This excellent guidance will help ophthalmologists answer questions they may have when presented with patients with low vision needs, such as “Which patients should be referred to low vision services?”, or “Is there a level of visual acuity below which a patient should be referred?” As in referral for cataract surgery, it depends on the functional vision of the patient, and their visual requirements for daily living.
It is never easy to tell someone that treatment cannot be offered for their sight loss, or to offer them registration. However, there are many simple strategies that can be incorporated into the way the ophthalmologist practices – even during the busiest clinic– that will ensure the people encountered in clinic experience a smoother journey into accepting their low vision and living with it.
Authors Anne Sinclair and Barbara Ryan commented, ‘We were delighted that The Royal College of Ophthalmologists recognised the need for training in this area by including it as part of the syllabus for ophthalmologists in training. This publication is designed to support that curriculum.’
In the UK, low vision has not been defined in legislation. The definition for low vision adopted by the UK Low Vision Services Consensus Group, which had representation from all relevant professions and organisations, is: ‘A person with low vision is one who has an impairment of visual function for whom full remediation is not possible by conventional spectacles, contact lenses or medical intervention and which causes restriction in that person’s everyday life’. This definition includes, but is not limited to, those who are registered as severely sight impaired (SSI) and sight impaired (SI).
The number of people with low vision Registration data are very useful in considering the extent of low vision in the UK. There are about 350,000 people registered as having a sight problem in Scotland, Wales, Northern Ireland and England. The Royal National Institute of Blind People (RNIB) estimates that more than two million people are living with sight loss in the UK today. People who are aged 65 years or older accounted for 90% of new cases of permanent sight loss in the UK in 2016-17. The number of people in this age group is predicted to increase by almost 50% over the next 20 years.
Although the prevalence of sight impairment in children is low, there has been a greater than twofold increase in the incidence of blind/severely sight impaired and partial sight/sight impaired in children in England between 1982 and 2019. There are ethnic variations in the preponderance of causes of sight loss. South Asians have a higher risk of cataracts and of diabetic eye disease than other population groups and the risk of glaucoma is much higher for the black population compared to the white population. The incidence of sight loss is greater in areas of social deprivation. This may partly be due to late presentation related to the costs of travel and treatment.
Of the 609,000 people in the UK with moderate visual impairment in the MRC trial, 74 per cent were women. Globally, women bear excess blindness compared to men. In these surveys, overall, women account for 64.5% of all blind people. The excess of blindness in women was marked among the elderly and not due only to differential life expectancy. Globally, 216.6 million people are affected by moderate to severe visual impairment, of which about 36 million are blind.
The authors of the Low Vision essential guide for ophthalmologists are: Dr Anne Sinclair, Professor Barbara Ryan, Professor Jonathan Jackson & Dr Maggie Woodhouse
Read the full guidance, Low Vision: the essential guide for ophthalmologists
Read the CCEHC statement and the results of a recent survey highlighting the need for low vision services review.
Visit the Standards & Publications section for other ophthalmic service guidance.