Preventable sight loss

Introduction

Sight loss is the largest cause of age-related disability but remains the leading cause of age-related disability.  It can lead to a decrease in quality of life increasing risk of social isolation, poor mental health, falls and hip fractures, poverty and the need for daily life assistance.

Sight loss risk increases with age and in those with diabetes and is a growing concern due to an aging population and increasing diabetic population.

Over 50% of sight loss is preventable and changes in lifestyle can reduce the risk of developing poor eye health and sight loss. The most common forms of preventable sight loss are caused by:

• Age-related Macular Degeneration (AMD)
• Cataracts
• Diabetic retinopathy
• Glaucoma

The key to reducing avoidable sight loss will be increased public awareness, increasing take up of eye tests for early detection and promoting healthier lifestyle choices.

Key inequalities and risk factors

The RNIB outlines a range of health inequalities:

• One in five people aged 75 and over are living with sight loss
• One in two people aged 90 and over are living with sight loss
• Nearly two-thirds of people living with sight loss are women
• People from black and minority ethnic communities are at greater risk of some of the leading causes of sight loss
• Adults with learning disabilities are 10 times more likely to be blind or partially sighted than the general population

A genetic component exists to AMD and risks can also vary between ethnicities, with White and Chinese being at greatest risk. Lifestyle choices include excessive alcohol consumption, poor diet and nutrition, obesity and smoking which have been found to increase chances of developing AMD.

Uptake of sight tests is lower than would be expected particularly within areas of social deprivation.

Facts, figures and trends

Citing evidence from the 2009 Future Sight Loss UK 1: Economic Impact of Partial Sight and Blindness in the UK adult population,  Bracknell Forest Council and Bracknell and Ascot CCG sensory needs strategy 2016-2020 states that:

• almost 2 million people in the UK live with low vision which is approximately 1 in 30 people
• of these, around 360,000 people are registered with their local authority as blind or partially sighted
• the number of people in the UK with low vision is set to increase dramatically. It is predicted that by 2050 the number of people with low vision in the UK will double to nearly 4 million

To underline the age related nature of sight loss, the Institute of Public Care – POPPI & PANSI databases predict the number of people aged 18-64 in Bracknell Forest predicted to have a serious visual impairment between 2015 and 2030 will be stable (Mid-year 2014 population baseline.  Source: Stats.Share: Population – accessed 15 June 2016):

This contrasts with the predictions for people aged 65+ (Stats.Share: Population – accessed 15 June 2016):

Age-related Macular Degeneration (AMD)

AMD causes loss of central vision – what you see when you focus straight ahead.  Degeneration is gradual and doesn’t affect peripheral vision (side vision), so does not cause complete blindness.

There are two types of AMD – wet and dry.

• Dry AMD is the most common (90%) but is the less serious and is caused by build-up of deposits inside the back of eye (macula).  About 1 in 10 people with dry AMD go on to develop wet AMD
• Wet AMD is caused by abnormal blood vessels forming underneath the macula and damage its cells. Wet AMD is more serious than dry AMD. Without treatment, vision can deteriorate within days.

A number of treatments exist which can improve sight in those with wet AMD and these can be found on NHS Choices.

The proportion of people with AMD is higher in the borough than in the south east and England as a whole.  However, the figures are statistically similar and it should be noted that the number of people diagnosed with AMD is small (annual average of 24) and changes in proportion will therefore appear larger.

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. People are at higher risk if they:

• have had diabetes for a long time
• have a persistently high blood sugar (blood glucose) level
• have high blood pressure
• have high cholesterol
• are pregnant
• are of Asian or Afro-Caribbean background

Diabetic retinopathy is the leading cause of preventable sight loss in working age people in the UK and early detection through screening halves the risk of blindness.

The number of people being screened is increasing year on year (3.5 thousand in 201/11 to 3.8 thousand in 2102/13), however, rates are lower than the regional and England averages:

Costs

In 2014-15 there were 16,842 hospital admissions with a main diagnosis related to diabetic retinopathy, compared with 11,504 in 2013-14.  In both periods, there were more admissions for men than women, and nearly all were planned.

For more information on diabetes and screening, please see the diabetes and non-cancer screening chapters of the JSNA.

Glaucoma

Glaucoma is a condition caused by build up of pressure within the eye which damages the optic nerve (the connection to the brain) and the nerve fibres from the retina (the light-sensitive nerve tissue that lines the back of the eye).

There are several types.  The most common is open-angle glaucoma where drainage canals in the eye become clogged.  It affects up to two in every 100 people over 40 years old and around five in every 100 people over 80 years old.  People of black-African or black-Caribbean origin are also at increased risk. Acute angle-closure glaucoma is much less common and is where drainage canals in the eye become blocked. People of Asian origin are more at risk of getting this type of glaucoma compared with those from other ethnic groups.

The number of people with sight loss due to glaucoma is negligible in Bracknell Forest and figures were suppressed in 2012/13 and 2013/14 as they were so small as to be person identifiable.  Rates in previous periods were statistically similar to the England average.

Costs

In 2014-15 there were 21,792 hospital admissions with a diagnosis related to glaucoma (excluding glaucoma caused by accident or injury) compared to 21,293 in 2013-14.  The vast majority of admissions were planned.

In 2014 there were 9.03 million items prescribed for glaucoma at a cost of £98 million (NHS Digital 2014, accessed 01/06/2016).

Cataracts

Cataracts occur when the lens of the eye becomes cloudy leading to blurry or misty vision.  Cataract surgery is the most common operation performed in the UK, with more than 300,000 procedures carried out each year.

Hospital episode statistics from 2002/03 to 2011/12 (NHS Digital, accessed 15 June 2016), an average of 624 people in every 100,000 people living in Bracknell Forest underwent cataract removal surgery each year and this is very similar to the national average rate.

Costs

In 2014-15 there were 169,813 hospital admissions or senile cataracts of which the majority of admissions were for women. This compares with 146,655 admissions in 2013-14.  The vast majority of admissions were planned.

Care, management and support

The Care Act 2014 made it a statutory requirement for all local authorities to keep a register of people who are sight impaired and severely sight impaired to ensure their needs are assessed and met.

The figures in Bracknell Forest whilst lower than the England average is nevertheless, statistically similar.

People can self-refer or be referred to the council sensory needs team who can help people with very poor eyesight according to their needs and circumstances.  The team provides information on registering sight loss and how to get appropriate support to improve quality of life and remain independent including benefits and concessions on travel, parking and the TV licence.

People with sensory 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 Bracknell Forest to target these needs along with enhanced self-assessments and specialist rehabilitation services.  Further work on this will be undertaken through the Sensory Needs Partnership Board.

The council’s Community response and reablement  team can help people recovering from illness or treatment and help people to develop a long-term recovery plan to regain independence.

Want to know more?

Cataracts in adults: management (NICE, expected 2018) – guidelines are in development for use by health and social care professionals, people using health and care services and/or carers or advocates.  Click to register for updates.

Commissioning guide for eye care and sight loss services (UK Vision, accessed 15 June 2016) – resources for commissioning eye health, eye care and sight loss services.

Glaucoma: diagnosis and management (NICE, 2009 update due 2017) – guideline covers the diagnosis, treatment and care of adults (18 years and over) with a diagnosis of the condition known as ‘chronic open angle glaucoma’, ocular hypertension (raised eye pressure) and those at a high risk of developing glaucoma. Click to register for updates.

Glaucoma in adults (NICE, 2011) Sets out specific, concise quality statements, measures and audience descriptors to provide patients and the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

Macular degeneration (NICE, expected 2017) – guidelines are in development based on evidence from specialists, health and social care professionals, affected individuals and  representative organisations.  Click to register for updates.

Sensory Needs Strategy (Bracknell Forest Council and Bracknell and Ascot CCG, 2016) – sets out the priorities for commissioning services in Bracknell Forest based on an assessment of national evidence and local research to improve outcomes for people with sensory loss, including sight loss.

UK Vision Strategy – sets out a cross-sector approach for major transformation in the UK’s eye health, eye care and sight loss services.

This page was created on 27 February 2014 and updated in August 2017.  Next review date September 2018.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Preventable Sight Loss. Available at: jsna.bracknell-forest.gov.uk/ageing-well/keeping-well/preventable-sight-loss (Accessed: dd Mmmm yyyy)

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