Annex K
Epidemiology of Common Eye Disease
Glaucoma
Chronic glaucoma is a potentially blinding disorder requiring lifelong care once the diagnosis is made. The prevalence of glaucoma rises from 1-2% of the over 40s, to 5% of the over 75s. It is expected that the prevalence of glaucoma will increase by 40% by 2020.
Glaucoma affects approximately 1-2.5% within the white Caucasian population in Scotland; something in the region of 80,000 people living with this lifelong, sight threatening condition. The incidence within African Caribbean groups is significantly higher. The prevalence of ocular hypertension is around 5% of the over 50 age group.
At present glaucoma care accounts for approximately 30-40% of all outpatient visits in ophthalmology departments. Some 15-20% of new referrals are glaucoma related. Of this group 33% are confirmed of having the disease, 33% are considered suspicious and require further follow up and 33% are found to be negative. Therefore 66% could be described as inappropriate referrals and these patients could be effectively managed in the community.
Transferring the management of chronic glaucoma to the community would free up a substantial number of valuable out patient visits.
The triage/filtering of glaucoma referrals and the transfer of stable glaucoma patients to the community for ongoing management is one of the areas being considered by the CCI Eyecare Pathway working group.
Cataract
Cataract is a common ocular condition and affects the vast majority of people with age. Approximately 80% of people over the age of 65 will have some form of visual disturbance due to cataract.
Cataract is usually managed in the early stage of the condition by community optometrists observing the development of the condition and offering counselling and advice to patients. Often early cataract will result in significant changes in refractive error and appropriate advice and alterations to spectacle prescription will suffice at this stage. Ultimately most 47 patients are referred for cataract surgery and modern surgical techniques have a remarkably high success rate.
Approximately 3.2% of the population over 65 years of age would benefit from cataract surgery at any one time - some 26,016 people in Scotland. It is estimated that the demand for cataract surgery will increase by 70-80% by 2020.
Studies have indicated that approximately 80% of people with cataract are not in contact with an eyecare practitioner and often suffering the Con sequences of visual impairment unnecessarily.
AMD/ ARMD
Age-related macular degeneration is a common finding particularly in older people and is the most common cause of irremediable serious visual loss in people over 65 years of age. Macular degeneration also accounts for 14% of new partial sight and blind registrations for the working population (aged 16-64).
In 2002 813,000 people were over 65 in Scotland; approximately 400,000 had some form of visual impairment in one eye, 20% of who have visual impairment in both eyes. ARMD is the commonest cause of permanent visual loss in people over 65. The condition has resulted in visual impairment to approximately 90,000 Scots this year.
It is expected that the incidence of ARMD will increase by 40-50% by the year 2020.
ARMD is the leading cause of blind and partial sighted registration in people over 65 - approximately 50% due to ARMD. In addition RNIB estimates suggest that under certification is as high as 64% for blind and 74% for partial sighted registration.
Diabetes
Diabetes affects over 3% of the population in Scotland there are approximately 190,000 people living with the disease, and this number is increasing (Diabetes UK). Estimates suggest that some 40% of diabetics remain undiagnosed at any one time.
Approximately 6% of diabetics have sight threatening eye disease. Diabetes is the commonest cause of visual impairment in people of working age. In addition maculopathy is more common within the diabetic population and cataract tends to present approximately ten years earlier in patients with diabetes.
It is expected that the incidence of diabetes will increase by about 300% by the year 2020.
Vision and Falls
There is a growing body of evidence indicating a correlation between visual impairment and falls. NICE have recently produced advice and guidance relating to falls in older people and have established the link of impaired vision and falls. The NICE advice indicates that an assessment of visual function should be an integral component within the multifactorial assessment programme for someone who has fallen or is at risk of falling. Most of the studies thus far seem to have limited their concern to loss of central vision; more work needs to be done on loss of peripheral vision and the consequent risk of falls.
The association between falls and poor vision exposes just one of the hidden costs of visual impairment.
A RNIB study estimated that £25m spent on rehabilitation and mobility training for older blind and partially sighted people would save £220m in the social and healthcare costs of falls.