The UK Vision Strategy aims to improve eye health and prevent sight loss across the age range, asAnita LightstoneexplainsAnita Lightstone BSc FCOptom SAAO

UK Vision Strategy Project Director, Funded by Royal National Institute of Blind People (RNIB), London

ABSTRACT   
The UK Vision Strategy is a Vision 2020 UK initiative, led by the Royal National Institute of Blind People (RNIB), to develop a unified plan for action on all issues relating to eye health and sight loss across the four countries of the UK. The Strategy was developed in response to a World Health Assembly resolution of 2003, which urged the development of national plans to tackle sight loss. Launched in April 2008, the UK Vision Strategy is a bold, ambitious plan to radically improve the eye health of the nation, eliminate avoidable sight loss, improve services to people, including children, with sight loss, and increase inclusion in society for blind and partially sighted people. Health and social care professionals joined the voluntary sector, Government representatives, service users and individuals with experience of sight loss to develop the Strategy. Local groups of health and social service professionals and service users are being formed across the UK to find ways to implement the Strategy. Any health professional with an interest in this work can contribute to their local group either through their professional representative on the group or directly. Journal of Family Health Care 2008; 18(5): 162-164 


Key points

_ The UK Vision Strategy represents the national aims for eye health and services for people who are blind or partially sighted
_ It has been developed by a broad coalition of health and social care organisations, Government representatives, the voluntary sector and service users
_ It aims to improve eye health in the UK, eliminate avoidable sight loss and enhance the inclusion, participation and independence of blind and partially-sighted people
_ Health and social care providers must make eye health a greater priority at both national and local level, investing in early detection and treatment of eye conditions
_ Services for people with sight loss must improve, and must include emotional support which is almost non-existent
_ Blind and partially-sighted people must have greater access to employment opportunities and the use of ICT equipment
_ Public awareness of eye health and sight loss needs to improve so that people can make informed choices about their eye health
_ Local groups to promote the UK Vision Strategy are already being set up across the UK, and health professionals should enquire about these and lend their support

Sight is the sense that nine out of 10 people most fear losing1, yet eye health and sight loss issues are often low on health and social care agendas and people in the UK show a low awareness of eye health and the causes of sight loss. Currently around two million people in the UK have sight problems that impact on their daily lives, e.g. being unable to read a newspaper or recognise a friend across the street. Every day a further 100 people will begin to lose their sight. With an ageing population the prevalence is set to increase significantly, as the majority of those with sight loss are older people. However, an estimated 80,000 people of working age and 25,000 children in the UK are also affected by sight problems2.

What is the UK Vision strategy?  

The UK Vision Strategy3 stems from Vision 2020, a global initiative by the World Health Organization and the International Agency for the Prevention of Blindness. The UK Vision Strategy aims to radically improve the eye health of the nation, eliminate avoidable sight loss, improve services to people with sight loss, and increase inclusion in society for blind and partially sighted people. It has had input from over 650 organisations and individuals, including the NHS Confederation, social services, professional bodies, voluntary organisations and patient representatives, as well as support from the UK Governments. It is the first time that all these groups have come together to create a wider reaching plan and together they represent a powerful force for change.Eye Health test


Why do we need the Strategy?
 

Eye health must be a public health priority, given the ageing population and an increasing demand on services. Age-related macular degeneration (AMD), glaucoma and diabetic retinopathy have all increased in England and Wales since 1990-91 and figures for diabetic retinopathy among the over-65s have more than doubled4. Health service providers, particularly in the NHS, must recognise this and prioritise eye health at both national and local levels. There is also an economic case for intervention: Australian research has suggested that early intervention in eye care produces a four-fold return on investment5. Low awareness of eye health, together with a failure to invest in the early detection and treatment of eye conditions, means increased spending on health, social care, education and training to support people in the later stages of eye disease.

What can be done to improve eye health and prevent loss of sight?

There is a great deal we can do to prevent loss of sight. Evidence suggests that over 50% of sight loss is due to preventable or treatable causes. This is most marked in the older population, where the proportion is estimated to be between 50- 70%6. To reverse this trend, increasing awareness is crucial.

Health education  

Many people fail to understand the impact of their lifestyles and health conditions on their sight and currently there is limited public health information to help. Smoking, obesity and unprotected sun exposure all increase the risk of sight loss, while many conditions also have a genetic factor. In addition, the early stages of some eye diseases show no symptoms, so that by the time symptoms manifest themselves, the disease may already be advanced. Yet many eye conditions such as glaucoma, one of the main causes of blindness, are treatable if detected early enough. Lack of awareness among professionals and the general public has left too many people living with sight loss that could have been avoided. The UK Vision Strategy highlights tackling this as a priority area for action.

Screening  

Retinal screening for people with diabetes is an example of where we need to increase awareness and resources. Diabetic retinopathy is a common cause of blindness, but early detection and treatment lessen the risk of this. In England we need to make faster progress in implementing the Government's national retinopathy screening programme, which advocates that people with diabetes should receive free retinal screening by digital camera every two years from the age of 12 years7. Expectant mothers with diabetes should also have this screening during pregnancy as the risk of retinopathy is increased at this time.

Black and Minority Ethnic groups  

Poor take-up of services from groups at higher risk of eye disease also needs to be urgently addressed. Groups at greater risk of sight loss tend to be those most vulnerable to exclusion from services, including people from Black and Minority Ethnic (BME) groups who are expected to have a higher prevalence of some common age-related eye diseases8 Diabetes is more likely to develop in people of South Asian origin, and in people of African and African-Caribbean descent. It is also more common in people of Chinese origin and other non- Caucasian groups8. These population groups are at particular risk of sight loss from diabetic retinopathy. An RNIB project in Glasgow9 has found that diabetic retinopathy is more common in individuals of Pakistani, Indian or Bangladeshi descent than in Caucasians. These individuals make up a sizeable minority of the population in Glasgow.

Meeting the needs of individuals  

In addition, people with other major health conditions or disabilities must not miss out on eye care and support if they lose their sight. Organisations across the health, social care and voluntary sectors need to work in partnership to improve local vision strategies and meet the needs of individuals. Health professionals in particular need to ensure that knowledge about eye care and the prevention and management of sight loss reaches their colleagues in other agencies, their clients and the local population.

Children and young people  

A further priority of the UK Vision Strategy is identifying and addressing potential sight loss among children and young people. This includes the early detection of both sight-threatening and correctable conditions. Plans to improve services should include making clients and the public more aware of sight tests and screening programmes. It is important to increase access to these facilities and ensure that screening programmes follow existing best practice and are kept under regular review.

Teachers and schools  

There is a need for schools to be more aware of eye health and sight impairment in pupils, and school nurses have a part to play in improving current levels of knowledge among teaching staff. Children and young people with sight loss should be assured of full access to the curriculum and equality of opportunity throughout their education. This should extend to participation in all possible activities, including social activities.

Transition from children's to adult services  

Clear and smooth transition pathways from children's and young people's services to adult services should be developed, to ensure that rights to benefits and support are not lost during this process and young people are enabled to fulfil their potential. This applies equally to health services and social care services and should include support from the voluntary sector as appropriate.

Commissioning   

The UK Vision Strategy calls for the commissioning of fully integrated and effective eye care and sight loss services, including low vision services. Better integration of primary and secondary eye care could be achieved if eye-care health professionals and service users were involved in the planning of these services, in conjunction with Strategic Health Authorities and Primary Care Trusts. This is one way to provide the most effective, timely and accessible services and treatments for each individual, and the best use of community and hospital resources. Services should be person-centred and create seamless pathways through health, social care and the voluntary sector.

Emotional and other support after sight loss

Increased investment in emotional support, including counselling, is needed to support those who are blind, partially sighted or newly diagnosed with conditions leading to blindness. Evidence shows that the incidence of depression is at least twice as high in visually impaired older adults as in the rest of the population10. Access to emotional support and links to peer support networks are vital and must be made available as soon as people need them. The absence of such support often means that people will be much slower to regain their confidence and learn new skills. Providing emotional support will enable people to access other, practical support more successfully too. Assessments should consider daily living, mobility and communication needs, community equipment and housing adaptations, particularly in relation to the provision of a personal budget. This would enable blind and partially sighted people to exercise greater choice and control in their lives. They also need to be followed up at regular intervals as an individual's condition and situation changes.

Research

The UK Vision Strategy calls for research to shape future developments. Research should focus on improving understanding of the nature and distribution of sight loss, diagnosis, the prevention and cure of blindness, the optimisation of services for people with sight loss, and the development and validation of new treatments for sight threatening and correctable conditions.

Conclusion

The Strategy is ambitious, but also achievable. A wealth of professionals and people with experience of sight loss have brought the Strategy this far, and with continued and growing support we can deliver its aims.
Local groups are now being established across the UK, with representatives from health professionals, social workers and service users. The groups are looking at ways of raising awareness and improving eye care. If any health professionals are interested in finding out more or contributing to their local group, they should make enquiries locally or contact RNIB (see Further information).

References

1. Royal National Institute for Blind People (RNIB). Survey of the sense people most fear losing. London: RNIB Press Centre, March 2008. www.rnib.org.uk (accessed 26 August 2008)  
2. Keil S. Key Statistics. London: RNIB, 2008. www.rnib.org.uk/statistics (accessed April 2008)
3. UK Vision Strategy. A Vision 2020 UK initiative led by RNIB. London: RNIB, April 2008
4. Bunce C, Wormald R. Leading causes of certification for blindness and partial sight in England and Wales. BMC Public Health 2006; 6: 58
5. Taylor HR, Pezzullo ML, Nesbitt SJ, Keeffe JE. Costs of interventions for visual impairment. American Journal of Ophthalmology 2007; 143(4): 561-565. Epub 2006 Dec 8.
6. Tate, R Smeeth L, Evans J, Fletcher A, Owen C, Rudnicka A. The prevalence of visual impairment in the UK. RNIB report/Vision 2005
7. NHS. English National Screening Programme for Diabetic Retinopathy. www.retinalscreening.nhs.uk (accessed 26 August 2008)
8. Department of Health. National Diabetes Service Framework. Chapter 1. London: Department of Health 2007. www.dh.gov.uk (accessed 26 August 2008)
9. RNIB website (Scottish section). www.rnib.org.uk (accessed 26 August 2008)
10. Burmedi D, Becker S, Heyl V, Wahl HW, Himmelsbach I. Emotional and social consequences of age-related low vision. Visual Impairment Research 2002: 4(1): 47-71

Further information
RNIB
The Royal National Institute of Blind People (RNIB) is leading the UK Vision Strategy, in collaboration with other interested organisations. To find out more about the UK Vision Strategy visit www.rnib.org.uk/ukvisionstrategy or www.vision2020uk.org.uk. Readers who want to know more about getting involved in the UK Vision Strategy in their area are welcome to telephone the UK Vision Strategy Unit at RNIB on 020 7391 2043 or e-mail UKvisionstrategy@rnib.org.uk