Background
Methods
Aim, design and setting of the study
Participants
Data analysis and epistemology
Reflexivity
Results
Demographics
Demographical information | Participants (n = 16 + 1 partner) |
---|---|
Gender | |
Female | 11 (64.7%) |
Male | 6 (35.3%) |
Ethnicity | |
White British | 15 (88.2%) |
White Other | 1 (5.9%) |
Black Asian and Minority Ethnic | 1 (5.9%) |
Relationship with participant (if interviewed in a dyad) | |
Partner | 1 (100%) |
Visual impairment(s): | |
Visual field loss | 10 (62.5%) |
Visual perceptual disorders | 5 (31.3%) |
Visual acuity loss | 4 (25.0%) |
Ocular motility impairment | 4 (25.0%) |
Other1 | 2 (12.5%) |
Acquired neurological impairment: | |
Stroke (primary) | 7 (43.8%) |
Stroke (secondary)2 | 2 (12.5%) |
Multiple sclerosis | 2 (12.5%) |
Traumatic brain injury | 2 (12.5%) |
Basilar artery migraine | 1 (6.3%) |
Meningioma | 1 (6.3%) |
IMD Decile3 | |
1 (most deprived) | 0 |
2 | 3 (17.3%) |
3 | 2 (11.8%) |
4 | 2 (11.8%) |
5 | 4 (23.6%) |
6 | 1 (5.9%) |
7 | 3 (17.3%) |
8 | 0 |
9 | 1 (5.9%) |
10 (least deprived) | 1 (5.9%) |
Mean (SD), [Range] | |
Age (years) | 44.1 (11.2), [29–74] |
Years since neurological impairment diagnosis/onset | 5.0 (5.4), [0.9–21] |
Years since visual impairment onset | 5.1 (5.5), [0.9–21.5] |
Years of education | 16.9 (2.7), [12–22] |
Thematic analysis
Theme | Subtheme |
---|---|
1. Making sense of the visual impairment | • The emotional impact of the diagnosis • Fear, uncertainty and adjusting to the diagnosis |
2. The responsibility of vision care | • The patient burden in seeking support • Research, social media, and self-seeking help • Changes to self-identity |
3. Influential factors in care quality perception | • The staff-patient relationship, and power balance • Communication, and good care versus good luck • Receiving vision care during the COVID-19 pandemic |
Making sense of the visual impairment
The emotional impact of the diagnosis
…with having no understanding of traumatic brain injury and they [health professionals] never said anything…they didn’t seem to know I was in post-traumatic amnesia…it was [from] me personally googling…and coming to the realisation myself a year down the line that I suffered a very severe traumatic brain injuryID04I had a stroke…completely unexpected, there were no FAST symptoms whatsoever…I instantly lost part of my vision on the right-hand side…ID05.…you go through the various stages, it’s that shock, then the anger… Sight is a primaeval sense that people fear losingID07.
my third nerve would buzz and then I could definitely link it to, if it buzzed then the next day I could see more, I could move my eye more…ID04… it was just like stars in front of my face, it felt like when I was about to faint and I’d been saying for 2 weeks that I was having some problems with my sight and nobody had done anything…it was then found out that I had the visual field lossID06[I get]…occasional clouded vision if I get really, really tired. It’s the focussing thing generally because one eye moves faster than the other…now and again [I get]…double vision with my forward [vision]…ID02[I get] pain…dizziness, forgetfulness, broken words and stammering. So, I’ll forget to speak…and I can walk into things and I can become very forgetful whilst I’m talking to somebody…ID01
Fear, uncertainty and adjusting to the diagnosis
At first, they [health professionals] didn’t know what the condition was, they assumed it was maybe a stroke, but then went to Meniere’s disease…and, a professional…did tests on me and said it’s basilar artery syndrome…It [the condition]’s not stopped [and] normally it stops and gives people some respiteID01it really upset me, it made me feel like why are they not listening to me…I knew that something was wrong with me…that distressed me more, the fact that I knew something was wrong…ID06
I wouldn’t be allowed to drive unless I wore an eye patch…that would be a big thing…I don’t like the idea of driving with an eye patch over the right eye… because I was hit on the right side [road traffic accident] I don’t like the idea of not being able to see on the right-hand side.ID04…things like exercise…now I have to take a step back and just do 10 rather than 20 min…I did have a…panic attack…I felt overexerted and…I knew in the back of mind I’d already had a stroke, I just didn’t want to risk itID10I just make sure I cross the road properly… I don’t wear headphones outside now…it’s getting a little better but I am being more cautious like, making sure that I have someone on my left if I’m outside…ID13
I can I look like I’m drunk even though I don’t drink…. So, I’m a bit self-conscious of that.so I don’t like to go out…I’ll tend to be quiet and not speak or if I do speak it’s quite short which comes across rude and it’s not me being rude it’s just being over cautious and not wanting to look like a bit of an idiot.ID01I hate going out…I don’t like going for shopping…because I bump with people because…I cannot judge distance as well…sometimes I fall down because I didn’t see the pavement, which makes me very anxious…when I bump with people [they] think oh I just didn’t see [them] but it’s a problem with [my] vision.ID03
The responsibility of vision care
The patient burden in seeking support
I didn’t know it [neurological impairment] was going to affect my [vision]…I didn’t realise it would visually impair me. So, I didn’t raise it with my consultant… they’ve not provided me any support for my eyesight loss but only because I’ve not told them.ID01they [hospital staff] literally said bye we will see you later, they gave me no information at all, no suggestions of phone numbers for [charity organisation] or anything at all on things I could do to try and improveID06
…mum and dad were very supportive but obviously they don’t have any knowledge of any of the conditions…they didn’t think I’d have any problems because of my head injury…they weren’t told anything [from the health professionals]ID04I get on with it but I would feel terribly sorry for somebody who didn’t have…a very supportive family, very supportive friends…ID07
it’s always really useful when you meet other people who have either the same or a similar condition…you can say to somebody…things that you wouldn’t really bother asking a doctor. I went along to some local groups, which I didn’t stick with because I found them a little bit depressing. I’m quite a positive person and…obviously because the diagnosis, it wasn’t what I thought was a very positive atmosphereID02I’d researched stuff off my own back, no medical professionals gave me anything. I joined the [charity organisation] Facebook groups and…it was only in there that I started getting suggestions from other people in the same situation…if I’m honest I felt like a fraud because I was partially sighted whereas everyone in my group was totally blind…I remember being like this is this not going to help me at allID06
Research, social media, and self-seeking help
…I do read a lot about [neurological condition], in the beginning…I just wanted to know more about it…I’m very aware that there’s a lot of information out there that isn’t maybe quite accurate so I found the [charity organisation] very useful because I’d see that as quite a trusted sourceID02…I did loads of research…it was just very difficult because I’m not a doctor so…sometimes…you go down that rabbit hole [and] it makes you feel worse…I’d rather hear it from someone [who] at least has a bit of training on it rather than just some guy on YouTubeID10
I’m doing this research, it’s free, they’ll even pay you… So, its free rehab they’re paying you to do…and people [from peer support group] were still like oh no it’s a little bit too far for me, and I’m thinking God I would have travelled to America to get my eyesight backID10No [I didn’t receive visual treatment] from the hospital but I did another research thing, a student from the University… there was a computer-based thing where you had to hit keys to move things about…I still keep that up because…I think it helps but I’m not sure…ID02
I found out about [private vision clinic]…I thought I might as well give it a go because I’ve got nothing to lose, other than money…I think it said I’d improved like 5% but I think…that 5% is for me knowing the task more, I don’t think it’s from my eyesight improvingID06looking back now I think it was a bit of a shamble, it’s this doctor on YouTube and she claims that she can get up to 15 to 80% of your vision back if you’ve had a stroke and…It was almost 10 thousand dollars, so that’s how much I wanted my eyesight backID10
Changes to self-identity
I was a very healthy person. I cycled over eight miles a day, I drank [alcohol] little, I didn’t smoke and nor did drugs [pause]. I lost my job from [neurological impairment]…most of my friendship group didn’t know how to deal with it…I now say I’ve got no friends because they don’t come round anymore…ID01I had to apply reapply for my [driving] license and I told [the driving agency] I’d had a stroke…and because my vision…it was revoked…I completely lost my independence through all of thatID05I was very independent…I had to move back in with my parents for them to look after me, and having to ask them to drive me around everywhere, it took me back to being 15 again…I just I stopped socialisingID06
I want to be able to get back to normal life…but I spend my day googling exercises I can try and finding people that have gone through similar things…But there is hope that it might improve.ID14my wife has only in the last six months decided or accepted that she is in fact my carer because she gets my medication, she drives me around and provides food, but she’s only just accepted thatID05I think that anyone that hasn’t got a partner as committed and interested as [partner], they’d struggle a lot. I don’t know where I’d be now, if it was not [for partner] to help [with sorting] my food out, and like make those little changes…ID16
Influential factors in care quality perception
The staff-patient relationship, and power balance
when the appointments were happening around my vision I would say I was too tired and didn’t have the mental capacity, so I wasn’t looking at anything to do with the vision, I was just leaving it to what the hospital told me.ID04they could have given me leaflets…I would have liked that information…even when they [health professionals] were talking to me I tried to write notes in the phone and they told me off and they were like oh don’t worry we will send it in a letter but the discharge thing was all in their language…ID13
I rang up [patient advice and liaison service] at the hospital…I hadn’t heard anything for 15 or 16 months, and all of a sudden, I had a phone call… and then they referred me to the orthoptist…ID06it took a lot for me…I was getting really frustrated…I was ringing around and [saying] listen, you know there’s something wrong with my eyes can somebody refer me…I remember being really annoyed…[it was] after that when I had to go and see the specialistID10
Communication, and good care versus good luck
[I was offered vision care] quite early into the process…and that’s continued all the way through, every time I have an appointment at the [neuro] centre I see the vision lady as well [pause]. As a patient it’s that element of control…a lot of your life you don’t have control of anymore but you feel like you’re in control of your appointment, when you go and what you want, it’s very person centred.ID02The nicest person I had in the medical service…cared more for [my wife] as well [as me]. She was asking about how she [wife] was doing and she was looking for services for us…she realised that care wasn’t just for that person the care was for in the family as wellID01
…my eyes went funny again so I went to the hospital and [the consultant] was really not very nice with me at all…insinuating that I was a hypochondriac…but my GP has been absolutely fantastic [helping with vision care referral]…I count myself lucky that I’m with themID09…it was a struggle just to get the appointments…I remember getting so frustrated because I was ringing and ringing and ringing and I eventually went in [to hospital] and thank God I actually knew one of the nurses…I said listen can you have a look at my file and just find out why am I waiting so long for an appointment…ID10.I think there needs to be more like connection with services…I’m lucky because I work in a hospital so I’ve referred myself [to the clinic]…so, I’m luckyID13
I would say there appears to be, the fact that the paramedics didn’t realise you can have a stroke without FAST symptoms…particularly for hemianopia and none of them ever pick up on it…I would have thought if you’re going into any kind of medical training you would have [that] knowledgeID05once you’ve been diagnosed there should be somebody really outside the door with a leaflet. I do think it should be factored in. Even if it’s patient services liaison just sat outside the hallway just to say…what your condition is…ID01
Receiving vision support during and since the COVID-19 pandemic
I’ve got nobody to help…[I’m] just not going to know what’s out there and what help I can get. I would say…because of COVID my aftercare was absolutely lacking for everythingID11.I’ve got another telephone appointment at the end of this month…I know COVID’s still going on but the levels are drastically dropping…I’m a slight worried that this may be the way most consultants now go…I just find telephones quite rude…if I’m having a conversation with somebody I can see how that person…reacting and talking…and [if] I’m unshaven and my clothes are hanging off and I’m smelling a bit they’ll say clearly I can see you’re not [doing well].ID01
I didn’t receive any letter from [the hospital] and I tried to chase them up. I tried to call them and no answer, and I sent them an email, no answer. And my vision gets worse…it’s not really good communication with patient, I know it’s COVID but this is about the health and about the vision, it’s about my life to be honest.ID03When lockdown happened…I rang up my doctors in tears and I was just like I can’t do this anymore, I’m having no help, I’m having no support. So, they then referred me to the local low vision people…all these were just purely from me ringing the doctors being like I can’t do this anymoreID06
…before COVID [I went] to a walking group…and often we would need to get public transport… But once we got into COVID they started saying you can’t sit next to someone else and they would tape [seats] off. Even though that [restriction]’s been removed, I certainly [don’t] have the confidence to go on public transport of any descriptionID05…then COVID happened and I think it’s hampered my recoverybecause I just feel like I can’t get back to being the old me…I can’t take my daughter to nursery, I have to get…taxis to work and that’s like taking your life in your hands…it’s that horrendous, I just can’t look [due to vision impairment]…it feels like I’m a burdenID11