A national approach to improving eye health: Progress in Wales

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A national approach to improving eye health
Progress in Wales Dr Gillian Richardson
Executive Director of Public Health Aneurin
Bevan Health Board
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How many blind and partially sighted people are
there?

• In the UK
• 182,000 have severe sight impairment/blindness
• 300,000 registered blind or partially sighted
• 2,000,000 with significant sight loss
• In Wales
• 47,300 have severe sight impairment/blindness
• 16,000 are registered blind or partially sighted
• 115,000 with significant sight loss
• Access Economics (2009)
• Sight loss is a major health issue in Wales as 9
  above England.

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Epidemiology of eye conditions that cause sight
loss

• In Wales
• 30,027 glaucoma
• 31,000 cataracts
• 28,600 age related macular degeneration
• In 2010/11 over 400,000 outpatients attended
  hospital eye services in Wales. 85,000 of these
  were new patients.

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Age and eye health
Glaucoma
Cataracts
Age 65
Age
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Morbidity and quality of life

• Sight loss ranks among top ten causes of
  disability
• Decreased quality of life, impact on individuals
  families and society as a whole
• Increased risk of falls and injuries
• Leads to depression and social isolation
• Sight loss is one of top three causes of suicide
  amongst older people (Waern et al, 2002)
• 11,000 people in Wales suffer a stroke each year.
  70 survivors suffer visual impairment. (Rowe et
  al 2011)

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Socio-economic deprivation sightloss

• Chronic eye disease is worse in areas of multiple
  deprivation and low income (World Health Assembly
  Vision 2020 Resolution 2006)
• People living in deprivation are less likely to
  access primary eye care services (Dickey et al
  2007)
• Association between severity of glaucoma at
  presentation with socio-economic deprivation
  (Johnson et al 2011)
• Proximity to primary eye care services is
  associated with poorer visual acuity in
  presentation of AMD (Johnson et al 2011)

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Impact of sightloss on NHS in Wales

• Sight loss costs the NHS in Wales an estimated
  107 million in direct costs (eg, in patient
  treatments, outpatient attendances, prescriptions
  and NHS funded eye tests)
• Prevalence of visual impairment increases with
  age (WHO 2007) so due to an ageing population
  this will double in next 20 years (Frick and
  Foster 2003)
• Estimated annual costs for sight loss in Wales
  including direct and indirect costs is 324
  million. (ref for all above, Access Economics
  2009)
• Frick and Kymes (2006) state the economic burden
  of sight loss similar to that of cancer, dementia
  and arthritis

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Regular eye examinations - early detection

• Regular sight tests help maintain good eye
  health, particularly for those most at risk
• Important as some serious eye conditions do not
  have visible warning signs (eg glaucoma)
• Early detection will also enable more to be done
  to delay disease progression.
• Sight test with an optometrist at least every two
  years.
• RNIB recommends an annual sight test for children
  up to sixteen and annually for people 60 years.

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NHS Sight Tests and Wales Eye Care Initiative

• In Wales, NHS sight tests are free for
• People aged 60 years , children under 16 years
  or up to 19 years in full time education, 40
  years with family history of glaucoma, on low
  income.
• Wales Eye Care Initiative (WECI)
• Optometrists who have signed up to WECI provide
  various free eye examinations for
• People who have sight in one eye, hearing
  impairment or profoundly deaf, suffer from
  retinitis pigmentosa, have family origins from
  various BME communities, are a risk of eye
  disease by other reasons of race or family
  history.

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Wales Eye Care Initiative, continued

• Primary Eyecare Acute Referral Scheme (PEARS)
• Someone with a sudden eye condition that requires
  urgent attention, eg red eye, painful eye, loss
  of vision
• Visit accredited PEARS optometrist.
• Self refer or referred by GP, pharmacist etc
• Welsh Low Vision Service
• Service provided to determine whether any low
  vision aids can help a person with low vision.
• Free assessments by accredited optometrists
• All low vision aids are provided on loan, free of
  charge

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Uptake of NHS sight tests in Wales for 60 years
General Ophthalmic Services (GOS) statistics
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Map showing uptake of NHS sight tests for 60
years in Wales 2010/11
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Uptake of NHS sight tests in Wales - Children
3-15 years, GOS statistics
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Map showing uptake of children 3-15 years NHS
sight tests in Wales 2010/11
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What's happening in Wales?
In 2010 the Wales Vision Strategy Advisory Group
of eye care partners, produced an implementation
plan to coordinate the Welsh response to the UK
Vision Strategy. The plan runs from 2010-2014 and
delivers against three main objectives To
improve the eye health of people in Wales To
eliminate avoidable sight loss and support people
with sight loss Inclusion, participation and
independence for people with sight loss. All work
on sight loss prevention enhances progress to
achieving first two of these objectives.
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What's happening in Wales?

• Wales Eye Health Project established in 2010
• Now in second year and phase two of project
• Advisory group has wide representation from
  health and eye care sector in Wales and chaired
  by Sir Mansel Aylward
• Aim of project
• reduce preventable sight loss,
• reduce financial burden of sight loss on NHS in
  Wales,
• improve quality of eye care services,
• to raise public and professional awareness of eye
  health

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Wales Eye Health Project

• Phase 1 involved
• Patient feedback of primary and secondary eye
  care services - highlighted issues around waiting
  times, accessibility and quality of services
• Mapping of primary and secondary data sources -
  highlighted huge gaps in data collection and lack
  of intelligent data being collated to review and
  help plan services

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What's happening in Wales?

• Phase 2 involves
• Professional and public awareness of eye health
  in particular at risk groups - identified as BME
  groups
• Public Health Wales have funded a small pilot
  project to raise awareness of eye health and the
  different eye health examinations available in
  Wales to people from BME communities. Advisory
  group recently formed and planning project
  implementation and evaluation.

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Eye health on public health agenda in Wales

• Public Health Wales increasingly involved in
  prioritising eye health
• Meetings and seminar in partnership with RNIB
  Cymru, Optometry Wales, MEGAFOCUS, PHW, Primary
  Care about how health professionals can integrate
  eye health into their work programmes (eg smoking
  cessation, screening, early years etc)
• Children's eye health projects in Cardiff and
  Vale health board and Aneurin Bevan health board
• Cwm Taf Community Engagement Project
• Supports NEHW and integrates eye health with
  falls
• Eye health on public health agenda in Wales!
  Wednesday 9th May Welsh Assembly voted on a
  motion for Welsh Government to make a measurable
  reduction in avoidable sight loss, a public
  health priority
• A new eye care plan is being drafted for Wales
  which will reflect sight loss prevention

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Location of optometry services
Location of optometric practices in less deprived
areas People from deprived areas reported less
use of eye care services (WHS)
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Welsh eye care health examination
WECHE rate variable across South Wales and
within Cwm Taf Not related to drivers of need,
such as ethnicity
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Finally

• Considerable progress made in last few years
• Great partnership work and commitment to
  preventing avoidable sight loss
• Welsh Government recognising eye health as a
  public health priority is a huge opportunity to
  drive work forward and ensure less people lose
  their sight unavoidably
• Challenge - allocating resources available with
  competing public health priorities, increasing
  uptake of sight tests and various examinations
  for at risk groups, ensuring screening for
  4/5year olds, improving eye health data

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Thank you
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References

• Access Economics (2009) Future Sight Loss UK 1
  The economic impact of partial sight and
  blindness in the UK adult population. RNIB
• http//www.rnib.org.uk/aboutus/Research/reports/pr
  evention/Pages/fsluk1.aspx
• Burmedi D, Becker S, Heyl V, Wahl HW, and
  Himmelsback (2002) 'Emotional and social
  consequences of age-related low vision a
  narrative review', Partial sight and blindness
  research Vol. 4, No1, pp 47-71
• Dickey et al, (2007) Utilisation of eye-care
  services An examination of the effect of
  Scotlands free eye examination policy. Scotland
  University of Aberdeen.
• Evans, Fletcher and Wormald (2007) Depression and
  anxiety in visually impaired older people.
  Ophthalmology. February 2007.
• Frick KD and Foster A (2003) The magnitude and
  cost of global blindnessan increasing problem
  that can be alleviated, American Journal of
  Ophthalmology 90 272-275

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References

• Hayden, (2012) RNIB Community Engagement Project
  Insight Research National report. UK RNIB
• http//www.rnib.org.uk/aboutus/Research/reports/pr
  evention/Pages/CEP_barriers_enablers.aspx
• Johnson et al (2011) A review of evidence to
  evaluate effectiveness of intervention strategies
  to address inequalities in eye health care.
• http//www.rnib.org.uk/aboutus/Research/reports/pr
  evention/Pages/evaluation_interventions.aspx
• Legood R, Scuffham P, Cryer C (2002) Are we blind
  to injuries in the visually impaired? A review of
  the literature. Injury Prevention 8 155-160
• RNIB (2006) Open your eyes, Campaign Report 25
• RNIB (2011) Preventing Sight Loss in Older
  People barriers and enablers to the uptake of
  sight tests in older people

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References

• RNIB (2012) Preventing Avoidable Sight Loss.
  Developing an evidence base to build better eye
  care services.
• http//rnib.org.uk/PROFESSIONALS/HEALTH/SERVICES/P
  ages/optometrists.aspx
• Rowe et al (2011) Accuracy of referrals for
  visual assessment in a stroke population, VIS
  Group London
• Scuffham et al (2002) the incidence and cost of
  injurious falls associated with visual impairment
  in the UK, Visual Impairment Research 41-14
• Waern et al (2002) Burden of illness and suicide
  in elderly peoplecase control study BMJ June 2002

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Data Used

• Routine data
• Office for National Statistics
• Service data
• Quality and Outcomes Framework
• Diabetic Retinopathy Screening Service Wales
• Cwm Taf outpatient clinics
• Patient Episode Database Wales
• Local Government Data Unit
• General Ophthalmic Services
• Comparative Analysis System for Prescribing Audit

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Data Used

• Modelled data
• National Eye Health Epidemiological model
• GP annual prevalence survey
• Association of Public Health Observatories
  diabetes prevalence model
• Survey data
• Welsh Health Survey

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Contact Details

• Dr Gillian Richardson
• Executive Director of Public Health (consultant)
• Aneurin Bevan Health Board
• Tel [phone]
• Email Gill.Richardson2_at_wales.nhs.uk
• Sian Biddyr
• Eye Health Promotion Manager RNIB Cymru Wales
  Vision Strategy Advisory Group
• Tel [phone]
• Email sian.biddyr_at_rnib.org.uk