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A national approach to improving eye health: Progress in Wales


A national approach to improving eye health: Progress in Wales Dr Gillian Richardson: Executive Director of Public Health Aneurin Bevan Health Board – PowerPoint PPT presentation

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Title: A national approach to improving eye health: Progress in Wales

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

Epidemiology of eye conditions that cause sight
  • 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.

Age and eye health
Age 65
Morbidity and quality of life
  • Sight loss ranks among top ten causes of
  • 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)

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
  • 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)

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
  • Frick and Kymes (2006) state the economic burden
    of sight loss similar to that of cancer, dementia
    and arthritis

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
  • RNIB recommends an annual sight test for children
    up to sixteen and annually for people 60 years.

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
  • 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

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

Uptake of NHS sight tests in Wales for 60 years
General Ophthalmic Services (GOS) statistics
Map showing uptake of NHS sight tests for 60
years in Wales 2010/11
Uptake of NHS sight tests in Wales - Children
3-15 years, GOS statistics
Map showing uptake of children 3-15 years NHS
sight tests in Wales 2010/11
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.
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
  • improve quality of eye care services,
  • to raise public and professional awareness of eye

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

What's happening in Wales?
  • Phase 2 involves
  • Professional and public awareness of eye health
    in particular at risk groups - identified as BME
  • 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.

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
  • 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

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

Thank you
  • 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
  • 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

  • Hayden, (2012) RNIB Community Engagement Project
    Insight Research National report. UK RNIB
  • http//www.rnib.org.uk/aboutus/Research/reports/pr
  • 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
  • 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

  • RNIB (2012) Preventing Avoidable Sight Loss.
    Developing an evidence base to build better eye
    care services.
  • 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

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

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

Contact Details
  • Dr Gillian Richardson
  • Executive Director of Public Health (consultant)
  • Aneurin Bevan Health Board
  • Tel 01495 765454
  • Email Gill.Richardson2_at_wales.nhs.uk
  • Sian Biddyr
  • Eye Health Promotion Manager RNIB Cymru Wales
    Vision Strategy Advisory Group
  • Tel 029 20449594
  • Email sian.biddyr_at_rnib.org.uk
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