People with sight loss may be denied support because of outdated rules written over half a century ago, according to new research (1) commissioned by Thomas Pocklington Trust.Researchers from Cardiff University analysed a unique database compiled by the Welsh Low Vision Services (2) and discovered that almost 70% of those needing to use low vision support services were not eligible to register as visually impaired.In some areas of the UK people are unable to access support services unless they are registered.
“Our research shows that people need to access support services before their vision drops to registrations levels,” said Dr. Barbara Ryan who led the research team.“This suggests that the criteria set for registration are not fit for purpose.”
The definitions used today (3) were written more than fifty years ago, when low vision rehabilitation services had not even been established in the NHS. Now, in a letter published today (22nd June) in the British Journal of Ophthalmology (BJO), the researchers call for new criteria (4) to be adopted in order to allow people to seek help at an earlier stage.Sight loss responds better to rehabilitation if it is dealt with early.
“If help is to be available to all those who need it the criteria must be changed,” said Ryan.
The WLVS database is the first to gather routine information about the way services are used and the characteristics and social circumstances of the people who use them.This makes it the fullest description of people with sight loss attending community based low vision services in the UK and provides evidence not available elsewhere.
Previous studies have also focussed on people who are registered whereas the WLVS are community based and available to everyone.About 60% of those seeking help were not registered and nearly 70% had eyesight that was better than the levels set for registration.
Since registration figures influence funding and planning of support services, this mismatch between the records and the reality could mean that the real scale of sight loss in the UK is both underestimated and under-resourced.Registration figures are already being questioned as they are not rising at the expected rate, given the aging population.Now the Cardiff study has been able to identify barriers to registration.It found that people who lived alone were less likely to register and that age was also a significant barrier. The older a person was the less likely they were to register.Of those surveyed almost half lived alone and almost 70% had age-related macular degeneration.Younger people were more likely than older people to go for a consultation with an ophthalmologist and men were more likely to go for a consultation than women.
Said Dr. Angela McCullagh, Research and Development Director, Thomas Pocklington Trust, “The Welsh database is a vital new tool for anyone involved in supporting those with sight loss.By exposing the mismatch between registration rules and the reality of living with sight loss this database has already begun to make a difference.”
Editor’s Notes:
1.All Wales Visual Impairment Database (AWVID), a Thomas Pocklington Trust Occasional Paper No.24.The analysis of the data was carried out by Barbara Ryan and Tom Margrain from the School of Optometry and Vision Sciences, Cardiff University, and by independent epidemiologists Angela Reidy and Darwin Minnassian. They extracted data collected over three years (April 2004 - April 2007) from 5817 adults making their first visit to low vision services.The study is available from www.pocklington-trust.org.uk
2.In Wales, statutory funded services for people with sight loss are provided in two settings – NHS funded low vision services and local authority funded rehabilitation services.About half of those using NHS funded services use the Welsh Low Vision Service (WLVS).This is an “open access” service, located in community-based optometric practices, where direct referrals are accepted following a recent eye examination.
3.To register as visually impaired a person’s visual acuity must be worse than 6/60.In the survey about 85% had visual acuity worse than 6/12, about 30% had visual acuity of 6/60 or worse and 10% had a visual acuity of worse than 3/60.
4.The authors suggest the World Health Organisation criteria for ‘moderate visual impairment’, visual acuity 6/18 or worse, as a more appropriate criteria for registration.
