It is not news that we have an increasingly elderly population and with this comes an increase in eye health-related diseases such as glaucoma and age-related macular degeneration. Our future planning for optometric and dispensing manpower and skills focuses on the pathways to manage these and other diseases when they are in their active phase requiring diagnosis, monitoring and treatment.
It follows that ageing patients will also mean there are more patients who are living with sight loss in the future. According to the RNIB there are around one third of a million people registered as blind or partially sighted and over two million who live with some sight loss that impacts on their daily lives, predicted to rise to 2.2 million by the year 2020 and double to four million by 2050. Given the size of these numbers it is a surprise that this is an area of optical practice that is not given the attention and forward thinking it deserves – at least that is my perception.
It goes without saying that we should be working towards reducing preventable sight loss, thought to be around 50%, through encouraging good eye health behaviours, such as regular eye examinations, but the required and essential public health campaign is a topic for another day.
Whatever we do there will still be large numbers of patients who need support for sight loss, either with low visual aids, common sense advice and/or emotional support. This support may be from a combination of optical practice, the hospital system, the voluntary sector or public health. My question is; ‘Are optical practices currently able to adequately provide the services and signposting for this patient group, that should be part and parcel of a standard optical practice’? My answer would be that they are not and so what should we be doing to change?
It is easy to see what the obstacles to this are. To give practical help a practice needs practitioners with appropriate skills, a stock of simple visual aids and knowledge of what is available in the locality in order to refer onwards for supply of more complex aids or advice around the home or emotional support. While low vision assessment and dispensing is part of core competencies for both optometrists and dispensing opticians, it is not an area that is well covered in training and now it seems that it is not something that is practised regularly.
Hence skills are not well developed in the first place, and in this scenario optical practice is not seen as the first port of call for these patients, particularly in areas where provision is through the voluntary sector or hospital. To be fair I must acknowledge there will be a minority who have the skills and who have maintained and utilised them well and all credit to those individuals. Funding of a low vision service is always a constant source of frustration and it is an easy target for clinical commissioning groups (CCGs) to reduce.
The solutions are less clear. How do we raise the profile of optical practices to get involved, ideally as the first point of call for advice and guidance? It would be great to have a similar pathway to the set up in Wales, where there are specially trained low vision practitioners working out of high street optical practice. However, such a system is unlikely to evolve in England, so it will be up to each local area, perhaps the local optical committee or eye health network, to map out the existing pathways, identify where there are gaps and to lobby other agencies locally to fill in those gaps.
The obvious place for practices to be involved is the provision of simple visual aids where this is not already readily available to patients, but where there is already adequate provision, then at the very least each practice should be aware of where they are able to signpost patients to. Where there is inadequate provision and funding, each CCG, Health & Wellbeing Board and Strategic Transformation Partnership, (where they exist), should be lobbied, as this fits exactly with the desire to get people living independently.
These organisations should also be interested in providing emotional support for those living with visual loss, where it is known there is a higher level of depression and mental health issues, with associated costs to the NHS and loss of quality of life for the individual.
It would be great to see more optometrists taking up additional competences in low vision accredited by the College, the uptake of which I suspect is far lower than those who take up additional glaucoma and independent prescribing?
This is an area of patient care that optical practice should ‘own’ and one that will raise the profile and standing of optical practice in the community.