More than just a pair of eyes
Let us start with a dose of philosophy in order to set the scene. What am I? Yes, it’s a tough question, and a classic, a question you wouldn’t expect to find in an article about eyesight, but nevertheless, it is a necessary and valuable starting point, because the question illustrates a fundamental point.
We are more than the sum of our biology; we are more than just a machine made out of meat. When we ask the big question, we don’t think about skin, bone, muscle and blood, we think of ourselves in terms of our core, our personal and spiritual identity. We think of ourselves in a holistic sense.
So, would it be fair to suggest that a visually impaired person is more than just one or two damaged or non-functioning eyes? In my opinion, yes – of course we are more than just our eyes, in fact, our identities and needs should not be dictated by the medical or the surgical. So, what does this question mean in the bigger context? Well, it means a lot, as it provides the background to a discussion about how measuring and mending eyesight is just one aspect of care.
Letters and lights
When I could see, every examination began with a challenge to see how many letters I could see on the chart. This little pantomime would feel me with a mix of dread and adrenaline, as it would always feel like a test. If I could see few letters than last time, I had somehow failed, and it would result in further probing, pain and maybe even surgery.
But, dutifully as always, I would squint at the gently glowing box and summon all my powers of concentration in order to will myself to read as many lines as I could. After this, came the frame. The bright and uncompromising lights of looking and learning, of gazing and measuring. Whatever happened, whatever I felt, it was all about my eyes, and not me.
As my sight worsened, the ballet of bothersome nonsense continued. After letters it was fingers. After fingers, it was hand movement. After hand movement it was light. The way in which my sight was measured changed, but the fundamental remained – my eyes were the centre of the experience, and not me. This always struck me as odd, because living with pain and, dare I say it, sight loss, affects an individual, sometimes in the most profound ways.
Medical and Social
Let’s briefly touch on models of disability. Not because it helps us understand the complexities of personal experiences, but because it helps us to frame a discussion about eye examinations and the experience of the patient.
In brief, the medical model of disability argues that the person with the disability, in this case visual impairment, has a medical problem, a disease, illness or failing that medicine can fix. This rather dated model claims that there is something wrong, something not working properly, and it must be fixed. It asserts that whatever issues the disabled, or visually impaired person has, is because of their condition and nothing to do with the way in which society treats or measures them.
On the other hand, the social model of disability, suggests that there are larger, more complicated factors to consider, issues that go above and beyond the medical. These factors include societal attitudes, and how society must take some responsibility in the treatment and inclusion of disabled people. The social model, adopted by most countries, asserts that the medical – the condition or illness, is a starting point, and that emotional and mental health is impacted by experiences and attitudes.
So, why is it that clinical intervention, mending rather than maintaining, seems to be the order of the day?
Mend and Maintain
When I was young and partially sighted, things were slightly different to how they are now. There was of course, still the obsession with saving eyesight, sometimes to the detriment of the patient’s health. There was also the darker factor of the surgeon’s ego. I remember one particular surgeon who took it as a personal and professional challenge to undertake a particularly complex procedure. I would hope that such things don’t happen nowadays, but I’m sure they must, because like it or loath it, it is a side effect of human nature.
One way in which services were better thirty or so years ago, was in the field of low vision. In the past there seemed to be the appetite and the budget for dedicated and committed professionals to help maintain vision. Not through medical intervention, but through glasses, magnifiers etc. This approach empowered the patient, it gave the patient the opportunity to take ownership of their level of eyesight and do something to use it, to stretch it and challenge it. This meant that people like me got every drop of useful eyesight they could out of their remaining eye.
Nowadays, it seems that there isn’t the budget or the resources to offer such a comprehensive service. instead, the order of the day seems to be “mend” through surgery and/or drugs, and hope for improvements. Essentially, the medical model is being adopted and the more holistic, more empowering approach is being neglected. The knock-on effect is that people who may have additional needs, be they emotional, mental or physical, are denied a chance to express their concerns and gain meaningful, non-medical help. So, what does this mean? let’s take two fictional scenarios:
I am 68, I have problems with my eyesight. Reading is becoming difficult, and the television has turned into a blob in the corner of the room. I had a consultation, and I was told I have cataracts and glaucoma. They give me eye drops and offer me surgery. I feel frightened, frustrated and alone.
I am 68, I have problems with my eyesight. Reading is becoming difficult, and the television has turned into a blob in the corner of the room. I had a consultation, and I was told I have cataracts and glaucoma. They give me eye drops to control the pressure. The doctor makes me an appointment to see somebody about changes I can make to my home – talking books, audio description on the television, and different lighting. The doctor asks me how I feel, I tell her. She puts me in touch with someone who can listen to my worries and concerns. I leave the consultation with knowledge and confidence.
The holistic approach is far better. It fosters trust and openness, and gives the patient an opportunity to explore both their thoughts and feelings, and discuss ways to make their life easier. What this approach does is potentially prevent people’s mental health from declining at a later date; as through early intervention, the right emotional support and advice can make all the difference. What a slightly longer and more empathetic eye examination does, is take future strain away from the NHS, and allow people to take control of their care.
We are more than just a broken part. We are not a car that needs a new battery, or a computer that needs a new CPU, we are more complex. Surgery isn’t always the answer but listening and talking is a fabulous starting point. Doctors need to be more flexible in their approach and offer additional services. Allied to this, they need to be able to deal with individuals who may have additional needs, such as learning or developmental impairment.
If a more holistic model was adopted, if a social philosophy was to be allowed to blossom, patients would feel better emotionally, and therefore need not access services in the future. Giving the patient the opportunity to explore visual aids, technology and talking therapy is a far kinder, far more civilised way forward.
With thanks to BJ Edwards for this excellent guest blog www.bjedwards.co.uk