A common misconception of our work as domiciliary optometrists is that we spend most of our time testing older people but in fact we visit people of all ages who are unable to leave their homes.
My own preconceptions quickly changed after a half day’s shadowing with Specsavers in the summer after which I switched to domiciliary full-time. Arriving at a rural location, I was directed to a cottage where I was introduced to a 23-year-old woman in a wheelchair. She smiled at me as her carers explained she had suffered brain damage after an accident – she’d been run over by a man using his phone while driving. Her only movement was in one hand, and she had severe speech and communication difficulties.
My patient had never worn glasses and this was her first eye test in years. I dispensed glasses for myopia, and her smile and the speed at which she read the letters suggested she was excited to have better vision. Her ocular history was unknown to us, so I had no way of knowing how long she had been silently struggling with distance vision. It was satisfying to be able to make an improvement to her quality of life.
Helping our severely autistic patients interact with the world around them is also very rewarding. One of my colleagues tested a teenage boy who spends all day watching television, as his agoraphobia prevents him from leaving the house. As my colleague corrected his myopia with glasses, the boy’s body language altered, he sat up straighter and looked a lot more interested in the TV show that was on.
As well as patients with physical disabilities, we see many who are unable to make their own decisions due to mental health issues.
Another one of my colleagues visited an elderly lady with dementia who lived in a care home. Her daughter had requested an eye test as her mother had not been to an optician for more than five years. The patient was adamant that she could see very well and an eye test was not required. The care worker explained to her that her daughter had requested the test and that it would be in her best interests so, slightly reluctantly, she let my colleague continue.
He noted that she had a very dense congenital cataract in her right eye so was depending mainly on her left eye. He performed retinoscopy on her left eye and found a significant prescription – she would clearly benefit from a new pair of glasses. Seeing the difference that the glasses would make while she watched television brought a smile to her face. It is always so satisfying to be able to provide a valuable improvement to a patient’s sight.
It did not take me long to appreciate the benefits that domiciliary eye care provides to such a wide range of people in the local community. After my move into domiciliary I looked afresh at the reason I went into optometry – to help bring sight to those who need it most. I felt there was no better way than by helping vulnerable people, who are unable to visit an optician unaccompanied, to access fundamental services such as routine eye tests.
When I worked in store I thought I knew some of my regular patients well, but really I knew little about them. When you test in someone’s home, you get a real insight into their life and loves. One lady showed me photos of her son, who died aged 40. She said he lived his life to the full and so should I. I don’t think I’ve ever felt so much emotion on a day at work.
It took a bit longer to realise how the work would affect me. Working in domiciliary is clinically demanding, but also an emotional experience for all of us.
Domiciliary work is wonderfully varied, but it can be tough – for example, when climbing three flights of stairs with equipment in both hands or having to inform a patient that glasses cannot improve their vision. We have a busy schedule, seeing six to eight patients a day, and traffic can be a bugbear. But I’m surrounded by a great team with a great sense of humour, I look forward to seeing my patients, and it’s one of the most rewarding jobs I’ve ever had. As one of my patients told me, quoting Oscar Wilde: ‘Some cause happiness wherever they go, some whenever they go.’ I like to think we’re the former!
Sinitha Ratnaselvam is one of the Specsavers domiciliary optometrists covering North East London and Essex.