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Preventable Sight Loss

Introduction

A person with sight loss has difficulty in seeing, which cannot be corrected using glasses or contact lenses. This is also referred to as sight or visual impairment. An Ophthalmologist (generally based in an Eye Clinic) can measure how good a person is at seeing into the distance and around them. These measurements can then be used to decide how severe the sight loss is and whether or not the person is eligible to be registered as sight impaired/partially sighted or severely sight impaired/blind. If registration is appropriate, a Certificate of Visual Impairment (CVI) is completed. Only the Ophthalmologist can confirm eligibility for registration, by signing the document. The CVI is then sent to the relevant authority whose duty it is to then offer registration to the individual concerned; it is the authority that holds the register, not the hospital, and people can refuse to be registered.

The Royal National Institute of Blind People (RNIB) estimates that there are two million people with sight loss in the UK. This includes 360,000 people who are registered blind or partially sighted. It is estimated that by 2050, the number of people with sight loss in the UK will double to four million.

Over 50% of sight loss is preventable, and many people are living with sight loss that can be improved. People should, therefore, be encouraged to attend screening with an optician so that any potential sight loss can be identified and addressed.

The three major causes of preventable sight loss are age related macular degeneration (AMD), glaucoma, and diabetic retinopathy.

  • Age related macular degeneration (AMD): there are two types of AMD, wet and dry. Dry AMD is the more common condition, which develops slowly has less severe outcomes. Wet AMD is the more serious condition, which causes severe sight loss in 10% of cases.
  • Glaucoma: the eyeball contains a fluid which is constantly produced by the eye, with any excess drained though tubes. Glaucoma develops when the fluid cannot drain properly and pressure builds up within the eye, known as the intraocular pressure. Glaucoma often affects both eyes, usually to varying degrees; one eye may develop glaucoma quicker than the other.
  • Diabetic retinopathy: Diabetic Retinopathy is when high blood sugar levels cause damage to the retina (light sensitive layer of tissue at the back of the eye), and is a complication of Diabetes. If left untreated, Diabetic Retinopathy can lead to blindness. Treatments such as pan-retinol laser therapy exist, and can prevent sight loss. All people with Diabetes are entitled to annual diabetic retinopathy screening.

Prevention and treatment of these three conditions is the key objective in public health eye care. The numbers of people who are partially sighted or blind as a result of one of these three conditions are measured in the Public Health Outcomes Framework.

What do we know?

Key facts about sight loss:

  1. There are almost two million people in the UK living with sight loss. This figure includes those that have uncorrected refractive error or cataract that may be reversed. This figure also includes around 360,000 people registered as blind or partially sighted in the UK, who have severe and irreversible sight loss.
  2. Sight loss affects people of all ages but especially older people: 1 in 5 people aged 75 and 1 in 2 aged 90 and over are living with sight loss.
  3. There are over 25,000 blind and partially sighted children in the UK aged 0-16. As many as half of these children may have other disabilities.
  4. There is a link between sight loss and reduced wellbeing. Over one-third of older people with sight loss are also living with depression.
  5. Two-thirds of registered blind and partially sighted people of working age are not in paid employment.
  6. The number of people in the UK with sight loss is set to increase in line with population ageing: by 2050 the number of people with sight loss in the UK could be nearly four million.

Sight loss can affect people of all ages but becomes more common with age. Older people with sight loss are also much more likely to have additional health conditions or disabilities. Sight loss impacts on a person's life in many ways. It affects the way in which people perform tasks of daily living such as reading, cooking, cleaning, shopping and accessing facilities in the community. It also impacts on their employment and/or education, their social life, and their general wellbeing and mental health. People with a learning disability and people from black and minority ethnic groups are at a greater risk of sight loss (Action for Blind People).

Excessive alcohol consumption and smoking have been found to significantly increase chances of developing AMD which is a major cause of sight loss.

The provision of emotional and practical support at the right time can help people who are experiencing sight loss to retain their independence and access the support they need. A persons experience in the eye clinic is crucial. It is here that they receive their diagnosis, undergo treatment and potentially go through the process of receiving a Certificate of Vision Impairment - the latter can have a devastating effect on a person's life.

Those affected by sight loss need to be well informed about their condition and how it will affect them now and in the future. They need to be empowered and made aware of practical support available, such as visual aids, educational and psychological support. They will also need access to a Rehabilitation Service to learn new daily living skills and for mobility training. Being put into contact with support networks and charities (Blindness and Partial Sight) can also be very helpful.

Facts, Figures, Trends

There are an estimated 3,530 people living with sight loss in Reading. 420 people are living with severe sight loss (blindness). By 2020 these numbers are expected to increase to 4,110 and 510 respectively. 2.3% of people living in Reading are estimated to have sight loss, which compares to 2.95% of people in the UK as a whole (RNIB).

The following estimates show the number of people in Reading living with major causes of preventable sight loss (RNIB);

  • 4,336 people are living with the early stages of AMD; 334 people are living with late stage dry AMD; and 686 people are living with late stage wet AMD
  • 1,052 people are living with cataract and 1,290 people are living with glaucoma
  • 8,131 people have diabetes and 73% of those who were offered it attended retinal screening in 2012/13
  • 2,277 people are living with background diabetic retinopathy and 260 people are living with later stages of the disease

The figures below relate to outcomes in the Public Health Outcomes Framework for Reading for the year 2013/14.

Figure 1: Public health outcomes measures

Outcome

Number

Per 100,000

Compared to England

4.12i - Preventable sight loss - age related macular degeneration (AMD)

33

175.2

Higher

4.12ii - Preventable sight loss - glaucoma

6

9.6

Similar

4.12iii - Preventable sight loss - diabetic eye disease

<5

*

Similar

4.12iv - Preventable sight loss - sight loss certifications

62

38.9

Similar

Source: Public Health Outcomes Framework

A European Survey found that loss of vision was the second biggest health concern of ageing, after memory loss (Age UK). One in five people aged 75 and over are living with sight loss; compared to one in two aged 90 and over. 

Figure 2: Older people in Reading estimated to have sight loss

Age group

Number with sight loss

Aged 65 to 74

590

Aged 75 to 84

911

85 and over

1,119

Source: RNIB

In Reading:

  • There are a total of 925 people registered as blind or partially sighted. 445 people are registered blind and 480 people are registered partially sighted.
  • 6% of registered blind and partially sighted people are also recorded as having an additional disability

Figure 3: Sight loss registrations in Reading per 100,000 population

image1

Source: RNIB

The total costs of eye care and supporting people with sight loss are difficult to establish due to the range of services and indirect costs involved. The main direct healthcare costs associated with eye care are within primary ophthalmic services, prescribing and pharmacy and within secondary care where costs are associated with outpatient services and day cases, clinics, eye casualty and inpatient services.

  • This 2011/12 NHS programme budget spend on problems of vision equates to £34.16 per person in Reading
  • The estimated indirect cost of sight loss in 2011 including the cost of family and friends providing informal care equates to £52.20 per person in Reading (RNIB)

Sight loss is closely linked to falls. Boyce (2010) estimates that 3.8% of falls resulting in hospital admission could be attributed to visual impairment, costing 10% of the total of treating accidental falls. When these estimates are applied to the population of Reading, 183 falls are directly attributable to sight loss; and 15 required hospital treatments.

The Royal National Institute of Blind People (RNIB)'s report Liberating the NHS: Eye Care, Making a reality of equity and excellence (2010) estimates that the NHS could save £2 billion through regular sight testing and early detection. 

Figure 4: Sight Tests By Age Group

image2

Source: RNIB

National & Local Strategies (Current best practices)

The UK Vision Strategy 2013-2018 details a framework for change and to develop services to help prevent avoidable sight loss and ensure all-round care is provided.

The strategies three key outcomes are:

  1. Everyone in the UK looks after their eyes and their sight
  2. Everyone with an eye condition receives timely treatment and, if permanent sight loss occurs, early and appropriate services and support are available and accessible to all
  3. A society in which people with sight loss can fully participate

'Seeing it my way' is a framework from the UK Vision Strategy 2013-2018 of outcomes identified as most important by blind and partially sighted people. Over 1,000 people with sight loss were involved in developing these outcomes. 

  1. That I understand my eye condition and the registration process
  2. That I have someone to talk to
  3. That I can look after myself, my health, my home and my family
  4. That I receive statutory benefits and information and support that I need
  5. That I can make the best use of the sight I have
  6. That I can access information making the most of the advantages that technology brings
  7. That I can get out and about
  8. That I have the tools, skills and confidence to communicate
  9. That I have equal access to education and lifelong learning
  10. That I can work and volunteer

Reading Borough Council Sensory Needs Team: The Sensory Needs Team is made up of specially trained staff who can offer appropriate information, advice and support to people with a visual impairment, as well as deaf, deafened, hard of hearing and deaf/blind adults. If someone has a diagnosed sight loss the team can:

  • Talk through your sight loss with you to understand how it affects you (and your family) and offer practical advice about how you can manage and overcome these difficulties.
  • Guide you through the registration process and tell you of the advantages some people get by being registered.
  • Offer advice and information and tell you about local services and national organisations that can offer the support and services you need and want.
  • Identify and provide small aids and equipment to help you in your daily life. Many people are surprised how a simple piece of equipment can make a big difference.
  • Offer training in: low vision and communication; independent living skills and orientation and mobility techniques.

Services provided by Reading Association for the Blind; a charitable association offering services to the blind and visually impaired in Reading http://www.readingassociationfortheblind.org/

What is this telling us?

  • Screening uptake, timely treatment and early and appropriate service access are vital to improve eye health.
  • People should be encouraged to attend regular eye screening with an optician.
  • Those people affected by sight loss need to be well informed and empowered. This can be through the use rehabilitation services, support networks and the provision of access, aids, and equipment.

What are the key inequalities?

A link exists between low income, deprivation and those living with sight loss. Three quarters of blind and partially sighted people live beyond or near the poverty line. Blindness can often lead to social exclusion. Deprivation can be both a cause and an outcome of blindness.

What are the unmet needs / service gaps?

People with visual loss reported that their greatest unmet need was for information, followed by accessibility, disability awareness and for aids and equipment. Efforts have been made within Reading to target these needs along with enhanced self-assessments and specialist rehabilitation services.

See also

Diabetes

Deprivation by Ward and Lower Super Output Area

Mental health

Carers

References

Bosanquet, N. (2010). Liberating the NHS Eye Care: Making a Reality of Equity and Excellence.

Boyce, T. (2011). Falls - costs, numbers and links with visual impairment.

Age UK. (2012). 'Survey Reveals Sight Loss Fears', http://www.ageuk.org.uk/latest-news/archive/survey-reveals-sight-loss-fears/.

Public Health England (2015), Public Health Outcomes Framework. PHE, London.

http://www.rnib.org.uk/knowledge-and-research-hub-key-information-and-statistics/sight-loss-data-tool

http://www.patient.co.uk/doctor/severe-and-partial-sight-impairment 

http://www.rnib.org.uk/knowledge-and-research-hub/key-information-and-statistics

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