Managing visual impairment and blindness

All three tend to develop slowly, which is part of why a carer often notices a change before the person themselves does. A client peering closely at print they used to read easily, misjudging a step, or turning their head to bring something into their side vision are all worth mentioning to their family, since an appointment sooner rather than later gives the best chance of slowing whatever is causing it.

A client who is already registered as sight impaired, has diabetes, or has been told by an ophthalmologist that they are at risk of glaucoma also qualifies for a free test regardless of age. If getting to the opticians is difficult, ask whether they offer a home visit; most high street chains do, alongside NHS-funded home eye tests for anyone who cannot leave the house unaccompanied. The NHS page on free eye tests and optical vouchers has the full eligibility list, including help with the cost of glasses for anyone on a low income.

At the table, the same principle applies. If you are reading a menu aloud, include the price of each item, and describe where things are placed using the position of the hands on a clock face, covered in more detail in the next section. A handshake works as well as a smile when you meet or say goodbye, since it is something both of you can feel.

If your client also has dementia, the two conditions interact: someone who cannot see a face clearly relies even more on a familiar voice and a consistent routine to feel orientated. Managing clients with dementia goes further into the approaches that help when memory is affected too. And if touch of any kind, from a steadying hand to a hug, is something you are working out with a particular client, can carers hug clients? covers reading consent.

To guide someone, offer your arm rather than taking theirs; they hold just above your elbow and half a step behind you, which lets them feel your movement before it happens. Walk at a normal pace, and pause slightly before a step up or down rather than announcing it and then hesitating, since a clear pause says more than words. On a narrow path, tell them and let them drop behind you rather than pulling them sideways. At a doorway, tell them which way it opens.

A cluttered home is where guiding becomes hard work rather than routine. Clearing trailing cables, moving furniture out of the main path between rooms, and marking the edge of steps in a contrasting colour all make a real difference, and risk assessment for carers has a template for working through a home room by room with exactly this in mind.

An ophthalmologist issues the Certificate of Vision Impairment (CVI) after an eye test shows enough loss to qualify, and a copy goes to the local council, who then have a duty to contact the person about the wider support register. None of this happens automatically from a diagnosis alone, so if your client's ophthalmologist has mentioned registration and nothing has followed up, it is worth them asking their GP or eye clinic directly. RNIB's guide to registering as sight impaired explains the process and what a CVI looks like.

Sight loss severe enough to affect someone's ability to manage personal care safely, such as preparing food, managing medication or getting around the home, can also be grounds for a claim for Attendance Allowance, whether or not they choose to register. It is worth raising with the family if nobody has looked into it yet.

Access refusals for guide and assistance dogs remain common enough that RNIB and Guide Dogs run a joint toolkit to help owners challenge them; if a client tells you they were turned away from a shop, café or taxi because of their dog, RNIB's reporting on guide dog access refusals explains what to do about it.