Preventable sight loss

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 optician can measure how good a person is at seeing into the distance and around them. They can use these measurements to decide if a person is sight impaired and how severe this impairment is. Once a person is certified as 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 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. Prevention of sight loss is a 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.

The diabetic eye screening programme is covered in more detail in the section non-cancer screening.

What do we know?

There are three major causes of preventable sight loss:

  • Age related macular degeneration (AMD) is a condition which affects your central vision. The causes of AMD are not fully understood but it is known that older age and a family history of the condition are strong risk factors as well as alcohol and smoking.
  • Glaucoma occurs when fluid in the eye cannot drain properly and pressure builds up. Though the cause of this is often unclear, the risk is known to be higher in those who are short-sighted, older adults, those with family history and those from African or Afro-Caribbean origin.
  • Diabetic retinopathy is a condition in which prolonged high blood sugar causes damage to the back of the eye (the retina).

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).

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 Slough, 130 falls are directly attributable to sight loss; and 11 required hospital treatments.

Those affected with 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, 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 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. Equally, when someone experiences sight loss it is vital for them to have support in their homes and communities.

Facts, Figures, Trends

There are an estimated 2,590 people living with sight loss in Slough. 290 people are living with severe sight loss (blindness).

By 2020 these numbers are expected to increase to 3,350 and 390 respectively. 1.9% of people living in Slough are estimated to have sight loss, which compares to 2.95% of people in the UK as a whole (RNIB).

The RNIB estimates that in Slough there are 3,277 people are living with the early stages of AMD, 1,130 people living with glaucoma and 1,914 people are living with the early stages of diabetic retinopathy (background diabetic retinopathy).

When compared to the national benchmark (Table 1), the only cause of sight loss for which there are significantly higher rates in Slough is diabetic eye disease. This is consistent with the known higher rate of diabetes locally.

Table 1: PHOF Indicators – rate of sight loss due to major causes

Outcome Number Rate per 100,000 Compared to
England average
 4.12i Sight loss due to
age-related macular degeneration (AMD)
23 172.7 Similar
 4.12ii Sight loss due to Glaucoma <5  *  Not compared
 4.12iii Sight loss due to diabetic eye disease  12  10.5  Higher
 4.12iv Sight loss certifications  53  37.1  Similar

(Source: Public Health Outcomes Framework)

Sight loss registration

In Slough there are a total of 580 people registered as blind or partially sighted. 310 people are registered blind and 270 people are registered partially sighted. Figure 1 illustrates this number as a rate per 100,000.

31.9% of registered blind and partially sighted people are also recorded as having an additional disability.

Figure 1: Sight loss registrations per 100,000 population (2012/13)

Figure 1

(Source: RNIB)

Sight testing and screening

We know that of the 9,500 people in Slough who have diabetes, 86.6% of those offered eye screening over 2013/14 had a record of having attended eye screening that year. Though the rate of diabetic eye screening in Slough is good and among the highest rates in the South East, the rates of general eye tests in the population is significantly lower than the average across the South East (Figure 2).

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 2: Rate of NHS sight tests per 100,000 population according to age group

Figure 2

(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.

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, 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 Slough 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.