Supporting Patients with Sight Loss with Guide Dogs UK (27 Apr 2026)

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Dr Marilena Giannoudi (MG): Hello everyone, and welcome to another episode of Clinical Conversations, brought to you by the Royal College of Physicians of Edinburgh Training and Members Committee. My name is Doctor Marilena Giannoudi and I am on the T&MC and today I am delighted to be joined by Becky Howard, who is a sighted guide training officer with Guide Dogs, and Bruce Cruickshank, who is a volunteer with Guide Dogs, and we will be discussing how we can support patients with sight loss and visual impairment. Good morning. Thank you both for joining me.

Rebecca Howard (RH): Hi. Thank you for having us.

MG: I guess if it's okay, the best place for us to start would be if you could please describe a little bit about your role.

RH: Sure thing. So, hi everybody. I'm Becky Howard, so I'm a sighted guide training officer with guide dogs. So basically, that means I deliver sight loss awareness training, which also includes a sighted guiding aspect, the goal being to make places and spaces more accessible to people with sight loss. So, at the moment, Guide dogs are providing this training free of charge. And that is the main aspect of my role. And I'll pass on to Bruce here.

Bruce Cruickshank (BC): Good morning, everybody. My name is Bruce. I'm a volunteer with Guide Dogs. I assist Becky with the certificate training. I do multiple other things for guide dogs. I'm also a guide dog owner, so I'm used to navigating various spaces and attending medical appointments and things with our visual loss.

MG: Okay. So, we have an expert patient with us today. And can I ask you both what are the most common eye conditions that you come across within your work?

RH: Sure. So currently in the UK, there's around two million people living with an uncorrectable sight problem. And actually, as life expectancy increases, this figure is actually expected to double by twenty fifty. And I think the one thing to highlight with sight loss and eye conditions is there's hundreds of different types of eye conditions, and they really can present themselves differently to individuals depending on the condition, depending on the severity. And that's why it's so important to remember that sight loss is really unique to the person experiencing it. And really, no two days are the same. So, when you're working with a patient, it's really important to sort of take that person centred approach and find the core needs and what support they are looking for. I've got a statistic here, actually, that I thought you might find interesting. So, eighty percent of all people who are blind or partially sighted are aged sixty or over. And to sort of break down that statistic, one in twelve of us will become blind or partially sighted by the time we're sixty. It rises to one in five by the time we reach seventy-five. And it actually goes to one in two by the time we reach ninety.

MG: Oh my gosh.

RH: Absolutely. So, it's just something to think about with the demographic of people that we're working with. And sometimes people like. Bruce, you highlighted a good point earlier about working with potentially the older generation and people maybe not considering it a sight loss or eye condition, for example, like if they had cataracts, because obviously there are treatment options for that. So, to sort of touch on. You asked what are the more common eye conditions? I wanted to highlight a few that are most common. So, cataracts is actually up there with the more common eye conditions that we come across. Macular degeneration is a massive one. And that's also referred to as age related macular degeneration, as it does sort of happen later in life. We also have things like glaucoma and retinitis pigmentosa, and we've got diabetic retinopathy as well, which I thought briefly, if you're happy to share a little bit about that.

BC: So, I myself lost my eyesight due to diabetic retinopathy. There is varying stages of it. It can be that you can have what it classed as a floater in your eye or total sight loss due to mismanagement of high blood sugars, possibly blood pressure and things. That is correctable steps that they can take to try and preserve their eyesight. But unfortunately for me, didn't work for me. I am one of the very rare few with diabetic retinopathy that has total sight loss, because most variants of it is that you have some residual sight left. I'm one of the rare ones, as I said, that has no sight.

MG: Okay. And I must say I'm not an ophthalmologist, and most of my knowledge is what I learnt at medical school. But based on the diagnosis that you gave, my understanding is that the majority of them are actually irreversible other than obviously cataract. And there may be, as Bruce, you suggested, you know, certain stages of the disease where we can pause the loss. But in most of what you've described, we can't necessarily reverse it. Is that what you see?

BC: Yeah, that would be correct. Yeah. Because age related macular, there's two different kinds of wet and dry. I always get them mixed up. Maybe it'll help me or one of them can be treated with injections. And there's one that has no treatment plan at all, and I can't remember which one is which. What is the one that you would get a treatment option for? Yeah, that's what I thought. I wasn't sure.

RH: So yeah, you're absolutely right. Most people, once they're diagnosed, potentially there could be treatment like glaucoma, for example, by prescribing eye drops. But I think one of the main challenges would be people not going to the opticians every two years. Like obviously we live with our sight every day. So, by actually what we see, it's not until people start to experience things like, for example, maybe they're bumping into things that they're not seeing. So, they're like losing that depth perception that they realize that something's wrong. But by that point, it's actually got to a stage that it's a bit further progress than you would have imagined. So yeah, we really take a sort of proactive approach at Guide Dogs to encourage people to get their eyes checked regularly and get booked in with opticians. So yeah, that's the sort of thing we're looking at. And I think it's as well signposting that. There's lots of support out there, like Guide Dogs, obviously, as a charity. We're able to support people at any stage, like with our services. It doesn't have to be that a person has total sight loss. So yeah, we do encourage people to get in touch, and it would be the same for other charities, their potential support networks out there for people and great advice that they can achieve.

MG: Perfect. And just because you mentioned it. So, I think it wouldn't be right if I didn't kind of pick up on this. But what is needed for someone to be referred to you or for someone to reach out to you? Is there a certain level of sight loss, or can anyone with sight loss kind of reach out to guide dogs?

RH: So, I would say that anybody with sight loss can reach out to guide dogs. So, people wouldn't need to be like registered blind or partially sighted, for example, to have a guide dog. I think it's like that person centred approach is what's so important to understand the needs of the person and what might be beneficial to them, and whether having an actual guide dog as a mobility aid. As a suitable option. Or would it be something like long cane training with. Maybe their local authority might be more beneficial and then looking at a guide dog at a later stage of life. So, I definitely would say encourage people to get in touch with us and we would have that conversation.

MG: They can at least be signposted to the right direction.

RH: Absolutely. We do have like a telephone number. It's on our website. It's called our guide line, and that's open Monday to Friday, nine till five. And anybody could get in touch. It could be a family member wanting to chat about our services, which is a really nice way to start getting involved with.

MG: Yeah. Well, what I'll do is in the podcast footnotes, I will make sure that we link the website so that any of our listeners can go on and have a read and see what's available. So, from our point of view, as the majority of our listeners are either doctors in training medical students or healthcare professionals of the wider multidisciplinary team. What can we as healthcare professionals do to provide a good experience for people with sight loss? And I appreciate there is a spectrum of sight loss, but in general, what do you think is good for us to be doing?

RH: Absolutely. I think I've mentioned the word person centred quite a lot, and I think that is really key, like having those open conversations with people to find out the support they need. Because you're absolutely right, it will vary person to person, and it will also vary depending on what's happening in their like sort of immediate environment, like something like light in a room, like if they were in a hospital or clinic environment with certain conditions, like for example, cataracts, it can be very glary for people like facing a window at the moment. I would maybe struggle actually seeing you on the screen. We're in contrast like diabetic retinopathy, for example. People may struggle in darker light environments and it's just thinking about that as people mobilized through an environment. I think having a sort of general understanding, even just of mobility Aids and what people might need, you know, if somebody comes in with a long cane. And I actually had a conversation that was interesting recently. Obviously, the white long cane is what we sort of recognize as a mobility aids. But now you get all sorts of different colours. Like people can have like a pink long cane, if that's something that they want to use. And it's just sort of having a general awareness of that. Have you seen somebody equally? Like if somebody had a guide dog that they were bringing into the clinic? Bruce, do you want to touch a little bit about, you know, what professionals should do if you were bringing your guide dog in?

BC: Yeah. When you access these types of areas with your guide dog, the rule is, is that you don't speak to working guide dog. Although if you are in an unfamiliar area to yourself and the dog maybe doesn't know that area either, you still need an element of assistance. So, it's being mindful that the person may need assistance. Although a lot of people in my situation that have guide dogs maybe don't want to ask for help, they want to be independent because that's kind of what is promoted is to be independent rather. Well, that's the idea of the mobility aids and things just to be independent. But sometimes you still need assistance. So, it's being mindful that the dog is there to do a job, but sometimes we still need assistance. And if you're in a, say, a waiting room, the clinic may be running late. It may be that the dog still needs to go to the toilet. The dog might need a drink. So, some clinics do offer these types of things, but it's quite nice that if the staff are persons, they end up towards ourselves as patients. But also, to get into consideration. The dog has needs as well.

MG: That's very important. And Bruce, you obviously mentioned an outpatient clinical Situation, if you don't mind me asking. Have you ever been in the situation where you've needed an inpatient admission?

BC: Yes. Multiple times.

MG: And how does that work for you?

BC: Well, it becomes a wee bit more challenging in the respect that the dog can't physically stay with you long term. So, you need a family member or a relation to look after the dog. But if I lived independently, I can contact the guideline, as Becky says, and they may be able to set up a volunteer fosterer for a wee while, just in time. Back on my feet and I get discharged from hospital. But when you're in hospital, it has its own challenges because you still need the mobility. So, then I transfer to a long cane, for instance. But then if you imagine a hospital setting, there is single rooms, there is four bedded areas, dormitory style. It becomes challenging because of other people in the room with you. Possibly you're sharing the communal toilet a communal shower. It has its own challenges because you don't know what's lining the floor, and spatial awareness is kind of totally different as well.

MG: So can I ask, and I appreciate no one wants to be in hospital other than doctors and nurses. And I say this to my patients all the time when they keep asking, when can I go home? When can I go home? But if we try and make the most of a bad situation, the times that you have been in hospital, have you ever thought if I had this or if this was different, my life right now would be much easier.

BC: I'm, I suppose, in a different ballpark to, I suppose, the general public, if you like. And I mean that with no disrespect to anybody. But what happens is, is when I'm admitted to hospital because of my physical ailments that I've got, I get a room to myself. So, I've got a smaller space to get lost in, if you like. I've got my own toilet, my own shower. And then I suppose the biggest challenge for me after that is, say, filling out a menu card, for instance, or when they give you a jug of water and the disposable cup that they change daily. Can I fill in cups of water and things for yourself becomes challenging because the way that you would do it at home is not the way you would do it at hospital. So, it still has its challenges, but there's I suppose there's ways to overcome that. But again, it's reliant on kind of support from the staff.

MG: Yeah.

RH: Touching on that, like support from the staff, a large part of the training that we talk about, we talk about sighted guiding and what that is and how important it is for people to have a knowledge of sighted guiding and that benefit. And what we mean by that is a sighted person guiding somebody with sight loss. And I think to recognise some of the key benefits of that is that it's safe practice, but it can also make a huge difference in promoting confidence and independence. You know, if you didn't have your gay dog in a hospital, but someone's able to say, let me guide you to the toilet and explain the layout and have those conversations. It can make a huge difference for that person. And I think then it sort of goes on to talk about, you know, the use of effective language and techniques. Like, you know, you were saying, Bruce, that the last couple of times you've been into hospital, you've been in a room by yourself. Yeah. And it's maybe chatting about the layout of that room, you know, where the table is like the water, for example, where that's getting laid out. And I think that that's something, you know, it's beneficial to everybody. And you said you were going to pop a website information on the footnotes of the podcast. And I do encourage everybody to check out our sighted guiding training on the website, because there's different variations of the training, like there's a one hour introduction to sighted guiding that everybody can access that's delivered weekly, but also we can do a bit more comprehensive training where people can actually practice sighted guiding and get that firsthand experience. As somebody before I started working at Guide Dogs, I definitely appreciated having practice. It definitely made me more confident. Hopefully Bruce can vouch that I'm not too bad sighted guide.

BC: Another big thing for me as an individual person, obviously being a patient with sight loss, that big thing makes you relax and kind of helps you build. A wee bit of confidence is when the staff introduce themselves, because sometimes the staff will come in and then pop out. Things like that. But when the nurses and the doctors and things come in and introduce themselves and they tell you that there's maybe as a medical student or this person, this person, and they say, oh yeah, we've got.

MG: Yeah. I think what you've said is just been so eye opening because I appreciate there is lots of things that people without sight loss take for granted. And it's just about us having an awareness that for you and for anybody with sight loss, it's not just about knowing where you need to be or how to get there. It's about all those tiny day to day Things as well. So, you know, your cup will be different. The positioning of things will be different. And I think it's for us what my kind of reflection on what you're saying is taking that extra bit of time to make sure that you've fully explained yourself, explained the situation, and making sure that the patient, on the other hand, is happy as well and has understood that. And I appreciate the hospital isn't a great environment because we're limited with the kind of equipment that we have. But asking if the equipment that we do have is, you know, effective for the job that we need it to be, or if we do need to think outside the box for other options for you.

BC: Yeah. That's right. As well, as you say, we are spending a wee bit extra time on things. And I suppose that's the most crucial part for yourselves as medical professionals is that time is the critical point where there's so much things to do in such a short space of time. I suppose it's trying to budget that into your already busy day and be mindful that you're being person centred towards every patient, not just the visual impaired people. It's been the same for everybody, I suppose, isn't it?

MG: Yeah. Of course. Okay, so I know we've kind of covered this, but if you had to summarise how we can support a patient, feel safe and confident in hospital even because I appreciate having a side room is ideal, but that's not always possible. How would you summarize, you know, feeling safe and confident in ways that we can help support that?

BC: That's like trying to pick a lottery number, I think, to be perfectly honest. But as you say, it's just knowing that you've gained some confidence with your spatial awareness being explained to you as to where to find the toilet, where to find your bedside calmness, so you can get your belongings so that you can own your pyjamas. You can get dressed whenever you're up to it, where you can have a washroom, whatever else, and it's knowing that you've got kind of support if and when you need it.

RH: Thinking on that it's thinking about maybe the potential barriers to independence that people might come across, like Bruce mentioned, the water jug, like thinking about that. And I think maybe explanations and descriptions might be really helpful. Like even if it's an open jug, if there's a lid on it, and if you have to hold the lid like things that as a sighted person, you would take that visual cue that you're taking the time to describe that. And even potentially like the room layout or where the toilet is to make sure that person feels really confident if they're able to go to the toilet. Whereas in describing the layout of the toilet before this call, Bruce and I had sort of discussed that aspect and that if you were sharing a space, it's then if people had maybe left things in the toilet or left things in the room. So, it's sort of having everybody in that space understand these potential hazards to like if you were leaving bags around potentially for somebody to navigate the space, that's a really big thing. It would also just mentioned the importance of introductions, and I think equally as important as to say hi and like what you're doing here, like your name, even if you've gone into that patient three times a day, I don't know if you would agree with me, Bruce, that it's so important to keep saying that because you're dealing with so many people, you don't want to be sort of working through that mental catalogue of who am I speaking to? Like, I recognize the voice and equally saying that that's me just leaving the room now because I've been guilty. If I've been out with somebody having a coffee. And the natural cue for me is to go to the queue to get the coffee, because I've asked for the order, and then I'd turn around and they'd be still speaking to me because I've not said I'm going to the queue. It's just something as simple as saying, that's me leaving now and I'll be back can make a big difference.

BC: There's also one thing that has just come at the moment that they do here in the ceremony, is that before any member of staff comes into your room by knocking the back of the door before they enter the room, and it just to make you aware that there's somebody coming in. And then every staff member here introduces himself. So, it could be something as simple as implementing that.

RH: Absolutely perfect.

MG: I think honestly, that has been so eye opening. I don't even know what more to ask, other than the fact that I think I need to go and do the training myself to feel more confident. Are there any final comments from yourselves for our listeners?

BC: Well, me personally, I think it's allowing obviously you guys have got a job to do, but as we said, it's being person centred. It's promoting for somebody like myself to still to be independent within the environment that they're in with the confidence that they've got. Because obviously my eye condition doesn't change. But anybody that is in hospital with any eye condition or whatever varying stage, if they're feeling under the weather, you know yourself, if you've got a bit of a sore head or the sun's glare in your eyes, you eyes squint a wee bit and that distracts you a little bit. So, when you're feeling under the weather, I'm guessing it would be the same situation. Is that your total? Your visual acuity and things would change and be flexible. So, it's being mindful of that as well that the person with, say, AMD, their eye condition may deteriorate slightly because of being under the weather or being stressed, being in a different environment, their confidence levels. So, it may present totally different way as to what they would do as normal. So, it's just allowing them, you guys to promote what they still have, what they still can use to kind of feel better about themselves.

MG: Thank you.

RH: I think for myself, the key thing, I think that we've gone through with these different questions is the importance of communication and yeah, confidence as well. So please do check out our website. Like I think that's the one thing when attendees come to our training, say, is that they now have the confidence to ask those open questions, and they have a bit more knowledge and information about how maybe to approach that. And I think it's so important. You can imagine a hospital environment. We've not really touched on the emotional aspect as well of all these changing environments. And I think, yeah, a greater awareness is never a problem. It's always good. Never goes away.

MG: Yeah, exactly. Definitely. Well, thank you both for your time, for your, you know, opening up to me and the listeners about your personal experience that's so useful. Thank you to the listeners for joining in. For more clinical episodes, please check out Clinical Conversations. For any career tips, please check out Career Conversations. And we look forward to seeing you next time.