15 May 2017
Groundbreaking research huge step forward for improving services for visual impairment
The first ever comprehensive national review of low vision services in Scotland has just been published.
The groundbreaking report, which was commissioned by the Scottish Government, has recommended that more eyecare services should be made available in the community.
Gillian Mitchell of Highland charity Sight Action, who is based in Inverness, co-wrote the important report, A review of low vision service provision in Scotland, with Dr Helen Court of NHS Education.
The in-depth review comes a decade after the introduction of free eye examinations and recommends schemes to reduce geographical differences in services. It identifies a number of challenges to consider for future planning of services, including access, service capacity and effective integration and signposting between service providers.
Low vision services aim to enable people with loss of vision to regain or maintain as much independence and autonomy as possible, and can include rehabilitation, visual aids, emotional support and advice. Low vision is common in older people and impacts on every part of a person’s life. It is associated with falls, reduced capacity to carry out everyday activities, the need for residential care and is one of the strongest risk factors for functional status decline in community living adults. Evidence suggests that low vision services significantly reduce visual disability and are associated with positive patient outcomes. Furthermore, for the relatively small costs of low vision aids, there can be huge cost saving in terms of health and social care support.
The report which has been broadly welcomed, highlighted a clear geographic inequality of access to services in terms of both waiting times and provision of aids for those with low vision.
A complete geographical mapping of the entire country was carried out, which identified a cluster of services around the more densely populated central belt areas of Scotland and considerably more scarcity around the rural areas, including the Highlands, with a large number of elderly with low vision.
In the Highlands and Islands 26 per cent of the population is of pensionable age – one of the highest proportions in the country which suggests that as low vision is more prevalent among the elderly that the North has a higher proportion of people with low vision needs compared to other areas such as Edinburgh which has just 17 per cent.
All optometric services for an initial low vision assessment, had a waiting time of less than two weeks but of the seven with waiting times of two to six months, five were hospitals with eye departments and two were local authority social services. One provider reported a waiting time of six months to a year.
Visual aids can enable those with loss of vision to maintain a degree of independence and autonomy. The report found that two thirds of providers supply the aids free of charge. Hospitals, local authority social services and community based optometry low vision schemes adhere to this along with half of societies/charities and the majority of specialist teachers but both the private optometry practices and university eye departments do not. Of those who do provide free aids 20 per cent have a policy on the number, which can be provided to a patient.
The report also calls for more hospital services to be brought into the community, helping to reduce hospital waiting lists and to standardise services making it a level playing field for everyone with low vision across the country.
In conclusion it recommends that more community based low vision schemes are developed and that a national community based low vision scheme, such as the model in Wales, is an effective method of service delivery, which delivers positive patient outcomes with a high quality of service.
Health Secretary Shona Robison, who commissioned the report, said: “Optometrists and ophthalmologists do tremendous work in delivering high quality eye care for the people of Scotland. However, as with all parts of the NHS, we must continue to improve - particularly to ensure no groups miss out on the services available.
“These recommendations will help support our wider primary care transformation work. I fully support them and look forward to seeing them implemented.”
Chair of Sight Action Maureen MacMillan, formerly an MSP for the Highlands and Islands welcomed the report.
She added: “This is a fantastic piece of work and it is a huge step forward for the provision of low vision services not just here in the Highlands but across the country.
“It is also a real credit to the hard work that is done by Sight Action that our small charity here in the Highlands was able to play such a large role in this groundbreaking report.
“I hope that the recommendations within the report will now be adopted and will help to improve the lives of people with low vision.”
Sight Action was established in 2010 to serve blind and visually impaired people in the Highlands and Western Isles by providing a number of services that will support and enhance their quality of life.
Sight Action currently has 2,500 people on its database and welcomes around 500 new clients each year. It is supported by NHS Highland, The Highland Council and Comhairle nan Eilean Siar, provides additional services that help clients to be as independent as possible.
There were 34,492 people registered as blind or partially sighted in Scotland in 2010 according to the Scottish Government and the numbers of people diagnosed with significant sight loss is set to double to nearly 40,000 people by 2031.