Type of publication:
Conference abstract
Author(s):
*Sanjana E.; *Ball E.
Citation:
Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 305-306), 2025. Date of Publication: 01 Jun 2025.
Abstract:
Introduction: Certification of visual impairment (CVI) provides an indication of the incidence of sight loss. In England, between 2022/2023, there were 20,330 new CVI registrations, a three percent decrease compared to 2019/20. CVI involves individuals being registered as sight impaired (SI) or severely sight impaired (SSI) and is determined by the patient's visual acuity and visual field defect severity. This study aimed to provide an indicator of the number of patients seen in the primary care setting who were referred to the Hospital Eye Service (HES) between 01 July 2023 and 31 July 2024, without receiving CVI. Method(s): A retrospective study that analysed 680 new patients, assessed between July 2023 and July 2024, was retrieved via the Trust's electronic clinical noting software, Medisightc, to identify the number of patients who were referred to ECLO for CVI registration at their first appointment with the Doctor. All patients referred via community ophthalmic services or community optometrists with advanced glaucomatous visual field loss were included within this study and their demographics, including age and sex, family history, referral pathway, visual acuity, intraocular pressure (IOP) measurements, cup-disc ratios (CDR), mean deviation values for visual field defects with corresponding severity grading, glaucoma diagnosis and CVI severity (SI or SSI) were analysed. Each patient's visual field defect severity grading was determined by utilising the Hodapp-Parrish- Anderson (HPA) Visual Field Criteria of Glaucoma Severity. Three patients were excluded from this study due to their preexisting comorbidities rendering them unsuitable for inclusion, such as AMD and retinal vascular diseases. One patient suffered from advanced dementia, so visual field testing was not possible. However, this patient's presenting IOP and disc appearance was sufficient to stage the severity of their glaucoma. Result(s): Among the 680 new patients assessed within HES, between 01 July 2023 and 31 July 2024, 3% (n =20) were referred to ECLO services for CVI. The average patient age was 77 years old and 55% (n =11) of the 20 patients who received CVI were male. Furthermore, among the 20 patients analysed within this study, 35% (n =7) were referred without receiving CVI by Community Health Eye Care (CHEC), 55% (n =10) were referred by their community optometrist and 10% (n =3) were referred internally by an ophthalmologist. All patients included within this study presented with a CDR of 0.8 or worse in at least one eye. Consequently, only 15% of patients were recorded as having moderate VF damage in their right eye, compared to 70% of patients having severe VF damage in their right eye. Comparatively, only 5% of patients suffered moderate VF damage in their left eye, opposed to 85% suffering from severe VF damage. 6 patients were certified as SI and all remaining were severely sight impaired. Eighty five percent of patients were diagnosed to have POAG (n =17). Ten percent were diagnosed to have NTG (n =2) and one patient was diagnosed with aqueous misdirection. Conclusion(s): CVI is a means of identifying patients in need of support and social care and it is an important health indicator to the local and national level in the United Kingdom. Health policies prioritise prevention and CVI data provides information on preventable causes of blindness. The incidence of SI or SSI is an indicator of the effectiveness of policies and the need for reforms. Visual impairment from glaucoma is asymptomatic, unlike other causes, such as Age-Related Macular Degeneration and Diabetic Retinopathy. Improved patient education, robust screening programmes within the community setting and strengthening the workforce and health infrastructure at different tiers of healthcare is the need of the hour. The role of timely referral to the HES, awareness amongst health professionals on the benefits of CVI registration and a continuous dialogue between the community and HES cannot be over-emphasised.
DOI: 10.1038/s41433-025-03831-0
