The State of the Nation Eye Health 2017: A Year in Review - RNIB
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The State of the Nation Eye Health 2017: A Year in Review
Overview Summary In September 2016 RNIB and Specsavers joined in partnership to transform eye health. One year on, this report presents the key achievements of the partnership to date, along with new information on the incidence of sight loss and attitudes towards eye health in the UK. For more detail about understanding eye health and sight loss please see The State of the Nation Eye Health 2016 report (available to download from rnib.org.uk). Acknowledgements Thank you to those colleagues within RNIB and Specsavers who have contributed towards the development of this report. We are grateful for the help of colleagues at YouGov Plc. We’d also like to thank both the professionals and patient representatives who participated in the policy roundtables, sharing their thoughts and experiences around addressing capacity issues in eye care services. A special thank you goes to those people who have shared their personal stories. Their experiences motivate us all to play our part in preventing avoidable sight loss. The State of the Nation Eye Health 2017: A Year in Review 2
Contents 2 Overview 3 Contents 5 Transforming eye health – one year on 6 Eye health in numbers 7 Micheal’s story 9 Alan’s story 10 The nation’s relationship with eye health 10 Progress since last year 11 Understanding the perceived barriers to visiting an optician 13 More than a sight test 14 Susan’s story 16 Working together to transform eye health 16 Making eye health visible: data and evidence 16 Raising public awareness of eye health 16 Influencing eye care commissioning and services 17 Fundraising to support RNIB 19 Introducing the policy roundtables 21 Glaucoma 24 Age-related macular degeneration 27 Cataracts 30 Minor eye conditions 33 Improving the commissioning of services 36 Anne’s story 38 Our agenda for action 40 Appendix A: Policy roundtable participants 42 Appendix B: Eye health indicators 46 Appendix C: References The State of the Nation Eye Health 2017: A Year in Review 3
Sally Harvey Dame Mary and Doug Perkins
Transforming eye health – one year on
What an exciting year it has been since However the continuing crisis in capacity
RNIB and Specsavers joined forces to within hospital eye care services means
improve the nation’s eye health and too many patients are not receiving the
prevent avoidable sight loss. We are timely treatment that they need. With the
proud to present this review showing the support of Specsavers, RNIB hosted a
difference we are making. series of expert roundtables to consider
innovative solutions and new ways of
Our work is now more important than
working across professional boundaries.
ever. This report reveals new evidence
We’re also delighted that statistics from
that one in five people will live with sight
last year’s report were referenced in a
loss in their lifetime. At least half of all
parliamentary debate on preventing
sight loss is avoidable so it is vital we
avoidable sight loss earlier this year.
enable everyone in the UK to look after
their eye health. This report includes excellent examples
of patients and professionals working
We are championing the need for regular
together to save sight and raise
eye tests so eye health conditions are
awareness of eye health.
identified and treated early.
We have achieved a great deal this year
Jacqueline Wood, 68, is one of many
by working in partnership. There is still
people whose sight was saved by a
much more to do. We are determined
routine eye test when she was diagnosed
to prevent avoidable sight loss. In this
with retinal detachment. She says: “As
report we set out our agenda for action.
a charity volunteer, my eyesight is so
You are invited to be part of something
important to me. When my optician said
bigger – to connect with others and
she had noticed a crease on the retina of
campaign for change. With one voice,
my left eye and was concerned this could
we are calling for senior decision makers
damage my sight, it was a total surprise. I
to prioritise eye health and commit to
was seen by Specsavers in London on the
delivering sight-saving services that meet
Monday, and by Wednesday of the same
patients’ needs.
week I’d had a successful operation at
Moorfields. After this experience, I would Join us in our work to transform the
definitely encourage others to have their nation’s eye health.
eyes checked on a regular basis.”
Sally Harvey Doug Perkins Dame Mary Perkins
RNIB CEO Specsavers Joint CEO Specsavers Co-founder
and Co-founder
September 2017
The State of the Nation Eye Health 2017: A Year in Review 5
Eye health in numbers
The alarming scale of eye health This year we can share analyses following
problems demands action. In ‘The State new work carried out by Deloitte Access
of the Nation Eye Health 2016’ report [1] Economics (DAE). DAE is an international
we shared research that estimated: leader in health economics. Looking
at the UK, DAE has drawn on robust
• More than two million people in the
research evidence of prevalence in
UK live with sight loss that is severe
combination with Government population
enough to have a significant impact on
statistics [2].
their daily lives, such as not being able
to drive.
• This includes approximately 785,000
people that have sight loss due to
uncorrected refractive error, meaning
their vision could be improved by
250
wearing correctly prescribed spectacles
or contact lenses.
Every day 250 people start
• Other causes of sight loss include: to lose their sight in the UK
• Age-related macular degeneration
(AMD) - approximately 475,000 This statistic is calculated by estimating
people the proportion of people living with
• Cataracts - approximately 380,000 sight loss in each age group at the
people start and end of 2016-17 in conjunction
with the likelihood of death during the
• Glaucoma - approximately 145,000 same period.
people
It uses the definition of sight loss
• Diabetic retinopathy - approximately generally adopted in developed
95,000 people countries (visual acuity of 6/12 or worse)
where an individual’s sight loss has a
• By 2030, we estimate more than 2.7
significant impact on their daily life.
million people in the UK will be living
with sight loss. This growth will be It includes people whose sight loss
primarily driven by an ageing population. is permanent and irreversible. The
• £28.1 billion was the cost to the UK most common cause of permanent and
of sight loss in the adult population in irreversible sight loss in the UK is AMD
2013. This includes a direct healthcare but glaucoma, diabetic retinopathy and
cost estimated to be £3 billion each year. other eye conditions can also cause
permanent sight loss. Many more people
The Indicator Table in Appendix B gives will live with sight loss as a result of
updates on a number of key statistics. uncorrected refractive error and cataracts.
The State of the Nation Eye Health 2017: A Year in Review 6
Eye health in numbers
Micheal’s story
Micheal Saunders, a lorry driver of 40
years, was forced to give up his job
after being diagnosed with wet age-
related macular degeneration (AMD),
an eye condition that can cause an
individual to lose their central vision.
A decade on, Micheal, now 74 years
old, visits the Austin Friars Eye
Treatment Centre every four weeks.
The centre, a collaboration between had developed the sight-threatening
Aneurin Bevan University Health condition.
Board and Specsavers in Newport, is
the first of its kind in the UK where a “For years I was treated at hospital,
high street optician provides initial which would often mean long
screening and referrals for people waiting times, but since the
with symptoms of wet AMD, and treatment centre has opened it has
NHS staff deliver treatment for the been fantastic. All of the experts
condition at the same location. are under one roof, it’s a convenient
location and there’s no long delays
“When I was first diagnosed 10 around appointment times now. It’s
years ago, treatment for AMD wasn’t taken away the stress from having
available on the NHS in Wales. I the treatment every month.”
had to wait six months before I had
treatment, which is a long time as Jason Williams, Optometrist and
vision can deteriorate within days in Director of Specsavers Newport, said:
some cases. “The speed that someone receives
“It was like I was hit in the chest treatment for wet AMD is absolutely
when I was told I couldn’t drive any crucial. With more collaborations
more. It was a huge part of my life – between primary and secondary
I’d driven throughout the UK, Europe healthcare providers, it will give
and America so to have this taken patients faster access to assessment
away from me has been really tough. and treatment, which is absolutely
I’d noticed my sight deteriorate over vital in helping to prevent avoidable
a couple of weeks and one day it was sight loss.
as if my vision was clouded by thick
“Regular sight tests are essential to
fog. I went straight to Specsavers.”
monitor a person’s eye health, and if
After an eye test, a Specsavers anyone experiences changes to their
optician referred Micheal to hospital vision then, just like Micheal, they
for further tests, which confirmed he must visit their optician immediately.”
The State of the Nation Eye Health 2017: A Year in Review 7
Eye health in numbers
1 in 5 people will live with experience sight loss in their lifetime as
a result of uncorrected refractive error
sight loss in their lifetime and cataract.
This is calculated using estimates of what
the total expected number of cases of
sight loss would be over the lifetime of
people born today, taking into account
how long they are expected to live.
It assumes that current sight loss
incidence rates for each age group and
gender continue into the future.
Women are at greater risk than men:
one in four women will develop sight loss
in their lifetime compared to one in eight
men. This is primarily due to the fact that
women have a greater life expectancy.
We used the same inclusion criteria to
estimate the probability that someone
born in 2016-17 will develop sight loss
in their lifetime. Many more people will
The State of the Nation Eye Health 2017: A Year in Review 8
Eye health in numbers
Alan’s story
Alan Murphy was 37 when a trip to
the opticians detected he had the
early stages of glaucoma; a leading
cause of visual impairment and a
condition that affects the nerves in
the eye that connect to the brain.
Paula Cunningham, Optometrist
and Director of Specsavers in
Connswater, Belfast, said: “It was
eight years ago when Alan came Alan’s case was unusual, as there
to us for his regular contact lens was no family history of the condition
appointment. As his two-yearly eye and it is also rare to have it so young.
test was almost due, I carried out He is now a true advocate of regular
a full test and was concerned that eye tests and good eye health, ever
his optic nerves did not look as since early diagnosis saved his sight.
healthy as I would have expected. I
subsequently referred him for further Alan said: “I would strongly urge
investigation and he was diagnosed people to go for regular eye tests. I
as suffering from glaucoma.” am grateful that Specsavers urged
me to have a full eye test as I had no
idea that there was anything wrong
with my eyes, other than needing my
“I would strongly urge regular contact lens check up. I was
people to go for regular shocked to learn that I had the early
eye tests.” - Alan Murphy signs of glaucoma and how serious it
could have become if left untreated.”
Paula, added: “As is clear from Alan’s
Thanks to the early diagnosis Alan case, early detection and treatment
can now manage his condition by is essential. Glaucoma can only be
using eye drops daily. The glaucoma detected through a full eye test. It
has left him with some loss of his develops gradually and the person is
peripheral vision. Other than that, he often unaware of any problem until it
can still see well enough to continue is quite severe. Any damage caused
driving, working and playing football. cannot be reversed therefore the
This might not have been the case if key message for the public is to get
his glaucoma had not been picked at their eyes tested at least every two
such an early stage. years, especially as they get older.”
The State of the Nation Eye Health 2017: A Year in Review 9
The nation’s relationship with eye health
23%
Almost a quarter of the
nation say they are not
able to see as well in the
distance or close up as
they used to and have not
yet sought advice
To find out what people think about sight, their eyes, and their wider health,
eye health, Specsavers and RNIB 25% of the UK’s adults are still risking
commissioned YouGov Plc to carry avoidable sight loss by not having an eye
out an online survey. Fieldwork was test every two years, which rises to 31%
undertaken between 23 June and 7 July of 18 to 24-year-olds.
2017. The survey questions were asked
Of further concern is the fact that 23% of
of a nationally-representative UK sample
the nation say they are not able to see as
of 6,430 adult respondents aged 18 well in the distance or close up as they
and above. used to and have not sought advice from
Progress since last year an optician or medical professional.
The NHS recommends that everyone With an ageing population and a younger
from the age of three undergoes an eye generation paying less attention to their
test at least every two years to address eye health, this problem could be set to
uncorrected refractive error and detect get worse.
any possible eye health conditions. Projections suggest that the number of
Research by YouGov in 2016* revealed people living with sight loss will increase
that 27% of people in the UK had not had to more than 2.7 million in 2030 [1] and 4
an eye test within the last two years. million in 2050 [4], driven by an increase
Our 2017 YouGov poll suggests that, in in the UK’s older population. Around 79%
the year since RNIB and Specsavers joined of people living with sight loss are over
forces to help transform the nation’s eye the age of 64 [1], while the most elderly
health, an additional 1.1 million people are at greatest risk, with one in every
have taken action to improve their eye three people aged 85 and over living with
health by visiting an optician [3]. some significant degree of sight loss [1].
Of people aged 55 and over, 13% told
While it is encouraging to see more YouGov they had not had their eyes
people taking steps to look after their tested in the past two years.
The State of the Nation Eye Health 2017: A Year in Review 10The nation’s relationship with eye health
If you had to choose, which one of the following senses
would you least like to lose?
Understanding the perceived • 33% did not think that there was
barriers to visiting an optician anything wrong with their eyes
In order to encourage more people • 24% said that they did not have time or
to have their eyes tested at the did not get round to it
recommended interval, it is important
• 17% were concerned about the cost of
to understand the perceived barriers to
new glasses
visiting an optician.
‘Nothing wrong with my eyes’
Without doubt, people are not forgoing
eye tests due to a lack of regard for their A third of those who had not been for an eye
sight. Sight is the nation’s most precious test in the past two years said that they had
sense by far. In our 2017 YouGov poll, not acted because they did not believe that
78% of people chose sight as the sense there was anything wrong with their eyes.
they would least like to lose, ten times
When those who had not been for a test
more than the next most popular sense,
in the past two years were asked what
which was smell at only 8%.
would prompt them to have one, the
Of those who had not been for an eye most common answers were: if they were
test in the past two years, the three most struggling to read (58%); if they were
popular reasons were much the same as struggling to see their mobile phone, tablet
they were in 2016: or computer (46%); if they were starting to
get headaches or tired eyes (45%).
The State of the Nation Eye Health 2017: A Year in Review 11The nation’s relationship with eye health
Specsavers’ Clinical Spokesperson Dr general health to be covered within the
Nigel Best said: “Not only does this mean appointment. Indeed, more than 80%
that some people are waiting for signs of the nation are not aware that an eye
of sight loss before visiting an optician, test can detect signs of cardiovascular
it also means that they are potentially disease, one of the major causes of death
preventing their optician from detecting in the UK [5].
signs of eye health problems or other
medical issues at an early stage. We know ‘I don’t have time’
that early intervention is important in the Almost a quarter (24%) of those who had
management and successful treatment of not been for an eye test in the past two
many conditions.” years said that they did not have time
Less than half the time taken during an to do so, or simply did not get round to
eye appointment involves testing sight. making an appointment.
Most of the time is spent assessing Time is a perceived barrier, as the average
indicators of wider eye health, including appointment takes about 20 to 30
cataracts, glaucoma and age-related minutes.
macular degeneration, and general
health issues, such as diabetes and high Our poll showed that over a two-year
blood pressure. period, 51% of people will have their boiler
serviced twice, 42% will visit the dentist
While 80% of those asked expect a high four times, 23% will have a health check
street optician to be checking for eye twice, and 36% will review their mobile
health conditions, only 27% expect their phone contract.
The State of the Nation Eye Health 2017: A Year in Review 12The nation’s relationship with eye health
Over a two-year period...
51% 42% 36% 23%
will get their boiler will visit the dentist will review their will get a health
serviced twice four times mobile phone check twice
contract once
Dr Nigel said: “As a nation, we devote support. More broadly, everyone in
more time to servicing our boiler than Scotland is entitled to a free NHS eye test,
having our eyes checked, despite the while in England, Wales and Northern
potential wider health implications Ireland factors such as income, being
of not doing so, putting ourselves at diabetic and having a family history of
unnecessary risk of sight loss.” glaucoma, can also mean that people do
not need to pay. Children are also entitled
‘Concerned about cost’
to free eye tests and glasses.”
Almost a fifth (17%) of those who had not
been for an eye test in the past two years More than a sight test
said it was because they were concerned As well as establishing whether or
about the cost of new glasses. not an individual needs some form of
vision correction an eye test can also
Cost is a wider concern, with a fifth (21%)
detect signs of general health problems.
of UK adults not prepared to pay anything
Examples include high blood pressure,
at all for an eye test, and a third (36%)
diabetes and even some types of brain
only willing to spend at most £25.
tumours. If any optician detects signs of
In terms of prioritisation, a quarter (24%) general health problems during an eye
of people who spend £50 on shoes a year test they can refer that patient to their GP
would not be prepared to pay anything at for further investigation.
all for an eye test.
*YouGov PLC. Total sample size 10,780
Dr Nigel said: “Cost should not, and adults. Fieldwork undertaken July 2016.
need not, be a barrier. The NHS provides Survey carried out online. Figures have
support towards the cost of eye tests been weighted and are representative of
and glasses for those in need of financial all UK adults (age 18 and over).
The State of the Nation Eye Health 2017: A Year in Review 13The nation’s relationship with eye health
Susan’s story
Susan Cooper from Milton Keynes,
was diagnosed with cataracts in both
eyes after her son raised concerns
about her driving.
The 69-year-old was initially hesitant
about visiting the opticians. “I’m
very independent, and although
several people had mentioned that
my driving hadn’t been too good, I
kept putting off the visit, believing my other and that it should be monitored
eyesight to be fine. for any further development.
“But when my son mentioned that Two years on, after noticing that
I’d been driving in the middle of her vision had deteriorated further
the road I was completely shocked still, Susan had her second cataract
and realised I had to go to the removed and her eyesight has since
opticians. The team at Specsavers returned to normal.
was fantastic and spotted cataracts
“When I think back to how my
straight away. Although it wasn’t until eyesight had deteriorated, and how
they asked me to cover my better much worse things could have been
eye that I realised how much my for me, I feel so relieved that I did
vision was impaired. It was such a eventually visit the opticians. I just
surprise to be told that I needed to wish I’d done something about it
be referred to Blakelands Hospital sooner. I was very stubborn but it
right away for treatment.” doesn’t bear thinking about what
could have happened if I hadn’t done
anything about it, and it only takes a
“It only takes a quick quick check-up, which can ultimately
save your sight.”
check-up, which can
ultimately save your sight.” Specsavers Milton Keynes Optician
and Director Rajesh Shah is delighted
- Susan Cooper with Susan’s recovery. He says:
“Susan is such an independent and
active woman and we could tell that
This was four years ago. While one anything that might threaten that
cataract was removed within months, would have a huge effect on her
her surgeon at Blakelands advised life. We are glad to see her vision
that it was too early to operate on the restored and lifestyle unaffected.”
The State of the Nation Eye Health 2017: A Year in Review 14Working together to transform eye health
Preventing avoidable sight loss is an This included a TV advert that reached
ambition that RNIB and Specsavers share. 74% of UK adults, activity across
Since the launch of our partnership at the national press and magazines, and more
House of Lords in September 2016, our than 1,400 poster sites across the UK.
organisations have worked together on Specsavers also hosted a live Twitter
a number of important activities to help question and answer session with an
transform the nation’s eye health. optometrist about eyesight.
Making eye health visible: data The campaign was supported by Lady
Penny Lancaster Stewart, Vice President
and evidence and long-term supporter of RNIB, who
RNIB and Specsavers launched our spoke on Good Morning Britain about the
partnership with the State of the Nation importance of eye tests for children and
Eye Health 2016 report [1], which adults and her own family experience of
brought together a wide range of data eye health issues.
on eye health across the UK, including
the estimated £28.1 billion cost of In March 2017, World Glaucoma Week
sight loss to the nation’s economy. The gave us the opportunity to focus
report was well received, achieving specifically on how eye health checks
national coverage across all forms of can prevent glaucoma from becoming
media, including two segments on ITV, sight-threatening. Working in a three-
various regional radio stations, as well way partnership with the International
as appearing in publications as diverse Glaucoma Association, TV ads, press
as Hello magazine and the Sunday articles and online activity enabled us to
Telegraph, with a combined reach of share messages about the value of eye
62% of UK adults. tests in protecting future sight and health.
We have continued to build on sharing
our data and evidence. Again this year,
we have worked with Deloitte Access Eye health checks can prevent
Economics, one of the global leaders glaucoma from becoming
in eye health statistics, to estimate the
sight-threatening.
risk of an individual losing sight in their
lifetime and how frequently sight loss
occurs throughout the UK (see page 6).
We also ran press advertising to support
Raising public awareness Diabetes Week in June 2017, raising
of eye health awareness of how the disease can also
affect sight.
Last September, we began our
partnership with a multi-million pound,
multi-media awareness campaign to mark
Influencing eye care
National Eye Health Week, to promote the commissioning and services
importance of eye tests and how they can The capacity crisis in hospital eye clinics,
help reduce avoidable sight loss. putting patients at risk of losing sight
The State of the Nation Eye Health 2017: A Year in Review 16Working together to transform eye health
through delays and cancellations, is of
urgent concern to RNIB and Specsavers.
During the first half of 2017, we hosted
five roundtable discussions to explore
how community eye care services have
the potential to complement hospital
care to make the most effective use of
limited resources. The events brought
together patient representatives and
professionals from different disciplines
to share evidence, insight and good
practice. Pages 19-34 summarise these
discussions.
Fundraising to support RNIB
To enable RNIB to carry on delivering eye
health information and support to people
with sight loss through its national Sight
Loss Adviser network, staff in Specsavers
stores throughout the UK enthusiastically
engaged in a variety of fundraising
activities during 2016 National Eye
Health Week. From wearing crazy shirts
and colourful opportunity to get creative.
in Norwich to cake bakes in Thameside,
they have contributed to a £100,000 Staff decorated their stores with spotted
fundraising target. bunting and balloons, which raised
their profile within local communities
This included supporting RNIB’s Wear and encouraged more people to have a
Dots Raise Lots campaign which regular eye test.
encourages people to ‘go dotty’ to help
raise awareness of the impact of braille, On International Sunglasses Day in June,
providing Specsavers staff with a fun Specsavers staff from a number of stores
across the UK showed their support
for RNIB’s Shades for Sight campaign.
People were encouraged to post selfies
and donate, while raising awareness of
the importance of wearing sunglasses in
protecting sight.
Some intrepid Specsavers staff have
also taken part in challenge events
on behalf of RNIB, including the Virgin
London Marathon, Chester Half
Marathon and the gruelling Three Peaks
in 24 Hours Challenge.
The State of the Nation Eye Health 2017: A Year in Review 17Introducing the policy roundtables
As part of our transforming eye health discussions will be submitted to the All
partnership, RNIB, supported by Party Parliamentary Group on Eye Health
Specsavers, hosted a series of five policy and Visual Impairment’s Inquiry into
roundtables to consider optimal models capacity issues in NHS eye care service
of eye care. The ageing population and and avoidable sight loss in England.
emerging new treatments mean that there
has been a significant uplift in the number The roundtables facilitated a collaborative
of patients requiring more appointments approach, with experts from voluntary
for treatment and monitoring of eye organisations, health services, health
conditions. Recent research [6] suggests professions, professional bodies,
that up to 22 people per month are commercial organisations and, crucially,
experiencing irreversible sight loss due to people living with sight loss or at risk of
NHS-initiated delays. sight loss, exploring solutions together.
RNIB carried out rapid literature reviews
The roundtables explored how improving
to produce evidence briefings, informing
delivery in eye care services can help
the key questions focused on in
to increase capacity. Three roundtables
discussion at each roundtable.
focused on a major eye condition, one on
treatment for minor conditions and a fifth A summary of the key points made at each
on improving commissioning. In particular, roundtable are presented in the pages
they considered the evidence for moving that follow, along with calls to action
eye care services into community where they were agreed (full notes of each
settings, and patient experience of of the roundtables are available from
those services. Information from these rnib.org.uk/specsavers-and-rnib-partnership).
The State of the Nation Eye Health 2017: A Year in Review 19Introducing the policy roundtables
Key learnings from the roundtables assessments. People experiencing
poverty often struggle to access eye
• Patient experience needs to be at the care services and present with later
centre of service design. For example, stage eye disease. The retail dimension
streamlining services to allow more of optometry can be a barrier to people
people to receive the appropriate tests, accessing eye tests, particularly for
reviews and treatment in one visit, rather people with low income. Inequalities
than requiring multiple visits which in access and outcomes need to be
can be costly to patients (e.g. parking considered throughout service planning
and transport costs), inconvenient to ensure that those most in need of
and sometimes challenging for the services receive them appropriately to
patient. Acceptability of alternative prevent avoidable sight loss.
venues and ways of delivering services
among patients e.g. age-related macular • Work is needed to change public
degeneration treatment services perception of high street opticians
delivered in supermarket car parks were (optometrists) so that their expertise in
discussed as a promising option. eye health is recognised and an eye test
is seen as a health check. The eye health
• Patients require information about work of optometrists and their potential
their diagnosis, condition, treatment to do more needs adequate funding.
options and associated risks in a
format that they understand. They also • Currently, efficient patient-friendly
need support to adhere to treatment models of care are established by
regimes, to understand the importance passionate committed clinicians.
of attending appointments, and how to Mechanisms are needed to facilitate
follow up hospital-initiated delayed or implementation of good practice
cancelled appointments. more consistently. National leadership
and strategy is required to support
• Innovative models of eye care are clinicians, service managers and
based on using the right health commissioners to increase capacity
professional in the right setting with the within eye care services.
right experience and skills. Continued
investment in training is essential. • Investing in IT systems that enable the
Continuing to build trust among efficient and secure transfer of patient
professionals is needed locally and data is essential to ensure best use
nationally as the role of optometrists, is made of the eye care workforce. A
ophthalmic nurses and other health national approach is needed to ensure
professionals is expanding to ensure IT solutions are consistently adopted.
services adapt to increasing demand.
More evaluation and audit is needed, • We need to prioritise eye care within
including patient-reported measures of health service commissioning and
outcome and experience. planning, for example inclusion in
Sustainability and Transformation
• Anticipating demand rather than Partnerships. Securing greater
responding to capacity crises through recognition of the value of eye health
proper service planning is desirable. This and the need for adequate resourcing
should be based on eye health needs is essential.
The State of the Nation Eye Health 2017: A Year in Review 20Glaucoma
28 February 2017, Manchester
What is the need? referral process. There are also schemes
that involve a variety of different health
Glaucoma is second only to age-
professionals monitoring patients with
related macular degeneration as
ocular hypertension or stable glaucoma
a cause of blindness in the UK [7].
Currently, estimates extrapolated from to enable better use of resources.
population surveys indicate that there
are approximately 700,000 cases of How do we ensure people most
glaucoma in the UK [8]. Due to capacity ‘at risk’ of avoidable sight loss
issues within eye care services, people get access to early detection,
are often experiencing long waiting times, diagnosis and treatment?
particularly for follow-up appointments [8].
Currently significant numbers of people
Patients with suspected glaucoma are with glaucoma are failing to access care
most commonly identified through eye before suffering sight loss [10]. This is
tests in high street optometry practices. particularly true for people experiencing
There are challenges detecting glaucoma socio-economic deprivation and of
and a high proportion of people are African and Caribbean ethnicity [11]. The
referred to hospital with suspected Royal College of Ophthalmologists has
glaucoma only to be discharged after questioned whether the current system
their first visit [9]. Some areas have is effective in detecting the condition
developed schemes to enable community early among groups who regularly
optometrists to repeat initial measures access eye tests, while missing those
or refine the initial assessment with with greater need [8].
more sophisticated tests to improve the
The State of the Nation Eye Health 2017: A Year in Review 21Glaucoma
Spotlight on Manchester on understanding glaucoma, how to
Royal Eye Hospital manage drops and how to navigate
the healthcare system.
Fiona Spencer, Consultant
Ophthalmologist, described the The glaucoma nurse leads these
innovative programme that the hands-on sessions where patients
glaucoma team at the Manchester have the opportunity to try
Royal Eye Hospital have developed different aids and are encouraged
to support self-management. to ask professionals about their
care. Although evaluation has
‘Get a Grip on Glaucoma’ invites demonstrated their value, the courses
patients to two sessions focused are not currently externally funded.
Participants suggested a range of ways of treatment?
addressing this:
Glaucoma requires lifelong care and it
• Compiling an eye health needs can be difficult for patients to consistently
assessment to inform service planning. adhere to treatment regimes. Participants
discussed ways to facilitate supporting
• Ensuring ‘every contact counts’ so all self-management and adherence:
health professionals (GPs, pharmacists,
district nurses, etc) who see an • Telephone calls might have value as
individual for any reason encourage part of planned follow-ups, but there is a
engagement with eye care. need to evaluate these.
• Achieving a shift in perception of • There is potential for community
optometrists so that people view an optometrists to do more to support
eye test as an important health check partnering with ophthalmologists.
from ‘someone who cares about you’,
• Community optometrists could lobby
rather than someone who just wants
commissioners to pay for supporting
you to buy glasses.
patients to adhere to treatment.
• Targeted health promotion campaigns
designed with, and for, those most at risk.
• A visual field test for use at home, such How to overcome barriers to
as a mobile phone app or game. commissioning optimal models
of care?
How can commissioning ensure
patients receive support for self-
management and adherence to
The State of the Nation Eye Health 2017: A Year in Review 22Glaucoma
Participants agreed that:
• Developing a culture of trust, respect
and partnership between professionals with roundtable participants:
involved is key. Michael has been struggling with
sight problems since he was
• Good communication between
born - he is now in his 70s. His
professionals and between patients and
eye conditions include glaucoma,
professionals is vital.
cataracts and detached retinas.
• The ability to compare the outcomes,
Michael feels strongly that his
quality and value of models in place in
six monthly ‘pressure check’
different local areas is needed.
appointments help him to
• There is strength in coming together maintain some sight. Yet he
with one voice to try to influence the regularly has to make contact
commissioning process. with his consultant’s secretary
to ensure he has a timely
Calls to action: appointment as his hospital
appointment letters are frequently
1. Approach the Clinical Council for
not sent to him.
Eye Health Commissioning to
develop commissioning guidance Michael said: “The power shouldn’t
for Sustainability and Transformation be with the secretaries, it should
Partnerships. be with the consultants.” He’s
concerned that not everyone
2. Improve provision of information to,
will be as confident as he is to
and involvement of, patients to identify
advocate for themselves, therefore
ways of increasing access to services
they risk their sight deteriorating.
for those most at risk of avoidable
sight loss.
3. Continue to share good practice
examples of extended models of care
across professional groups.
4. Increase sector-wide, cross-profession
activity to promote innovation and
increase roll out.
Patient representative Michael
Tupper shared his concerns
The State of the Nation Eye Health 2017: A Year in Review 23Age-related macular degeneration
6 April 2017, Birmingham
What is the need? • Following The Royal College of
Ophthalmologists’ guidelines for fast
Age-related macular degeneration (AMD)
track referral systems.
is the leading cause of blindness in the UK
[12]. With the continuing trend towards
an ageing population, new estimates
suggest that the number of people with
neovascular (or wet) AMD in the UK will Spotlight on Bristol Eye
rise by 59% between 2015 and 2035, Hospital taking AMD
from 1.85% among over 50s in 2015, treatment into the community
to 2.36% in 2035 [13].
Following a whole area analysis,
As a result of the availability of effective Consultant Ophthalmologist
treatments and the need for more Claire Bailey’s team were able to
regular interventions, the number of anticipate that additional capacity
patients needing to be seen by hospital would be needed to meet the
eye services has increased significantly. needs of AMD patients in the area.
Although many local services adapted to
meet this need, crisis in capacity continues They placed rapid access AMD
to ‘threaten optimal care and access to clinics in a GP surgery, a community
potentially sight-saving treatment’ [14]. hospital and, more recently, in a
unit parked at a supermarket.
How can patients be better Patient details are sent by
supported through treatment? community optometrists, enabling
Participants discussed the strategies they patients to be seen within a
employ to ensure patients receive timely week. In clinic, optometrists
care. These include: work alongside consultants to
triage patients. Scans are shared
• Analysis of what the need is, where it is
via electronic patient records
and the most effective delivery models
and a 4G network connection.
to address.
Those requiring treatment,
• Time for patient discussion prior to the unless complex, are given a
start of treatment (alleviating potential choice of location for follow-up
concerns); access to a sight loss advice appointments.
service where available.
Patient satisfaction with the
• Running clinics on bank holidays. community clinics is high – initially,
• ‘One-stop clinics’, reducing the number patients require reassurance that
of visits needed. Bristol Eye Hospital is overseeing
the care they receive, but once
• ‘Treat and extend’ regimes, giving receiving treatment in the
an injection at every appointment community, patients don’t want
but extending the time between to return to the hospital.
appointments (communicating the logic
to patients is key).
The State of the Nation Eye Health 2017: A Year in Review 24Age-related macular degeneration
What are the anticipated benefits What needs to happen for optimal
and challenges of delivering services to be commissioned?
AMD services in the community/ Initial investment would be required for
primary care settings? mobile services to get off the ground.
Delivering AMD services in the Those using tariff-based commissioning
community brings treatment closer to may have more to gain from service
home, reducing patient costs and waiting innovation; utilising appropriately
and travel times. Other anticipated skilled staff to increase capacity within
benefits included: the system, for example, appropriately
trained ophthalmic nurses or technicians
• Potential to build in emotional and injecting, rather than doctors.
practical support for patients.
Availability of funds from external sources,
• Closer working of multi-disciplinary such as pharmaceutical companies, can
teams of professionals. encourage innovation. However, services
• Skill set of optometrists, and other must ensure that the contract for any
professionals, is increased. partnership is appropriate (for instance,
there is no requirement to treat with a
• Potential cost efficiencies. specific drug).
Local Eye Health Networks and
Anticipated challenges included:
Sustainability and Transformation
• Demand for AMD treatment continues Partnerships (STPs) may have a role in
to increase. influencing commissioning. Suggestions
to raise awareness of eye care,
• Demonstrating the value of innovative increasing its profile for commissioning
models to Clinical Commissioning and to extend innovation included:
Groups (CCGs) - not all CCGs have
someone responsible for ophthalmology • Publication of quality standards that
to try to influence and often clinicians communicate what patients should
may not have access to commissioners. expect, as well as what services
should provide.
• Mobile/community clinics take some
capacity out of the hospital eye clinic. • Potential for forthcoming National
Institute of Health and Care Excellence
• IT systems needed to support secure, (NICE) guidance to address pathways
efficient, transfer of patient information. for AMD treatment.
• Getting permissions to include some • Incident reporting.
professionals in new ways of working
e.g. technicians as injectors. • Linking eye care to other issues such
as dementia.
• Potential benefit of targets for follow-up,
rather than simply first treatment.
The State of the Nation Eye Health 2017: A Year in Review 25Age-related macular degeneration Calls to action: 1. STPs to give greater profile to commissioning high quality eye care services. 2. Disseminate learning from innovative eye care services such as those in Frimley, Bristol and Newport, to show what is possible. 3. Influence and support commissioners of eye care services to take forward innovations to increase capacity in eye care. The State of the Nation Eye Health 2017: A Year in Review 26
Cataracts
24 May 2017, Bristol
What is the need? change’ towards meeting demand,
bringing care closer to home [20].
Cataracts lead to deterioration of vision,
which can restrict independent living
[15, 16] and can result in diminished How can we ensure that quality
quality of life [17]. Tasks, such as reading and patient safety is not sacrificed
a newspaper or driving at night, become to improve efficiency?
more difficult. Participants discussed implications
Surgery is highly effective at restoring clear for quality and patient safety if pre and
sight in cataract patients [18]. Yet many post-operative care are moved into the
patients face significant barriers in access, community. The role of optometrists was
resulting in a postcode lottery of waiting considered valuable. Pre-operatively,
times, restrictive referral criteria and optometrist-led referrals were thought to
rationing of second-eye surgery [18, 19]. be of good quality, leading to a reduction
in the number of inappropriate referrals.
Demand for surgery is predicted to
continue to rise. Moving aspects of Changes to the cataract pathway (such
the pathway (specifically pre and post- as no longer offering an overnight stay
operative care) into the community may or a review on the first day after surgery)
help relieve growing pressure, allowing can result in an information gap for
better use of ophthalmologist-led clinics. patients. Lack of information provision
Research suggests that the community- may have a detrimental effect on the
based approach is a ‘significant step patient’s quality of experience.
The State of the Nation Eye Health 2017: A Year in Review 27Cataracts
Spotlight on Singleton Hospital’s • 90% of optometrists in Wales are
integrated clinical pathway. trained to an enhanced level to
refine referrals and to carry out
Michael Austin, Consultant
post-op assessments, ensuring a
Ophthalmologist, presented on the
Wales integrated clinical pathway consistent service for patients.
as operating at Singleton Hospital, • Patients are given information
Swansea. Key points included: leaflets, specifically, RNIB’s
• Community eye care, hospital eye Understanding Cataracts leaflet.
care and support services deliver
an integrated service where trust • Whole Service audits are
between the professionals has been undertaken to ensure quality.
established. • Patient feedback suggests they
• Care is patient-centred and are pleased with their outcome.
ophthalmologist-led, with Interestingly, a minority, while still
ophthalmology trainees making satisfied, lacked full understanding
appropriate contributions. of their condition.
Information-sharing discussions should cataract pathway. Newmedica provides
be personalised, be offered verbally and ophthalmology services to the NHS in
in written format, and offered throughout more than 20 locations in England. The
the patient’s journey. model prioritises patient experience,
with most of its work supporting Trusts
In regards to patient safety, ‘routine’
to tackle backlog. Information and
patients make up the majority of cataract
consent packs are sent before attending
cases seen by hospital eye care services.
clinic, patients are offered counselling
Services must be equipped to identify
and the surgeon sees each patient
‘non-routine’ patients; patients with
pre-operation. Post-operation, patients
additional complexities, who need to
receive a telephone call to check how
be managed differently. This oversight
they are. Patients return to the referring
becomes all the more important when
optometrist, thus ensuring continuity
multiple services are involved in the
of care. Although participants felt that
pathway. To maintain the safety of all
aspects of the Newmedica model could
patients, an ophthalmologist-led pathway
improve overall patient experience,
was called for, with full clinical oversight
finding long-term solutions to capacity
of postgraduates in training-grade posts
issues was highlighted by some as
from consultant ophthalmologist trainers.
preferable to outsourcing. Going forward,
Newmedica Clinical Director, Nigel Newmedica plan to include the training of
Kirkpatrick, presented an overview ophthalmologists as part of the model.
of the Newmedica approach to the
The State of the Nation Eye Health 2017: A Year in Review 28Cataracts
For community-based schemes to be What evidence and information do
effective, participants raised the following commissioners need to improve
points: delivery of cataract care?
• To reduce fragmentation, services must Clinical Commissioning Group expect
be fully integrated. evidence around cost-savings, yet cost-
• Clear communication mechanisms analysis studies of different pathways are
are essential (particularly for sharing currently very limited. Although guidance
training updates). to monitor and capture cost savings is
available, most services aren’t utilising it
• Trust between professions is vital.
or don’t know how to. Moving aspects of
• Development of trainee ophthalmologists the cataract pathway into the community
is prioritised, ensuring exposure to may release some ophthalmologist time
routine and non-routine cases to build but not necessarily result in cost savings.
their expertise.
Establishing eye care plans in Sustainability
• Ensure appropriate training and and Transformation Partnerships was
monitoring where pre- and post-op care considered important. Suggestions to
is delegated to others. achieve this included designating an
• Patients should be given the right eye health champion in each area and
information throughout key stages of establishing a contact point in each area
the pathway, no matter who they see. to engage in influencing work.
• Clear clinical oversight should reduce the
risk of patients ‘falling through the cracks’.
• Good IT systems cannot be
underestimated.
The State of the Nation Eye Health 2017: A Year in Review 29Minor eye conditions
4 July 2017, London
What is the need? How can we ensure that quality
Until recently, minor eye conditions and patient safety are not
(such as dry eyes, watery eye and sacrificed to improve efficiency?
irritated or inflamed eyes) have been The following ways of ensuring quality
treated by visits to GPs, pharmacists and safety in MECS were suggested:
or Accident and Emergency (A&E)
departments. However, rates of A&E • Put the patient perspective at the heart
attendance have escalated and the of decision making.
system is creaking under the strain. • Set key performance indicators to
New services exist in some areas to give measure when and how patients are seen.
community-based optometrists the skills
to assess and treat these minor eye • MECS is a primary care led service
and should be commissioned from
conditions in the community in Minor
primary care.
Eye Conditions Services (MECS).
• MECS services should be commissioned
Research has shown patients like MECS within the context of a wider pathway.
and they are clinically effective [21].
However, they are not available in all • Ensure optometrists involved are
areas of the UK, so not all patients have appropriately trained and qualified.
access. In turn, capacity of services can • Ensure Clinical Commissioning Boards
be limited, meaning patients still need to involved in commissioning MECS
seek help elsewhere. include representation from key
stakeholder services and organisations.
The State of the Nation Eye Health 2017: A Year in Review 30Minor eye conditions
Spotlight on Lewisham follow-up outpatient appointments
and Lambeth MECS in comparison to a neighbouring
borough without MECS.
Richard Whittington, CEO of Local
Optical Committee Support Unit • Consultants agree that treatment
(LOCSU), presented research in the MECS is high quality, safe
evaluating the effectiveness of the and equivalent to that given within
MECS based in optometry practices Hospital Eye Services and that the
referrals out of MECS were high
across Lambeth and Lewisham,
quality and appropriate.
South East London. Low levels
of patient satisfaction with the • The neighbouring borough, Southwark,
existing service delivered by the eye has now joined the scheme.
department, delays in patients being However, the evaluation also found
seen, and escalating costs led to that only 50% of optometrists in
establishing the scheme. the area wanted to participate, so
patients couldn’t walk into any local
Evaluation of the new service has
optometry practice and receive
shown:
the service.
• A 100% patient satisfaction score.
A full cost benefit analysis of the
• 26% fewer first outpatient scheme was underway and reported
appointments and 12% fewer shortly after the roundtable [23].
How can eye care professionals • Recognise the role of GPs in the
work together to support pathway. GP support referring into the
commissioning MECS? service is vital.
Participants shared suggestions for ways • Better IT systems are needed to
to improve the current approach: facilitate exchange of patient data
between services.
• Change perceptions of what optometrists
• Utilise support available from
do: Research shows that more than
organisations such as LOCSU and Local
half of participants would still go
Eye Health Networks.
to their GP if they woke with an eye
problem tomorrow [22]. The public don’t Other suggestions from individual
always equate optometrists with eye participants included delivering MECS
health, they think of them primarily as services as a standard enhanced part
retailers of glasses. Changing patient of the General Ophthalmic Services
perceptions of optometrists as the first contract, rather than an enhanced
point of contact for eye health may service, and developing and adhering to
increase numbers accessing MECS. one MECS pathway (currently, several
different pathways exist, causing
inconsistencies in quality and access).
The State of the Nation Eye Health 2017: A Year in Review 31Minor eye conditions What information do commissioners need to commission care for minor eye conditions? Cost savings are an important driver for change. Commissioners are looking for evidence that new services will generate cost savings and some information is starting to be available for MECS. Some participants called for more transparency in hospital financial reporting, to inform decision-making. The LOCSU National Data Repository was seen as a key tool for keeping oversight of activity and outcomes. Concerns were raised that the commissioning of effective community based services is still not a priority for some commissioners, despite the availability of data to inform decision making. The State of the Nation Eye Health 2017: A Year in Review 32
Improving the commissioning of services
19 July 2017, Leeds
What is the need? of the Stroke Strategy for London that
developed specialist high-risk centres
Recent research by the British
and step down services was discussed
Ophthalmological Surveillance Unit [6] – it was felt that the current situation of
found patients are suffering permanent eye care is similar to the early days of
and severe visual loss due to health the cancer networks and we can learn
service initiated delays. The Royal from the development of the work around
College of Ophthalmologists’ (RCOphth) cancer services.
2017 report series The Way Forward
[8, 13, 24, 25] has highlighted that the The wealth of guidance that has been
current services are struggling to meet produced about the commissioning
demand, so services need to adapt to and delivery of eye care services by
improve efficiency and sustainability. the RCOphth, College of Optometrists,
Current NHS targets and tariffs prioritise individually and together, along with
newly referred patients over review the Clinical Council for Eye Health
Commissioning, was highlighted. There is
patients; however the latter are eight
recognition of the changing role of health
to nine times more likely to have an
professionals so that services make the
irreversible sight-threatening condition
best use of staff with the relevant skills
[26]. Commissioning of eye care services and competencies to delivery timely
is currently undertaken by Clinical services. Historically, ophthalmologists
Commissioning Groups in England managed disease while optometrists’ role
without direction from a national eye was detection. This is likely to change
care strategy. going forward as optometrists continue
to develop their skills and expertise.
What is needed to improve Improving data sharing is crucial to this.
commissioning to ensure eye care There was a suggestion that the issue
capacity meets demand to prevent of prescribing medicines needs to be
avoidable sight loss? addressed to improve efficiency.
Participants made the point that NHS Should we seek to secure the
targets and tariffs are driving practice
holistic commissioning of
and service provision rather than clinical
decision making. One solution might
integrated eye care services
be more clinically relevant targets, a across all specialities?
standardised approach led by clinicians. If yes, what evidence is needed
to facilitate this?
There needs to be better coding and
standardisation of ophthalmology Several participants suggested that
data to provide detailed information the best way to innovate to improve
to commissioners to facilitate efficient efficiency in care is via sub-speciality. One
service planning. participant felt that the NHS has a poor
record of successfully commissioning
Valuable learning can be gained from how integrated services across specialities.
other areas of health care commission, However, there is a real need for planning
plan and deliver services. The example eye care services across all specialities.
The State of the Nation Eye Health 2017: A Year in Review 33You can also read
