Services designed to improve mental well-being in patients with vision loss need to improve, according to a series of interviews conducted in Eye. Optometrists are often unaware of their patients’ need for mental health support, where to access the support, and how to direct these patients through the referral process, the report suggests.
A researcher conducted semi-structured interviews with patients diagnosed with an eye condition who received care from a hospital eye service (n=17), referring optometrists (n=5), and eye clinic liaison officers (n=5). A second researcher transcribed the interviews, and 2 additional researchers synthesized the results in a narrative analysis.
“[V]isual impairment has been independently associated with several mental health conditions, including depression, anxiety, and posttraumatic stress disorder,” the study authors note. “In addition, it has been shown that anxiety is one of the main reasons for clinic non-attendance at eye clinics.”
The team identified 3 broad recurring themes which included the emotional trauma of diagnosis, availability of mental health support, and the point where mental health support is most needed across the sight-loss pathway.
Several patients reported they had not received mental health support and were not made aware of any mental health resources. The referring optometrists agreed that adequate pathways to mental health treatment were lacking — 1 optometrist reported that they did not know what kind of support was available to patients at the time of referral and another reported a need for further training.
The eye clinic liaison officers expressed difficulty in providing support with some stating that private space to counsel patients was lacking. Liaisons who were embedded in a hospital eye service were less likely to report this concern, according to the report.
“It is important that an individual’s need for mental health services is ascertained for patients across the whole eye health and sight loss pathway (in all specialisms — cataract, glaucoma, [age-related macular degeneration], diabetic retinopathy, refraction and retinal specialisms), and also possibly beyond,” according to the researchers. “This is likely to require shared standards of care and close cooperation between primary care optometrists and [general practitioners], secondary care optometrists, ophthalmologists, ophthalmic nurses, orthoptists and [eye care liaison officers], and secondary care psychiatry and tertiary/community mental health and social care professionals and service providers.”
Study limitations include variance in practice across geographic regions, possible selection bias favoring patients with glaucoma, and limitations in the type of healthcare worker interviewed.
Trott M, Driscoll R, Bourne R, et al. Mental health support across the sight loss pathway: a qualitative exploration of eye care patients, optometrists, and ECLOs. Eye (Lond). Published online January 10, 2023. doi:10.1038/s41433-022-02373-z