Preventable sight loss

Preventable sight loss

Introduction

A person who has 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 can check on the general health of an eye and measure how good a person is at seeing short and long distance, as well as seeing what is around them. If they identify an eye health issue which cannot be corrected through glasses or contact lenses and requires medical attention, they will make a referral to an eye specialist. The eye specialist is known as an Ophthalmologist.

 

An Ophthalmologist can decide if a person is sight impaired and how severe this impairment is. Once a person is certified as sight impaired (or severely sight impaired), then that person can choose to register their sight loss with their local council.

 

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 sight impaired or severely sight impaired. 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 Age Related Macular Degeneration (AMD) - wet and dry - dry is the more common condition, but this develops slowly and the outcomes are less severe - wet is the more serious condition causing 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, 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 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 sight impaired or severely sight impaired as a result of one of these three conditions are measured in the Public Health Outcomes Framework.

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 strategy has three key outcomes which 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 sight impaired and severely sight impaired 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

 

The Wokingham services website lists a range of organisations which may be of use.

 

Local support can also be accessed through Optalis. They provide services to deaf, deafened, hard of hearing, deafblind and visually impaired adults living in the Wokingham Borough. This also includes offering help to those who, in addition to their hearing or sight loss, may also have a physical disability, learning disability, mental health issues or who are elderly.

 

They aim to provide the right help and advice for each person, as each individual has different needs and have specialist workers who can communicate in a variety of ways and are able to use sign language.

 

Services provided can include:

  • Support from a social worker

  • Advice, guidance and assistance on a wide range of issues, to help support positive independent living

  • Information about essential equipment to assist and improve daily living in the home

  • Information on deafblind issues

  • Information on interpreters

  • Advice, mobility training and equipment to help with sight loss      

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 including 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 the chances of developing AMD – a major cause of sight loss.

 

Those affected by sight loss need to be well informed about their condition and how it will affect them, both 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, mobility training and put in contact with support networks and charities (Blindness and Partial Sight).

 

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 person’s 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. Equally, when someone experiences sight loss it is vital for them to have support in their homes and communities. 

There are an estimated 4880 people living with sight loss in Wokingham Borough, with 580 people living with severe sight loss. By 2020 these numbers are expected to increase to 5,870 and 720 respectively.  3% of people living in Wokingham are estimated to have sight loss, which compares to 2.95% of people in the UK as a whole (RNIB).

 

Causes of sight loss

 

The following estimates show the number of people in Wokingham Borough living with major causes of preventable sight loss (RNIB):

 

  • 5,690 ( 6,460)  people are living with the early stages of AMD; 405 ( 470)  people are living with late stage dry AMD; and 835 (970)  living with late stage wet AMD

  • 1,300 ( 1520) people are living with a cataract and 1,470 ( 1540)  people are living with glaucoma

  • 9,560 (10,220) people have diabetes and 73.6% (73%)  of those who were offered retinal screening in 2012/13 attended

  • 2,675 (3,110) people are living with background diabetic retinopathy and 305 290 people are living with later stages of the disease ( all figures are taken form the Sight Loss Data Tool, Local Authority report, 2016)

The figures below relate to outcomes in the Public Health Outcomes Framework for Wokingham Borough for the year 2013 to 2014:

Public health outcomes measures for preventable sight loss
Public health outcomes measures for preventable sight loss

Care needs to be taken when basing decisions on this data as the numbers of people affected, and thus involved in the rate calculation, are so low. The increased life expectancy in Wokingham, compared to the national average, is also likely to affect the results for conditions affecting the elderly.

 

Ageing

 

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:

  • Aged 65 to 74 - 843 in Wokingham borough estimated to have sight loss
  • Aged 75 to 84 - 1092 in Wokingham borough estimated to have sight loss
  • Aged 85 and over - 1187 in Wokingham borough estimated to have sight loss
  • Source: RNIB


Sight loss registration

 

In Wokingham borough:

  • There are a total of 605 people registered as blind or partially sighted. 315 people are registered as severely sight impaired and 290 people are registered as sight impaired
  • 31% of registered sight impaired or severely sight impaired people are also recorded as having an additional disability

 

Although Ophthalmologists provide a certificate of sight loss, with data being returned to the Department of Health regularly, a sight loss register is also maintained by local authorities. Data from this covering the numbers and ages of people registered is passed to the Department of Health every 3 years. The next return due is for 31st March 2017 data. It is believed that a significant number of people do not take up the opportunity to register, so no data is presented for JSNA purposes. 

Sight loss registrations
Sight loss registrations

Spend on sight loss

 

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.

 

The 2011/12 NHS programme budget spend on problems of vision equates to £34.16 (£29)per person in Wokingham Borough, this includes inpatient and outpatient procedures , residential and community services and other relevant treatments.

 

The estimated indirect cost of sight loss in 2011 including the cost of family and friends providing informal care equates to £77.28 ( £87) per person in Wokingham Borough (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.

 

In Wokingham as of 2015 it is estimated that  4,806 people with sight loss are aged over 65 do experience a fall per year, 2,271 of these falls are attributable to sight loss, 46 people aged 65 with sight loss experience a severe fall per year, which requires hospital admission, 22 of these falls are directly caused by sight loss. ( RNIB, 2016)

Sight testing

 

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.

Sight tests by age group
Sight tests by age group

Social care

  

Some people with sight loss may be eligible for social care services. Usually such services involve the provision of aids, equipment, training and rehabilitation to support people in their daily living tasks. However for some people, their need for services is so great that care packages are required. At the end of March 2015, long term support packages were being provided as follows:

Long term support packages for sight loss
Long term support packages for sight loss

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 of support networks and the provision of access, aids, equipment, training and rehabilitation.

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


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 Wokingham Borough to target these needs along with enhanced self-assessments and specialist rehabilitation services.


Recommendations for consideration by other key organisations

 

There is great importance in promoting sight loss prevention through increased public awareness and encouraging early detection and treatment strategies. This should be carried out in partnership with voluntary sector organisations, Clinical Commissioning Groups, GP practices and the local authority in an effort to reach the widest number of people.