Adopting a healthy lifestyle is the zeitgeist but it seems the British public are still putting off visits to health professionals, with trips to the optometrist faring particularly badly. In its survey of 2,000 British adults, Johnson & Johnson found that nearly a third (31%) had put off a visit to a health professional, procrastinating rather than acting to solve a problem.
As well as assessing attitudes towards health and eye care in general, Johnson & Johnson also looked at how presbyopes coped emotionally with reduced near vision. As well as discovering that presbyopes felt unsupported in their journey, the round table also unearthed some disturbing attitudes towards high street opticians from the patients taking part in the discussion.
The research found that among the types of health visit being put off are trips to the GP by a quarter of those asked, attendance at blood test and pressure checks by a fifth and cholesterol check by 8%. The biggest proportion (42%) was among those putting of a visit to the dentist and its painful potential. Most shocking for the optical profession is that dental check-ups were run a close second by trips to the optician. Despite being painless, these are put off by 35% of those quizzed. The average delay adds up to a worrying eight months a figure 20% of the survey respondents said they later regretted incurring. Even worse a quarter have left a visit to the GP so long they now feel embarrassed to deal with the initial problem.
While many medical appointments become a necessity because of pain or disability presbyopia is an inevitability for most as they enter their 40 and 50s. Despite this a third of people with presbyopia are not seeking help the Johnson & Johnson research found. Dr Kamlesh Chauhan, director of professional education, northern Europe, said: ‘Health check-ups may be an inconvenience, but they are necessary for managing smaller issues before they become big ones. Presbyopia is a visual impairment which affect billions of people, but the early symptoms are subtle.’ He said while such minor frustrations could easily be put off there was no need. ‘We encourage patients to see their optometrist who can help make their lives easier.’
A breakfast round table meeting last week brought together 11 people, drawn from the eye care profession, optical press and patient base to discuss presbyopia and to look at the emotional aspects of coping with its onset. The meeting was chaired by TV medic, Dr Sarah Jarvis, under the title ‘Navigating the emotional impact of presbyopia’. It discussed presbyopia, the effect it has on patients and how they sought help from the optical profession.
With nearly half of over-45s avoiding an eye exam, education for patients and ECPs around the issue needed to be addressed the group agreed. ‘I found these statistics quite shocking,’ said Dr Jarvis of the research, adding that much more than vision needed to be considered when discussing presbyopia in practice. ‘It’s not just about being able to see, they [patients] don’t want to admit that they are getting old.’
Dr Chauhan said the research provided insights into the relationship between ECPs and their patients concluding that there was much more to vision than empirical measurement. ‘If we are not serving the needs of our patients it doesn’t matter how many qualifications you have. It’s about being connected.’ He said the ramifications were much wider than not being able to read small print. The presbyopic age group is entering the period when eye diseases become apparent while the effects of untreated presbyopia can impact the quality of people’s lives, he added.
The breakfast meeting heard from a number of patients on their experiences of seeking help when they realised their near vision was suffering. Jeannette Williams had never needed correction and despite having a family history of glaucoma, put off having an eye exam. At 45 she started to notice that reading small print was an issue and ‘was shocked’ at the speed of the progression. Despite this, she admits being in denial and did not want to find out she had glaucoma or another pathology. When she finally set up an appointment she was very disappointed with the way it was handled. ‘It wasn’t a pleasant experience, it was like being on a conveyor belt.’
She was very disappointed with the questioning about lifestyle and did not feel her ECP had tried to understand her needs or learn anything about her as a person or her visual needs. She was finally offered bifocals, varifocals or reading glasses but she said she did not want to have to wear glasses but contact lenses were never mentioned. ‘I would like to have had more communication. They need to take on the emotional aspect, it’s not just about your eyes. It’s about the emotional guidance you need in your life.’
Poor service was posited as one reason people put off visiting opticians.
This view was echoed by Steve Fung, a life-long contact lens wearer, who started to experience problems when reading on screen. He said he was quite nervous about being told that he might have to wear glasses ‘like an old man’. He also said his visit to the optician had been a poor experience and he had not been asked about his outside activities or sport. He said the consultation was all about product and he felt ‘like she [the optometrist] was reading from a script’. When he said he would like to consider multifocal contact lenses, he was told he would have to book another appointment. Despite telling the optometrist that he read from a screen for long periods of time that was not discussed or taken into consideration. Like Williams, Fung had attended a high street multiple and said the experience left him feeling anonymous.
Fellow presbyope Suzanne Shapiro also went to a multiple practice and agreed that the whole process was ‘too rushed’. She estimates that the eye examination had been conducted in eight minutes with the pre-testing handled by junior staff and she did not feel the process had been conducted properly. She said she felt the optometrist wanted her to buy glasses because it was more money in the till.
The ECPs on hand were keen to stress that time is needed to ensure everything is explained properly and all eyewear options explored. Optometrist Joy Hynes said chair time was important to have a proper conversation with the patient but in some practices that was not happening because of the volumes the ECPs were expected to achieve. In her practice she made sure all patients understood that presbyopia was about age not health and explained the options open to them. She also said talking to emerging presbyopes about what they may start to experience was useful. ‘There’s usually a window [of time] that you can get it into their heads.’
Tuija Kankaanpaa, an optometrist at Tom Davies Opticians, said she had personal experience of presbyopia and putting off getting varifocals. Chair time was raised once again but Kankaanpaa said in her practice appointments were an hour long, giving plenty of time to discuss the patient’s needs. ‘With every single patient we have time to offer contact lenses. With very short consultations it’s simply not possible to “do it all”,’ she added. Financial constraints were raised and Kankaanpaa made the point that her hour-long consultation costs £150.
Hynes said contact lenses are also offered to everyone who comes into her practice. If they do not choose contact lenses they may be offered a taster so they can at least experience them.
Aratope Jessica Ajose who works for a multiple practice agreed that patients in their 40s do mention presbyopia but tend to put it off. ‘Men are worse than women even when they are shown [that they can’t read at near]’. She took a light-hearted approach to broaching the subject. ‘Patients know what is going on but they are in denial.’
The group then discussed if older practitioner had a greater insight into presbyopia if they had reached that stage themselves. Ajose suggested that as multifocals were in her degree course it was a ready choice but wondered if older optometrists understood all of the contact lens options. The conclusion was that communication was the key.
Dr Chauhan spoke for all the professionals when he said the stories from the patients were ‘a little upsetting’. He concluded that those businesses were losing custom by not offering patients the options they wanted. The patients at the table urged practices to spend more time with patients insisting that it could be justified from the extra business it would bring. The patients also agreed that they would prefer to talk to the more senior professionals but they agreed that a trained, less senior staff member could also do the job if financial constraints needed to be met.
Summing up, Dr Chauhan said he wanted professionals to understand the disappointment patients felt adding that nobody joined the profession to disappoint patients. He wanted to find ways to get clinicians to understand the effect they have on patients’ lives. He said the emotional aspects discussed would be included in Johnson & Johnson upcoming education and events.
Patients are procrastinating and not seeking help either because they think it will go away or they are too busy, he said. They also do not want to admit they are getting old but medical conditions tend not to get better if left untreated. He urged ECPs to get to know their patients and guide them through the emotional as well as the visual changes taking place as they age. ‘We [optometrists] are in danger of becoming too technical. No one is ever going to say that is the best ophthalmoscopy I have ever had, it is the engagement they will remember.’
Drawing on her wider medical experience Dr Jarvis made the point that: ‘50-year olds today are not prepared to accept growing old like they did 30 years ago.’ Emotional and mental well-being are now routinely taken into account across healthcare to look at the wider well-being of the patient and things that will improve their quality of life. While medical professionals can offer emotional support they can’t always offer a solution.
‘Here [presbyopia] I see people putting off having an eye test and there is a solution to the problem.’