Recent trends in vision impairment certifications in England and Wales.

BACKGROUND: The Certificate of Visual Impairment (CVI) provides essential data for preventable sight loss indicators as part of the Public Health Outcomes Framework (PHOF) published annually by the Department of Health. Trends in CVI certification rates can provide information on the effectiveness of current services and treatments and may be used to guide allocation of resources, and is the only such indicator within ophthalmology. This study aimed to compare recent trends in new vision impairment certifications in 2017/18 against prior baseline data in England and document trends in new certifications in Wales. METHODS: PHOF data from 2010/11 and 2017/18 were examined with respect to preventable sight loss indicators: age-related macular degeneration (AMD) (Indicator E12a), glaucoma (Indicator E12b), diabetic eye disease (Indicator E12c) as well as the total numbers of certifications (Indicator E12d). RESULTS: In 2017/18, the rate of new CVI certifications was 41 per 100,000 population which has reduced from 43/100,000 in 2010/11 in England. Certifications for AMD reduced from 132/100,000 in 2010/11 to 107/100,000 in 2017-18. Certifications for glaucoma have remained stable at 13/100,000 in 2017/8. Certifications for diabetic eye disease have declined from 4/100,000 in 2010/11 to 3/ 100,000 in 2017/18. The number of vision impaired individuals that each Clinical Commissioning Group (CCG) has to support varies from 8 to 82 per 100,000 population. CONCLUSIONS: There has been a significant decrease in the rate of all CVI certifications particularly from AMD and diabetic retinopathy. However, maintaining this will require changes in the way care is delivered as the elderly population, which is at greatest risk of preventable sight loss, is projected to increase by 50% over the next 20 years. Inherited retinal diseases are now the leading cause of sight loss in the working age population. CVI data demonstrate the need for CCGs to tailor their investment in ophthalmic services to the needs of their specific patient populations. It is important that all ophthalmologists continue to provide accurate CVI data in order to help support the future equitable allocation of adequate resources to reduce avoidable vision loss.

Is there evidence that the yearly numbers of children newly certified with sight impairment in England and Wales has increased between 1999/2000 and 2014/2015? A cross-sectional study.

OBJECTIVES: To use routine data capture from hospitals in England and Wales to identify whether there has been an increase in the annual numbers of children newly certified sight impaired in England and Wales between 1999/2000 and 2014/2015 and to examine causes of certifiable sight impairment in children certified in 2014/2015. DESIGN: A cross-sectional study including an analysis of all certificates of vision impairment completed in hospitals in England and Wales each year between 2007/2008 and 2014/2015 and all certificates completed in hospitals in England and Wales in 1999/2000. PARTICIPANTS: Certificates for all individuals aged 16 years or less at the time of certification in England and Wales for each financial year between 1 April 2007 and the 31 March 2015 and for individuals aged 15 years or less for the year ending 31 March 2000. We obtained information on the main cause of certifiable sight loss for all children certified in 2014/2015. We estimated crude and sex specific incidence estimates with 95% confidence intervals computed by Byars method. RESULTS: In 1999/2000, the estimated incidence (95 % CI) of certification was 8.2 (7.7 to 8.8) per 1 00 000. In 2007/2008, the estimated incidence was statistically significantly higher at 10.1 (9.5 to 10.7). Since then a trend of increasing incidence with time has been observed until 2014/2015 when an estimated incidence of 13.3 (12.6 to 14.0) was observed. Hereditary retinal dystrophies, cerebral visual impairment and nystagmus were the most common single causes of certifiable sight impairment in children in 2014/2015. CONCLUSION: Our findings show that in England and Wales there has been an increase in the number of children newly certified sight impaired by consultant ophthalmologists since 1999/2000. This mirrors our previous findings based on data originating within social service departments.

Retrospective analysis of newly recorded certifications of visual impairment due to diabetic retinopathy in Wales during 2007-2015.

OBJECTIVE: The aim of this study was to analyse the changes in new certifications for both sight impairment (SI) and severe sight impairment (SSI, blindness) in Wales due to diabetic retinopathy (DR)/maculopathy between 2007 and 2015. RESEARCH DESIGN AND METHODS: This is a retrospective analysis of annual data of new certifications for visual impairment and blindness (Certificate of Vision Impairment) for England and Wales derived from the national database provided by the Certifications Office, Moorfields Eye Hospital, over a period of 8 years from 2007. RESULTS: In Wales there were 339 less new certifications for both SI and severe SSI from any cause combined from 2007-2008 to 2014-2015. The number SI and SSI combined specifically due to DR was reduced by 22 in people with known diabetes. This was a reduction in new certifications over the observation period from 82.4 to 46.9 per 100 000 (-43.1%) with a fall in SSI from 31.3 to 15.8 per 100 000 (-49.4%), respectively. During this observation period however, there was a parallel increase in 52 229 (39.8%) persons with diabetes in Wales. CONCLUSIONS: While acknowledging the limitations of the certification process and the increasing numbers of persons with diabetes, the incidence of SI and SSI per 100 000 population of persons with diabetes in Wales has almost halved over an 8-year period up to 2015. This may reflect the earlier diagnosis of DR and sight-threatening DR since the introduction of screening and/or improved diabetes management with timely onward referral and newer treatments.

Sight Impairment registration due to stroke-A small yet significant rise?

Objectives: In the United Kingdom, when an individual's sight falls to and remains at a certain threshold, they may be offered registration as sight impaired. Recent analysis of causes of registrable sight impairment in England/Wales indicated that visual impairment due to stroke had increased as a proportionate cause of sight loss. We aim to assess whether there is evidence of an increase in incidence of certification for sight impairment due to stroke in England/Wales between 2008 and 2014. Materials and Methods: The number of certifications with a main cause of sight impairment being stroke was obtained from the Certifications Office London. Directly standardized rates per 100,000 were computed with 95% confidence intervals and examined. Poisson regression was used to assess evidence of trend over time. Results: In the year ending 31st March 2008, 992 people were newly certified with stroke with an estimated DSR of 2.1 (2.0 to 2.2) per 100,000 persons at risk. In the year ending March 31st 2014, there were 1310 certifications with a DSR of 2.5 (2.4 to 2.7). Figures were higher for men than women. Poisson regression indicated an estimated incidence rate ratio of 1.03 per year with 95% confidence intervals of 1.028 to 1.051, P < .001. Conclusions: These data suggest a small but statistically significant increase in the incidence of certifiable visual impairment due to stroke between 2008 and 2014. Figures are, however, considerably lower than estimated, perhaps suggesting that more should be done to address the visual needs of those who have suffered stroke.

The Sight Loss and Vision Priority Setting Partnership (SLV-PSP): overview and results of the research prioritisation survey process.

OBJECTIVES: The Sight Loss and Vision Priority Setting Partnership aimed to identify research priorities relating to sight loss and vision through consultation with patients, carers and clinicians. These priorities can be used to inform funding bodies' decisions and enhance the case for additional research funding. DESIGN: Prospective survey with support from the James Lind Alliance. SETTING: UK-wide National Health Service (NHS) and non-NHS. PARTICIPANTS: Patients, carers and eye health professionals. Academic researchers were excluded solely from the prioritisation process. The survey was disseminated by patient groups, professional bodies, at conferences and through the media, and was available for completion online, by phone, by post and by alternative formats (Braille and audio). OUTCOME MEASURE: People were asked to submit the questions about prevention, diagnosis and treatment of sight loss and eye conditions that they most wanted to see answered by research. Returned survey questions were reviewed by a data assessment group. Priorities were established across eye disease categories at final workshops. RESULTS: 2220 people responded generating 4461 submissions. Sixty-five per cent of respondents had sight loss and/or an eye condition. Following initial data analysis, 686 submissions remained which were circulated for interim prioritisation (excluding cataract and ocular cancer questions) to 446 patients/carers and 218 professionals. The remaining 346 questions were discussed at final prioritisation workshops to reach agreement of top questions per category. CONCLUSIONS: The exercise engaged a diverse community of stakeholders generating a wide range of conditions and research questions. Top priority questions were established across 12 eye disease categories.