Sight and Eye Care

What is an Optometrist?

Optometrists are professionals who manage eye health care. They are known as eye care specialists. They have a wide range of knowledge on all aspects of eye health enabling them to perform eye health checks to determine the health of our eyes and what we can see. They are able to provide treatment/advice for various eye problems/diseases and spectacles/ contact lenses to correct visual problems. If you have a red eye or pain in your eyes or any kind of eye problem your first port of call should be to your local Optometrist.

Common Eyesight Problems

The most common eyesight problems any of us experience are those that can be easily corrected by glasses or contact lenses, e.g. long-sightedness (hyperopia); short-sightedness (myopia); presbyopia; and astigmatism.

Common eye problems that are not directly related to vision loss include dry eye, conjunctivitis and blepharitis (inflammation of the eyelids). Children may experience problems that are associated with vision development and these are most commonly lazy eye (amblyopia) and squints or turns in the eye (strabismus).

Problems such as cataracts, glaucoma and macular degeneration are longerterm conditions that may cause vision loss.

By having regular check-ups and wearing glasses or contact lenses if you need them, you can prevent problems with your eyes in the future.

Sight Tests and why they matter

Sight tests are the most reliable way of identifying potential problems with your eyes early on. For this reason, you are advised to visit your optician for a sight test at least once every two years; although you may be asked to attend more frequently depending on your age and medical history.

Sight tests are generally carried out by a qualified optometrist or an ophthalmic medical practitioner at a high street opticians, your local hospital's eye department or your local optometrist may do home visits.

As a rule of thumb, they take between 20 and 30 minutes to complete and, as well as checking your vision and need for glasses or contact lenses, they also include checks for eye diseases - like glaucoma or cataracts - or general health problems, such as diabetes or high blood pressure, which can have a knock-on effect on your eyesight.

Generally, an eye test will involve you being asked to read a series of letters from a chart on display in front of you. The letters become progressively smaller on each line of the chart. You may also be asked to look at a pattern of dots or lines, perhaps on a green or red background, and identify which looks clearer or sharper.

If you are taking a sight test for the first time in some while, you should not wear your glasses or contact lenses. However, you should be advised when you make your appointment as to whether you need to take your contact lenses out prior to your sight test. This is sometimes necessary because contact lenses can affect the short-term shape of your eye and may alter your vision as a result.

At the end of the sight test, your optician should discuss the results with you and advise you of the best course of action. If any problems that require further investigation or treatment are identified by your optician as a result of your sight test, they will be able to refer you to your local doctor or the appropriate hospital consultant ophthalmologist (specialist eye doctors who diagnose and treat eye disorders) for further treatment. It is also possible to arrange to be seen at a private eye clinic or hospital.

Opticians

It is not necessary to register with one particular optician in the way it is to register with a doctor, for example. These days, many high street companies provide an optician alongside other services. However, if you choose to return to the same optician, they will keep your records on file and many offer payment plans to enable you to spread the cost of glasses or contact lenses throughout the year.

You can discuss with your optician whether or not you need to pay for your sight test or are eligible to claim for NHS optical vouchers towards the cost of your glasses or contact lenses.

Getting a 2nd Opinion

If, after having consulted an optician, you would like a second opinion about your condition or treatment, you should ask your local doctor for a referral to another specialist, if they feel this is the appropriate course of action.

NHS Sight Tests

As discussed, regular sight tests are important to check the health of your eyes. This is especially the case for children as, by identifying sight problems early on, they can be helped with potential learning and development problems.

Regular checks are also especially important if you are a driver or your eyesight may be affected by your occupation (e.g. a VDU operator). Individuals with medical conditions such as diabetes, glaucoma or high blood pressure need to be vigilant too.

You may be entitled to a free NHS sight test if you:

• are under 16, or aged 18 or under and still in full-time education
• are aged 60 or over
• are registered as severely sight impaired / blind or sight-impaired / partially sighted
• have diabetes or glaucoma
• are aged 40 or over with a first degree relative (e.g. parent) with glaucoma, or you have been diagnosed as being at risk of glaucoma
• have been advised by an eye doctor (ophthalmologist) that you're at risk of glaucoma
• are someone whose sight test is carried out through the hospital eye department as part of the management of your eye condition
• are a prisoner on leave from prison
• are eligible for an NHS complex lens voucher - your optician can advise you about your entitlement

You're also entitled to a free NHS sight test if you or your partner are under 20 years of age and the dependent of someone receiving:

• receive Income Support
• receive Income-based Jobseeker's Allowance (not Contribution-based)
• receive Pension Credit Guarantee Credit
• receive Income-based Employment and Support Allowance
• Universal Credit and meet the criteria
• are entitled to, or named on, a valid NHS tax credit exemption certificate
• you are named on a valid NHS certificate for full help with health costs (HC2)

People named on an NHS certificate for partial help with health costs (HC3) may also get help.

Making a Complaint

If you have received goods or services from an optician using the services of an optometrist or a dispensing optician and they are registered with the General Optical Council, then you can make a complaint. In the first instance, you are advised to complain direct to the optician concerned as most issues can be amicably resolved. However, if you feel that your complaint needs to be further investigated, then you should put your complaint in writing to the Optical Consumer Complaints Service, (see Useful Contacts and Organisations section for contact details), which deals with concerns surrounding glasses or contact lenses that have been supplied during the last 12 months.

NHS Low Income Scheme

If you are eligible for help with NHS costs through the NHS Low Income Scheme, you may be able to claim some or all of the costs of sight tests, glasses and/or contact lenses for you, your partner and children. You can apply for help through the scheme by completing the HC1 form, available from your local Jobcentre Plus, GP Practice, Pharmacies and citizens Advice If you live in England you can download the form from www.nhsbsa.nhs

If you have savings or capitol ofless the £6000 and you are either a pensioner, a student, earning a wage, receiving state benefits or living in a care home you can apply online. Visit www.nhsbsa.nhs.uk for more information.

You should get your certificate within 4 weeks of applying. It is usually valid for 6 months - 5 years depending on your circumstances.

You may be entitled to full help with health costs by completing the HC2 form, if you or your partner is receiving Income Support, Pension Credit Guaranteed Credit, Income-based Jobseekers Allowance, Income-related Employment and Support Allowance, Universal Credit or if you are named on a Tax Credit NHS Exemption Certificate.

You may be entitled to limited help with health costs by completing the HC3 form to help with the cost of your glasses or contact lenses. The amount of help available is also known as a voucher value and depends on the strength of your prescribed lenses.

Getting glasses or contact lenses

If you need glasses or contact lenses, a prescription will be given to you following your sight test - this will be valid for two years, and gives opticians the information they need about your vision in each eye to supply and fit glasses or contact lenses according to your individual needs.

All glasses and contact lenses are provided privately. However, some people are entitled to an NHS optical voucher to help towards the cost of buying new glasses or contact lenses, or repairing or replacing an existing pair of glasses that has been broken or lost.

You may be entitled to NHS optical vouchers if you are:

• under 16
• aged 18 or under and still in fulltime education
• an adult on certain benefits
• are eligible for an NHS complex lens voucher (your ophthalmic practitioner will advise you on your entitlement)
• named on a valid NHS exemption certificate
• You are named on a valid NHS certificate for full help with health costs (HC2).

You can find out more about NHS optical vouchers on the NHS Choices website at www.nhs.uk. You may also want to obtain a copy of the Department of Health's HC12 leaflet, which outlines current NHS charges and entitlements, which you can find at www.nhsbsa.nhs.uk.

Replacing glasses on the NHS

Children under 16 years of age are entitled to a free NHS optical repair/replacement voucher, which will help towards the cost of repairing or replacing damaged or lost glasses. Your optician will be able to give you further information about obtaining a voucher.

If you are aged 16 or over, you will only be entitled to help with repair or replacement costs if you have an illness that caused the loss or damage of your glasses or contact lenses. For example, if you are eligible for an NHS optical voucher and you have an illness that affects your balance or a condition which causes seizures, such as epilepsy, then your glasses may have been damaged as the result of a seizure or fall.

To qualify for help with repair costs or replacement glasses, your glasses or contact lenses cannot be covered by a warranty, insurance or any after-sales service.

If you think you might be eligible for replacement glasses or contact lenses, you should ask your optician for a GOS4 form, which - once completed - should be forwarded to your NHS Business Service Authority, so that they can assess your claim. If they agree that you are entitled to help with replacement glasses, they will send you an NHS optical voucher to help you cover the costs.

Payment Schemes

Some high street opticians offer a range of payment schemes towards glasses and contact lenses. You should speak to your opticians about what payment plans and options they have in place to help you spread the costs of new glasses or contact lenses.

Eyecare for the over 40s

Even people who have always had perfect vision experience some deterioration in their eyesight as they get older. Therefore, it is important that you have regular sight tests. You are entitled to a free NHS sight test if you are aged 60 or over. Also, people over the age of 40 qualify for free sight tests if they meet certain conditions, such as having a close relative with glaucoma.

The Blue Badge Parking Scheme

If you are registered as severely sight impaired then you automatically qualify for the Blue Badge Parking Scheme, which offers concessions for on-street parking and free use of parking meters and pay-and- display bays. You may also be exempt from the limits on parking times imposed on others and can park for up to three hours on single or double yellow lines, as long as your vehicle is not causing an obstruction.

Although the scheme applies throughout the UK, there may be some variations from regionto region. A blue badge can cost up to £10 in England. To find out more, go to www.gov.uk or enquire with your local council for further details.

Eye care for disabled people

If you are disabled, then you may be entitled to a free NHS sight test and other vision-related services. If you are unable to visit an optician due to a physical or mental illness or disability, you may also be able to arrange for a sight test to be carried out at home.

Below you will find details of some of the most common sight care services:

Low vision aids

If you experience some loss of sight, attending a low vision service will help you make the most of your remaining vision. Low Vision services supply devices and offer support and advice about using your eyesight. As well as devices such as spectacle and hand held magnifiers, telescopic devices and electronic viewing aids services can help by teaching you techniques to make the most of your vision. Optical devices (those that include lenses generally) can be loaned through the NHS and may be available through your Hospital Eye Service, local optometry practice or local society. Some social care teams also supply this type of equipment. Electronic aids can be demonstrated by rehabilitation workers and skilled staff at local societies. Some opticians provide LVAs privately but, of course, they will charge for these items. Non-optical low-vision aids include everything from an anglepoise lamp, to bold-print books or liquid level indicators that beep to prevent you burning yourself when using hot water.

Your optician or family doctor will be able to advise you about local arrangements for the loan or purchase of LVAs.

Help from your local council

If, due to a loss of vision, you are finding it difficult to do things around the house, at school or at work, your local council may provide services to make life easier for you.

These services might include:

• social workers to support you and your family as you adjust to your vision loss
• training in how to get out independently
• help and advice concerning any health, education, rehabilitation or employment issues you may have
• equipment and alterations to your home
• machines for playing audio books
• training in the use of Braille or Moon (simplified raised print)

Rather than providing these services internally, some councils have an arrangement with a local voluntary organisation to provide support on their behalf.

Other sources of help

You may need professional help and training in order to make the most of your restricted vision. There are a number of organisations offering support to blind and partially sighted people. Please see Useful Contacts/ Organisations section.

Eye care for Children

The early detection of sight problems in children is thought to prevent ongoing problems in terms of learning and development. If you are expecting a new baby, they will be screened for eye problems within a few weeks of birth, and then either shortly before or soon after they start school at the age of four. However, as this is not the case in all areas of the country, parents are advised to check with their local health authority. If you have any concerns in between these tests, or if there are members of your family with eye problems, you can talk to your doctor or arrange to have your child’s sight tested by a local optometrist or eye doctor.

Sight test for children

Older children are usually given the same sight tests as adults but there are special tests for younger children or older children from whom adult tests are not

If your child needs glasses

If you child has had their eyes tested and they need glasses, you will receive an NHS optical voucher towards the associated costs. Children can choose from a wide range of frames that are both practical and fashionable. Your optician will probably recommend choosing plastic lenses because these are more hard wearing and safer than glass lenses.

If your child loses or breaks their glasses, they are automatically covered for replacement or repair on the NHS. You will simply need to complete a GOS 4 form, which is available through your optician. You will be asked to make a statement about what has happened and you will then be given a voucher to cover the cost. If you go to a different optician to the one that originally supplied the glasses, you will need to take your child’s latest prescription with you.

Children aged 16 or over are only entitled to help with repairing or replacing a pair of glasses if the loss or damage was caused by a disability.

Your optician can give you more information.

Children and contact lenses

Children can be fitted with contact lenses but it must be their choice, and they must also be able to demonstrate the ability to take the lenses in and out properly, as well as an understanding of how to look after them. Contact lenses that are not properly looked after and regularly checked can be associated with eye infections and other problems.

Registered as Sight Impaired/Blind

Please note that the new term for being registered blind or partially sighted is severely sight impaired or sight impaired respectively. However, we have used both terms in this guide because many people are still unfamiliar with the new terms.

A hospital consultant ophthalmologist can certify that you are severely sight impaired/ blind or sight impaired / partially sighted through the Certificate of Vision Impairment (CVI), which, once completed, is sent to yourself, your GP and your local council.

This means that you could be entitled to help in a number of ways, including the help with council tax bills and tax allowances, leisure discounts, free public transport, Blue Badge parking scheme and a 50% discount on a colour TV licence (currently discounted to £79.50 per year, only available if you are severely sight impaired)). Some people who are registered as Severely Sight Impaired may also claim the higher rate of the mobility component of the Disability Living Allowance.

Independent living if you are blind or visually impaired

You may be able to access a wide range of services and equipment to enable you to live independently at home if you become blind or visually impaired. Here are just a few examples, aids to independent living include kitchen gadgets, specially adapted telephones and mobile phones, or computer and television screen magnifiers.

Much of the equipment on offer may be provided through the social services department of your local council. Alternatively, the NHS Hospital Eye Service can also prescribe a range of aids for people with partial sight, often free of charge.

If you are severely sight impaired or visually impaired, you are entitled to a health and social care assessment from your local council. This means that someone from social services (usually an occupational therapist) will assess your needs and help you access the equipment and services most suitable for you.

You may also receive direct payments so that you can choose and buy equipment yourself instead of receiving it directly from social services.

Following this assessment, you may also be put in touch with a rehabilitation worker who can help you find new ways to manage the everyday tasks that you may previously have taken for granted. For example, they may encourage new ways for you to get around safely or communicate more easily (for example, by teaching you to touch type or use writing aids and communication software). Commonly used gadgets are those that help blind or visually impaired people manage potentially dangerous household tasks – for example, these might include:

• devices that alert you when a pot of liquid begins to boil
• gadgets that make a sound when the pot or container you are pouring liquid into is almost full
• knives with an adjustable guide to help you cut slices of even thickness
• tactile watches and alarm clocks
• tactile flashing cards for learning
• safe and sanitary mug with sensors
• Braille E-Book

For advice and information about these products and where to buy them, you are advised to contact a charity such as the Royal National Institute of the Blind in the first instance.

To find out more about accessible technology products (e.g., computer screen readers or telephones with colour contrasting touch pads), you might want to contact the Technology Association of Visually Impaired People (see Useful Contacts/Organisations for details).

Benefit Entitlements - Sight

If you are severely sight impaired or partially sighted (or you care for someone with a visual impairment), there are a number of benefits that you may be entitled to.

For people of working age:

• Personal Independence Payment (PIP) is a benefit that is meant to help you with the extra costs caused by illness or disability - including sight loss. It replaces Disability Living Allowance (DLA) for people aged 16 to under state pension age.
• Universal Credit (the Government is replacing a number of means-tested benefits with one new
benefit). It will apply to you if you are on a low income and it does not matter whether you are in or out of work.
• Employment and Support Allowance (ESA) is for people of working age who are unable to work because of disability or illness.

For Older People:

• Attendance Allowance. This can help with extra costs such as taxis, paying someone to help you with personal care or to read or reply to mail for you. You need to be over state pension age to claim.
• Pension Credit helps you top up the money you earn if you have a relatively low income. You may even get it if you have some.
• You can get free NHS sight tests if you are aged 60 or over.
• You can get a free TV license if you or someone you live with is 75 or over. And if you are not yet 75, you can still get a 50 percent reduction in the price of your TV license if you or someone you live with is registered severely sight impaired.

For Carers:

• Carers Allowance. This is the main benefit to claim if you are caring for another person. It is not means-tested and does not depend on National Insurance contributions.
• Carers Credit is a weekly National Insurance credit. Although not a benefit payment. It was introduced to help carers build up their qualifying years for the basic state pension. This means thousands more carers will be able to build up their basic state pension.

For Children:

• Disability Living Allowance. If you are a parent or a guardian of a blind or partially sighted child aged 15 or below.
• Universal Credit. The Government is replacing a number of means-tested benefits with one new benefit.

If you pay tax, if you are certified blind and are on a local authority register of blind persons, or if you live in Scotland or Northern Ireland and are unable to perform any work for which eyesight is essential, you can claim Blind Person’s Allowance. This is an addition to the Personal Allowance and is a fixed amount that is set against your income. If you can’t use up some or all of your allowance, you may be able to transfer it (see www.gov.uk for more information).

Naturally, your entitlements will vary according to your individual circumstances. RNIB publishes a useful series of factsheets about your rights to financial support (see Useful Contacts/Organisations section for contact details).