Seeing a way to better eye health

Sight loss devastates the lives of almost two million people in the UK – and the number is growing at an alarming rate, writes Martin Barrow

Every day in the UK 100 people begin to lose their eyesight. Many will be spared the devastation of the total loss of their vision, through early diagnosis and effective treatment. But for thousands of men and women it is the beginning of an irreversible descent into darkness, with devastating consequences for their health and quality of life.

The numbers are stark. Almost two million people in the UK live with sight loss. By 2020 this is expected to increase by 22 per cent and will double to almost four million by 2050.

Much of the increase can be attributed to an ageing population, for more than 80 per cent of sight loss occurs in people aged over 60. But increasingly poor lifestyle choices are taking their toll, with younger people being treated for sight loss that is linked to obesity or smoking.

The cost to the health service is substantial and continues to rise, estimated at around £7.9 billion this year. Demands on outpatient services are high, with ophthalmology having the second highest attendances in 2010-11.

Yet public awareness of the risks of sight loss, or its causes, remains low. Most assume deterioration in eyesight is an inevitable consequence of age and will present for an eye test only when it becomes obvious that new spectacles are needed. This means eyes may be left for several years without an examination that can detect the earliest signs of glaucoma or age-related macular degeneration (AMD).

Public health campaigns have done much to raise awareness of the risks of heart disease and different cancers, and of the harm caused by smoking and drinking alcohol. By contrast, eye health looks neglected. Few people know that the link between smoking and AMD is as strong as the link between smoking and lung cancer, or that poor and deteriorating eyesight is an indicator of a range of other health issues, such as diabetes and high blood pressure.

Evidence also shows that there is a strong link between low incomes and sight loss, with three out of four blind or partially sighted people living in poverty or on its margins. People on the lowest incomes are least likely to have their eyes tested, put off by concerns over cost, even though millions are exonerated from prescription charges. These include all those under 16 or over 60, people with diabetes or glaucoma and those at risk of glaucoma, and many people who are entitled to benefits, such as income support.

Poor lifestyle choices are taking their toll, with younger people being treated for sight loss linked to obesity or smoking

This lack of public engagement frustrates health professionals, who are often called to intervene once sight loss has become irreversible. The charity RNIB estimates that up to 50 per cent of sight loss is avoidable through early diagnosis and treatment. The importance of an effective national strategy to improve eye health, reducing the number of people who suffer sight loss, is recognised across the NHS, which is working with charities and patient groups to develop more effective eye health and sight loss services.

Earlier this year an updated UK Vision Strategy was published for the next five years following a consultation process involving 650 organisations and experts, from the Royal College of Nursing to the NHS Alliance.

Endorsed by Prime Minister David Cameron, the strategy included a commitment to raise awareness and understanding of eye health, with major public health and education drives, and improvements to the national screening programme, with particular emphasis on groups of patients considered to be most at risk.

The strategy also includes a strong commitment to provide greater support in the community for those who suffer sight loss. National Eye Health Week, from September 16, is a step towards improving awareness.

But achieving these demanding targets will be a challenge at a time of unprecedented financial constraints in the NHS and social services. The re-organisation of the health service has also disrupted some of the care pathways previously available to patients and will take time to settle.

Already almost half of people with diabetes do not take part in the full range of annual health checks to which they are entitled, including eye tests, and in July the RNIB, itself a key signatory of the UK Vision Strategy, published a damning report on the alarming variation in cataract service provision across England.

In effect, the RNIB said older patients were subject to a postcode lottery of services that limited access to cataract surgery, a safe and cost-effective procedure that can restore sight. Denying treatment left patients at risk of depression and hip fractures caused by falls, which were likely to be more costly to the NHS and social services than cataract surgery.

Patient groups are campaigning for the appointment of a national clinical director for eye health. Their hope is that a national leader will galvanise services in the way that Professor Sir Mike Richards brought about profound improvements in cancer services, before his recent appointment as chief inspector of hospitals, and maintain pressure on the NHS and the Department of Health to ensure that treatment and support is expanded to meet growing demand.