Title page
Contents
About Public Health England 2
1.0. Foreword 4
2.0. Executive summary 5
3.0. Introduction, scope, constraints, key policy and drivers and the National Eye Health context 6
3.1. Introduction 6
3.2. Scope 7
3.3. Constraints 8
3.4. Key policy and drivers 8
3.5. The National Eye Health Context 10
References 11
4.0. Population, demography, risk factors and overview of commissioned eye health services 13
4.1. Description of the population, demography and risk factors for eye health conditions 13
Derbyshire and Nottinghamshire 14
Leicestershire and Lincolnshire 14
Hertfordshire and the South Midlands 14
Relationship between risk factors for poor eye health or sight loss and the chosen HNA priority areas 19
Summary 27
4.2. Overview of commissioned services 28
4.3. Reflection on summary of need in relation to description of commissioned services 35
References 35
5.0. Children and young people 37
5.1. Needs review 37
Risk factors in children and young people 38
Sight loss in children and young people 39
5.2. Commissioned services 46
References 46
Appendix 1: Key Definitions 47
6.0. Age-related macular degeneration, cataracts and glaucoma in older people 48
6.1. Needs review 48
6.2. Commissioned services 57
References 59
7.0. Diabetic retinopathy and Retinal Vascular Disease 61
7.1. Needs review 61
7.2. Commissioned services 65
References 66
8.0. Blindness 67
8.1. Needs review 67
8.2. Commissioned services 75
References 75
9.0. Conclusion and recommendations 77
5.0. Children and young people 41
Table 1. Numbers of children and young people aged 0 to 17 on local authority registers for blindness and partial sightedness, 2013/14 41
Table 2. Estimated number of children aged 0 to 16 who are blind or partially sighted, 2015 43
Table 3. Pupils attending state primary, secondary and special schools who have a special educational need, and pupils who have a primary need of visual impairment 44
6.0. Age-related macular degeneration, cataracts and glaucoma in older people 52
Table 1. Numbers of people estimated to have late stage wet AMD and rates per 100,000 by upper tier local authority, all ages, 2016 and 2030 52
Table 2. Numbers of people estimated to have cataracts requiring surgical intervention and rates per 100,000 by upper tier local authority, all ages, 2016 and 2030 54
Table 3. Numbers of people estimated to have glaucoma and rates per 100,000 by upper tier local authority, ages 30 and over, 2016 and 2030 57
7.0. Diabetic retinopathy and Retinal Vascular Disease 63
Table 1. Estimated number of people living with diabetic retinopathy by upper tier local authority, 2016 and 2030 63
Table 2. Uptake of diabetic eye screening appointments by screening programme, 2015/16 65
8.0. Blindness 71
Table 1. Numbers and rates per 100,000 of people newly registered as blind during 2013/14 by upper tier local authority 71
Table 2. Numbers of people estimated to be blind and rates per 100,000 by upper tier local authority, all ages, 2016 and 2030 74
Figure 1. Geography 13
Figure 2. Population pyramids by local eye health network; 2015 mid-year population estimates and 2039 population projections. Figures are aggregated from upper tier and unitary local authority figures 16
Figure 3. Black and minority ethnic population by middle layer super output area (MSOA) 17
Figure 4. Index of Multiple Deprivation score by MSOA, 2015; the higher the score, the more deprived the area 18
Figure 5. Risk factor prevalence 21
Figure 6. Estimated numbers of people on QOF disease registers by local authority 25
Figure 1. Geography 37
Figure 2. Proportion of term babies born with low birth weight, 2015. With 95% confidence intervals 38
Figure 3. Proportion of women who smoke at time of delivery, 2015/16. Includes 95% confidence intervals. Figures for Rutland and Lincolnshire have been suppressed due to data quality issues 39
Figure 4. Crude rates per 100,000 children and young people aged 0 to 17 on local authority registers for blindness (i) and partial sightedness (ii), 2013/14 41
Figure 5. Rate of NHS sight tests in 0 to 15 year olds, 2015/16 45
Figure 1. Geography 48
Figure 2. Estimated rate of AMD per 100,000 population by upper tier local authority, all ages, 2016. Calculated from ONS mid-2014 based population projections for 2016 (5) and prevalence models from NEHEM (3) 50
Figure 3. Estimated rate of late stage wet AMD per 100,000 population by upper tier local authority, all ages, 2016. Calculated from ONS mid-2014 based population projections for 2016 (23) and prevalence models... 51
Figure 4. Rate of new certifications for sight loss due to AMD by upper tier local authority, ages 65 and over, 2015/16. Includes 95% confidence intervals 51
Figure 5. Estimated rate of cataracts requiring surgical interventions per 100,000 population, by upper tier local authority, all ages, 2016. Calculated from ONS mid-2014 based population projections for 2016 (23) and... 53
Figure 6. Estimated rate of glaucoma per 100,000 population, by upper tier local authority, ages 30 and over, 2016. Calculated from ONS mid-2014 based population projections for 2016 (23) and... 55
Figure 7. Rate of new certifications for sight loss due to glaucoma by upper tier local authority, ages 40 and over, 2015/16. Figures for Rutland and Milton Keynes have been supressed due to small counts.... 56
Figure 1. Geography 61
Figure 2/Figure 1. Rate of new certifications for sight loss due to diabetic retinopathy by upper tier local authority, ages 12 and over, 2015/16. Includes 95% confidence intervals Figures for Luton have been supressed... 64
Figure 1. Geography 67
Figure 2/Figure 1. Rate of new certifications for sight loss by upper tier local authority, all ages, 2015/16. With 95% confidence intervals 69
Figure 3/Figure 2. Rate of people registered as blind per 100,000 population as of 31 March 2014 by upper tier local authority 70
Figure 4/Figure 3. Proportion of those registered blind by age group as of 31 March 2014 by age group and upper tier local authority 72
Figure 5/Figure 4. Estimated rate of blindness per 100,000 population by upper tier local authority, all ages, 2016. Calculated from ONS mid-2014 based population projections for 2016 (23) and prevalence models from the RNIB 73