A national approach to improving eye health:

Progress in Wales

Dr Gillian Richardson: Executive Director of Public HealthAneurin Bevan Health Board

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.

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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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)

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)

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

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+.

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.

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

Uptake of NHS sight tests in Wales for 60 years+ General Ophthalmic Services (GOS)

statistics

- 3.81%50.96%60.76%54.77%Aneurin Bevan

- 5.08%48.93%56.12%54.01%Cwm Taf

- 0.19%54.93%64.05%55.12%Cardiff and Vale

17.67%61.90%52.98%44.23%ABM

8.8%49.39%45.54%40.59%Hywel Dda

1.18%32.99%28.85%31.81%Powys

3.51%38.45%41.61%34.94%Betsi Cadwaladr

3.21%48.80%50.85%45.59%Wales

% change from 2008

2010/112009/102008/9

- 3.81%50.96%60.76%54.77%Aneurin Bevan

- 5.08%48.93%56.12%54.01%Cwm Taf

- 0.19%54.93%64.05%55.12%Cardiff and Vale

17.67%61.90%52.98%44.23%ABM

8.8%49.39%45.54%40.59%Hywel Dda

1.18%32.99%28.85%31.81%Powys

3.51%38.45%41.61%34.94%Betsi Cadwaladr

3.21%48.80%50.85%45.59%Wales

% change from 2008

2010/112009/102008/9

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

- 3.24%34.63%31.64%37.87%Aneurin Bevan

- 3.33%37.56%35.99%40.89%Cwm Taf

2.89%39.05%34.91%36.16%Cardiff and Vale

- 3.11%30.13%29.66%33.24%ABM

- 8.01%21.22%27.01%29.23%Hywel Dda

2.04%26.98%29.14%24.94%Powys

- 5.28%24.02%24.33%29.3%Betsi C

- 2.98%30.52%29.93%33.5%Wales

% change from 2008

2010/112009/102008/9

- 3.24%34.63%31.64%37.87%Aneurin Bevan

- 3.33%37.56%35.99%40.89%Cwm Taf

2.89%39.05%34.91%36.16%Cardiff and Vale

- 3.11%30.13%29.66%33.24%ABM

- 8.01%21.22%27.01%29.23%Hywel Dda

2.04%26.98%29.14%24.94%Powys

- 5.28%24.02%24.33%29.3%Betsi C

- 2.98%30.52%29.93%33.5%Wales

% change from 2008

2010/112009/102008/9

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 WalesTo eliminate avoidable sight loss and support people with sight lossInclusion, 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 Wales, – improve quality of eye care services, – to raise public and professional awareness of eye health

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 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.

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

Location of optometry services

Location of optometric practices in less deprived areasPeople from deprived areas reported less use of eye care services (WHS)

Welsh eye care health examination

Local authority / health board

WECHE rate per

10001

PEAR

PEARS rate per

10002

NHS s

NHS sight test rate per

10003

The Vale of Glamorgan 11.4 17.1 236.2Cardiff 7.9 12.4 236.5

Cardiff & Vale HB 8.8 13.6 236.4

Rhondda Cynon Taf 2.9 12.7 254.8Merthyr Tydfil 10.3 14.0 289.9

Cwm Taf HB 4.3 13.0 261.5

Caerphilly 7.9 14.1 255.7Blaenau Gwent 4.7 7.6 250.9Torfaen 9.5 11.1 278.3Monmouthshire 4.7 10.5 326.3Newport 1.6 6.2 249.2

Aneurin Bevan HB 5.7 10.3 268.2

Produced by Public Health Wales Observatory. Source: Contractor Services

1 Welsh Eye Care Health Examination (WECHE) rate per 1000 adults aged 18+2 Primary Eyecare and Referral Scheme (PEARS) rate per 1000 total population3 NHS sight tests rate per 1000 all ages

WECHE, PEARS and NHS funded sight tests, April 2009-March 2010, rate per 1000 persons

WECHE rate variable across South Wales and within Cwm TafNot related to drivers of need, such as ethnicity

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

Thank you

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/prevention/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 Scotland’s 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 blindness:an 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/prevention/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/prevention/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

References

References• RNIB (2012) Preventing Avoidable Sight Loss. Developing an

evidence base to build better eye care services. • http://rnib.org.uk/PROFESSIONALS/HEALTH/SERVICES/

Pages/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 4:1-14

• Waern et al (2002) Burden of illness and suicide in elderly people:case 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@wales.nhs.uk

• Sian Biddyr• Eye Health Promotion Manager – RNIB Cymru – Wales Vision

Strategy Advisory Group• Tel : 029 20449594• Email: sian.biddyr@rnib.org.uk