patient details have been kept confidential.
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