Epidemiology and demographic of visual impairment:

Question 1

What is visual impairment

Answer 1

*Reduced binocular visual acuity, which cannot be improved even with best optical correction provided by conventional lenses
*Conventional lenses include the required distance correction and near vision additions up to +4DS

Question 2

What are conventional lenses

Answer 2

The required distance correction and near vision additions up to +4DS

Question 3

Example of someone who doesn’t have reduced VI

Answer 3

*If 6/6 in RE and 3/60 in LE with a binocular visual acuity of 6/6
*Then this individual would not be classified as having a visual impairment?
*Cause their binocular visual acuity is 6/6, which would not be classified as a visual impairment.

Question 4

Why is it important to define a visual impairment:

Answer 4

*It’s important to define a visual impairment because there are certain benefits associated with being visually impaired
*Best corrected VA i.e with glasses
*For example:
oFinancial help
oSocial help
*Because someone with a visual impairment might have difficulties with their activities of daily living e.g. reading, and might have a decline in quality of life.
*It’s also important in terms of epidemiological studies to understand what visual impairment is.
oSo when doing a large-scale study and want to know how many people don’t see particularly well in your area or in your country.

Question 5

What are the benefits associated with VI

Answer 5

*Financial help
*Social help

Question 6

What are difficulties of someone with VI

Answer 6

*Activities of daily living e.g. reading
*A decline in quality of life.

Question 7

How many definitions are there of VI

Answer 7

65

Question 8

What are the different terms used for vi

Answer 8

• Blind
• Partial sight
• Low vision
• Subnormal vision
• Visual impairment

Question 9

WHO vi

Answer 9

Presenting VA in better eye cause hard to get glasses so cause don’t have glasses, they might be visual impaired cause of that

Question 10

Mild VI

Answer 10

• 6 / 12 – 6/18

Question 11

Moderate VI

Answer 11

• 6/18 – 6/60

Question 12

Severe VI

Answer 12

• 6/60 – 3/60

Question 13

Blindness

Answer 13

> 3/60 E.G. if someone had VA of 2/60 and presenting VA in better eye was 2/60 then theyd be blind

Question 14

Near VI

Answer 14

Near vision worse than N6 or N8 at 40cm and best corrected VA better than 6/12

Question 15

What are the 2 categories of vi registration

Answer 15

*Severely sight impaired / blind
*Sight impaired / partially sighted

Question 16

Severely sight impaired / blind

Answer 16

• Blinds person act 1920 and National Assistance Act 1948
• Blind as unable to perform any work for which eyesight is essential
• There is no reference to near vision, occupation or any particular occupation or disability

Question 17

Severely sight impaired / blind guidelines

Answer 17

• 1.Acuity in better eye was below 3/60
• 2. Above 3/60 but below 6/60 with significantly contracted field ( cause can cause difficulties with activities of daily living )
• 3. Acuity better then 6/60 but with substantially contracted fields especially inferior
• 4. Note blind category was changed to severely sight impaired 2003

Question 18

Sight impaired / partially sighted guidelines

Answer 18

• There is no legal definition.
• Substantially and permanently handicapped by defective vision caused by congenital defect, illness or injury.
• NOTE: Partial sight category was changed to sight impaired in 2003
• 1. 3/60 to 6/60 with a full field
• 2. Up to 6/24 with moderate restriction of the field, opacities or aphakia
     *If have corneal opacities, hard to correct with glasses so might need cl’s but these opacities can cause abrasions and VA not good
• 3. 6/18 or better with a gross field defect i.e stroke or hemianopia or glaucoma or retinitis pigmentosa

Question 19

What is aphakia

Answer 19

• Cataract done and intraocular lens implanted in eye
• If emmetrope before cataract surgery, you end up with high plus glasses so become hyperopic = magnified = not good depth perception and poor va and hard judging distances

Question 20

Guidelines for children

Answer 20

• Children can be born with a visual impairment, or can develop it later on in their childhood.
• Children, unless they’re obviously blind, should always be classified as being sight impaired.
• At the age of 4 and over, its better to use binocular visual acuity when making a decision as to which category the child should be placed under.
• Children with visual acuity of 6/24 or better, as long as all that’s wrong with them is that they’ve got a visual impairment should be considered candidates for mainstream schooling.

Question 21

History for certification process

Answer 21

Prior to 2003 certification via
* BD8 form England & Wales.
* Scotland BP1 form ,
* Northern Ireland A655 form

Changes brought about in 2003
* Cause not everyone who was eligible was being registered and have help as having VI as forms were complicated so system changed
* Early identification of sight loss for social care
* Improved access to social care
* Increase registration
* Improve accuracy of data collection

Registration is voluntary

Question 22

What happened from November 2003

Answer 22

*Can be certified OR if not eligible for certification but needed help
*Can only be certified as having VI via Certificate of vision impairment (CVI form )- standard across UK

• Low Vision Leaflet (LVL) Previously Letter of visual impairment (LVI).
  *Usually available from primary care community practices for patients to self refer to Social Services e.g. high street practice
  *Not certify you as having low VI but its for those pxs who have difficulty but don’t meet criteria for VI
  *So can get help from social services
• Referral of Vision Impairment (RVI)
  *For eye clinic to refer patient to social services.
  *Should be done as soon as social needs become apparent, but where certification is not currently appropriate or cannot be carried out, for example if they are not being seen by a consultant.

Question 23

What do you use if you want to register someone as VI in UK

Answer 23

CVI form i.e certificate of visual impairment

Question 24

What are LVL and RVI forms for

Answer 24

Getting people help from social services but px cant be registered or certified as having VI

Question 25

What is certification and what does it do

Answer 25

CVI formally certifies a person as SI or SSI. *Provides a pathway for someone with sight loss to be brought to the attention of social services. *Epidemiological analysis provides information on the prevalence of visual impairment.

Question 26

Where does registration of VI happen and how does it work

Answer 26

*At social services *Fill out from to certify px VI and it goes to social services *Social services register that someone has SI or SSI

Question 27

Features of registration

Answer 27

*Care Act 2014 requires local authorities to establish and maintain a register of people who are sight impaired or severely sight impaired. *The Care and Support (Sight-impaired and Severely Sight-impaired Adults) Regulations 2014 provide for a person to be treated as being sight impaired or severely sight impaired if the person is certified as such by a consultant ophthalmologist *help local authorities plan and provide services for people who are visually impaired. *registration is voluntary

Question 28

Certificate of Visual Impairment

Answer 28

*Part 1 Patient details i.e name, address, NHS number and social services they fall under, Category of registration, Patient awareness-Information booklet sight loss & Contact with ECLO? *Part 2 – Visual Function (best corrected VA in RE, LE and BE, visual fields, has px been to LV clinic ) *Part 2a – Diagnosis (18 years and over only) *Part 2b – Diagnosis (under 18 years) – whats causing sight loss *Part 3 – Additional information such as does the patient live alone, communication needs *Part 4- Consent and information sharing, Ethnicity *Information for Driving Licence holders and general information about CVI

Question 29

CVI

Answer 29

*Certification only via Consultant Ophthalmologist I.E optom cant but if you think they need to be registered as SI, then refer to gp, gp refer to hospital eye system and seen by Consultant Ophthalmologist and certify that they reigester Copies for * Patient * Hospital * General Practitioner * Local council/Care Trust * Epidemiological analysis @ Royal College of Ophthalmologists Certifications office at MEH

Question 30

LVL

Answer 30

* For those who don’t meet criteria to be certified as VI *E.G. wet AMD – struggling with reading cause of AMD but cause 6/12 vision after injections and small visual field loss, theyre not classified as VI but still need help * Px fills in leaflet and sends to social services * Mechanism of self referral * Live alone? * Responsiblities as carer? * Difficulties * Concerns

Question 31

Referral of VI

Answer 31

Form similar to LVL * Patient consent cause sending it on pxs behalf * Filled in by hospital staff * Copy to GP and to social services * Urgency of referral

Question 32

Benefits of SSI Registration

Answer 32

* Blind person's personal income tax allowance * Reduction of 50 per cent on the television licence fee * Car parking concessions: the Blue Badge Scheme * Free postage on items marked "articles for the blind" * free permanent loan of radios, cd radio cassette players. * help with telephone installation charges and line rental. * Free NHS sight test * Other NHS costs * Discounted rail travel * Local bus schemes * Exemption from BT Directory Enquiry charges * Information in accessible formats * Leisure concessions * Council tax disability reduction * Welfare benefits * Attendance Allowance * Disability Living Allowance * Carer's Allowance * Employment and Support Allowance * Tax Credits * Pension Credit * Housing Benefit and Council Tax Benefit * Help from specially trained social services staff, usually called Rehabilitation Workers or Rehabilitation Officers * Protection under the disability discrimination act

Question 33

Access to work scheme

Answer 33

* Employer or Visually Impaired person should contact job centre * Important for VI person working and eyesight changed making it harder to carry out job * For other disabilities too * Assist disabled people by providing practical support and helping to meet additional costs associated with overcoming work related obstacles resulting from disability Examples of what may be done * Adaptations to Premises and Equipment. E.g. Zoom text for Computer * Special Aids and Equipment. E.g. CCTV * Travel to Work. E.g. Cost of a taxi if applicable reimburse

Question 34

Visually Impaired Children

Answer 34

Formal system in place to help children with visual impairment Children’s Act 1998/2004 * Help should be available to all ‘children in need’ * Registration not necessary * Even if not registered, have to be prioritised * Schools and education authorities need to provide help to all visually impaired children * Local Education Authorities identify all children recognised with special educational needs from age of 2 (up to age 19 if they are in full time education) * SENCO * Help VI person in class

Question 35

What is epidemiology

Answer 35

* The study of the distribution, determinants and control of disease in human populations * In order to set policies and priorities and to evaluate global eye health

Question 36

What is prevalence

Answer 36

* Measure of disease frequency * Number of people with a disease at a given time * Typically expressed in terms of a proportion (usually %)

Question 37

Equation for prevalence:

Answer 37

Prevalence = No. of cases or events / Total population at risk

Question 38

What is incidence

Answer 38

* Number of cases occurring in a specified time * Sometimes expressed as a rate: the number of new cases occurring over a given time frame in relation to the total number of persons at risk during the same time frame

Question 39

Equation for incidence

Answer 39

Incidence = No. of new cases over a given time interval / Total population at risk at the beginning of the specified time

Question 40

Visually impaired statistic

Answer 40

Of the 253 million people in the world who are visually impaired o 55% are women (139 million). o Approx. 203 million, representing 80%, are aged 50 years or older.

Question 41

Global causes of Blindness and MSVI (all ages)

Answer 41

* Cataract: 25.8% * Refractive Error: 48.99% - most common cause of VI – easily corrected by glasses * Glaucoma:2.78% * Age Related Macular Degeneration: 4.10% * Corneal Opacities:1.65% * Diabetic Retinopathy: 1.16% * Trachoma:0.79% * Other: 14.71%

Question 42

Change in prevalence of visual impairment from 1990 to 2015

Answer 42

*Decline observed in prevalence of visual impairment for most eye conditions except Diabetic Retinopathy and the ‘Other’ category. *Related to increase in the prevalence of diabetes CAUSING INCREASE IN VI

Question 43

Global Incidence of Visual Impairment:

Answer 43

* Incidence varies with age * Not many studies * Priverno Eye Study (Cedrone et al, 2003) *Blindness 0.1% *Low Vision 1.3%

Question 44

Risk Factors for Sight loss in the UK:

Answer 44

* Old Age * 31 per cent aged 85 years and over * Low Income * Diabetes * Smoking * Learning Disabilities * Ethnic Minority Groups * Other health conditions E.G HTN

Question 45

Prevalence of Visual Impairment in the UK:

Answer 45

* 149,938 people: SSI register (England & Wales) (2017) * 157,531 people: SI register (England & Wales) (2017 * Registration is voluntary so not everyone who has VI will appear on these registers so data is underestimating number of people with VI 2 million VI across UK

Question 46

UK Incidence of Visual Impairment:

Answer 46

* Incidence varies with age * 20605 new registrations on the SI and SSI register(2016/17)

Question 47

Prevalence of childhood VI in the UK:

Answer 47

- Approx. 12,000 SI and SSI children between the ages of 0–16 - Around half have additional disabilities and/or special educational needs - SSI Register (2017) * 0- 4 years: 637 children * 5-17 years: 4,651 children - SI Register (2017) * 0- 4 years: 604 children * 5-17 years: 5675 children

Question 48

Incidence of childhood blindness in the UK: New registrations:

Answer 48

SSI register (2017) * 0- 4 years: 200 children * 5-17 years: 205 children SI Register (2017) * 0- 4 years: 175children * 5-17 years: 310 children

Question 49

Common Causes of Visual Impairment UK: Adult Population:

Answer 49

* Glaucoma (30%) * Diabetic Retinopathy (8%) Other less common causes * Cataract * Myopia * Optic Neuropathies

Question 50

Causes of VI: Working population:

Answer 50

*Diabetic Retinopathy Eye (2004) 18, 257–261 But recent findings Liew et al 2014 have found that no. of registrations due to DR/DM has decreased and overtaken by hereditary retinal disorders *Other causes hereditary retinal disorders & optic atrophy

Question 51

Common cause of Visual Impairment UK: Children:

Answer 51

* Cerebral Visual Impairment 39% * Hereditary Retinal Disorders 22% * Optic Nerve pathologies 22% * Congenital Cataract 4%