Gwyneth Thomas, Health Statistics and Analysis, Welsh GovernmentChair of Together for Health: Eye Health Care Delivery Plan Statistics Group

Statistical summary of

ophthalmic services in Wales

Welsh Eye Care Services

How many?What?Where?More or less?

The patient’s eye care journey~ Primary eye care services

~ Hospital Eye Service~ Rehabilitation

Outline

Optometrist: sight test

Optometrist: EHEW

Diabetic Retinopathy Screening Service

Wales

Hospital Eye Service

Social Services: registers / help

Low Vision Service Wales

GP

Voluntary sector

A patient’s journey….

144 Ophthalmology hospital doctors

759,000 GOS sight tests

115,300 DRSSW results reported

16,800 admissions for cataracts

72,000 Low Vision Service Wales assessments

6,200 admissions for AMD

48,800 GP referrals to ophthalmology

26,600 NHS domiciliary sight tests

781 primary care practitioners

1,400 new Certificates of Vision Impairment

96,000 Eye Health Examinations Wales900 admissions for glaucoma

10,900 patients waited > 36 weeks

302,600 NHS optical vouchers

In numbers…

Eye care statistics

Currently nearly 100,000 people in Wales are living with sight loss. By 2020, this is predicted to increase by 22 per cent and double by 2050.

• 5% of adults aged 16 or over reported “eyesight difficulty”, 8% of people aged 65 or over (Welsh Health Survey 2012).

• The number of people aged 65 and over is projected to increase by 292,000 or 50 per cent between 2012 and 2037.

•Almost 16,600 people were registered with Social Services for a visual impairment (half as severely sight impaired and half as sight impaired; 31 March 2013)

• 1,362 people were newly certified as sight impaired in 2012-13; over 55% of these were aged 80 years or over.

How many people have sight problems?

Welsh Health Survey:

• Around half of adults (48%) aged 16 or over report using an optician in the previous 12 months (2012)

National Survey 2014-15 questions (to be published May 2015):

• Roughly how often do you have your eyes tested?

• Why haven’t you had your eyes tested more frequently?[answers include “Haven't had eye problems”, “Too busy”, “Hard to get an appointment” etc]

• If you had pain or redness in your eye, who do you think you would you contact for help in the first instance? [answers include “GP”, “Pharmacist”, “Optician” etc]

How many people have sight problems?

What we do know…

Primary care eye services

During 2013-14

• 758,572 General Ophthalmic Service sight tests were paid for by the NHS.

• 96,487 examinations were carried out under Eye Health Examinations Wales during the same year.

• Of the 115,344 patients screened by the DRSSW, 30% had diabetic retinopathy.

Number of sight tests paid for by the NHS, by year

General Ophthalmic Service sight tests

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14

Source: NHS Shared Services Partnership

GOS sight tests per 1,000 population

15 and under 60 and over

During 2013-14:

• 247 per 1000 population GOS sight tests were paid for by the NHS.

• Within Wales: Cwm Taf HB had the highest rate at 278 per 1000.

• People aged 15 or under: 274 sight tests per 1000.

• The highest rate was in Cwm Taf HB (371 per 1000).

• People aged 60 or over: 486 sight tests per 1000.

• The highest rate was in Cardiff & Vale HB (578 per 1000).

General Ophthalmic Service sight tests

Eye health examinations Wales

15 and under15 and underTests per 10,000 population Accredited premises

Eye Health Examinations Wales

During 2013-14:

• 314 examinations per 10,000 population were carried out under EHEW.

• Within Wales, Cardiff & Vale HB had the highest rate at 453 per 10,000.

• At the end of the year 295 premises were accredited to carry out EHEW examinations, 83% of all premises offering NHS eye care.

• All of the premises in Cardiff & Vale HB were accredited but only two thirds in Powys.

2013-14 data

63,500 males

31.3% any retinopathy

3.8% sight threatening or

severe

47,800 females

28.5% any retinopathy

3.1% sight threatening or

severe

6,600 Type 1

60.3% any retinopathy

14.4% sight threatening or

severe

108,300 Type 2

27.9% any retinopathy

2.7% sight threatening or

severe

156,400 eligible patients

145,300 scheduled appointments

115,300 results reported

Hospital eye services• Health Boards received 48,800 GP referrals for ophthalmology in 2013-14.

• In the year 2013-14 75 per cent of ophthalmology patients were treated within 26 weeks of referral but 11,000 patients waited longer than 36 weeks.

• There were 330,600 attendances to ophthalmology outpatient appointments in Welsh hospitals in 2012-13.

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

2009-10 2010-11 2011-12 2012-13 2013-14

GP referrals Total referrals (unpublished) Source: StatsWales

Number of GP referrals for first outpatient appointment for ophthalmology, Wales

Note: April 2012 data onwards, the data source is Outpatient Referrals Data Set (OPR DS)

Need to understand referrals for eye care better

Number of admissions for hospital eye care in Wales

Increases in AMD treatment, falls in cataracts

0

5,000

10,000

15,000

20,000

25,000

2008-09 2009-10 2010-11 2011-12 2012-13

Age-related macular degeneration Cataract Glaucoma Diabetic retinopathy

Source: Patient Episode Database for Wales (PEDW)

Rehabilitation services

Low Vision Service Wales

• A total of 7,237 assessments were carried out by the service during 2013-14, a rise from 6,851 in 2012-13.

• Around two thirds (66%) of these were for patients aged 80 or over.

• In around half of assessments, patients were recorded as having dry age related macular degeneration (AMD), just under one third cataracts and around a fifth each of hearing problems and wet AMD (more than two thirds wet/dry AMD).

0%

10%

20%

30%

40%

50%

60%

70%

0 - 18 years 19 - 59 years 60 - 79 years 80+ years

2012-13 2013-14

Source: Low Vision Service Wales

Low Vision Service Wales assessments by age group of patient (percentage) for 2012-13 and 2013-14

Two thirds of assessments are for patients aged 80 or over

Wales average:

84 LVSW assessments per 10,000 population aged 60 or over.

Cardiff & Vale:

117 LVSW assessments per 10,000 population aged 60 or over.

200 premises were accredited to carry out LVSW assessments, 56% of all premises offering NHS eye care.

Low vision service Wales: assessments per 10,000 population (60 or over)

• Almost 16,600 people were registered with Social Services for a visual impairment (half as severely sight impaired and half as sight impaired; 31 March 2013)

• 9% also were registered as having a hearing impairment.

• 1,400 new CVIs for 2012-13 were received by Moorfields Hospital.

• More than 55% were for people aged 80 or over.

Registers of sight impairment / certificates of vision Impairment (CVIs)

In 2012-13:

61% of new registers aged 65 or over were diagnosed with age related macular degeneration as the cause of sight loss.

15% aged 40 or over were diagnosed with glaucoma as the cause.

7% aged 12 or over were diagnosed with diabetic eye disease as the cause.

New CVIs: percentage within each age group by cause, 2011-12 and 2012-13

0%

10%

20%

30%

40%

50%

60%

70%

AMD (a) Glaucoma (b) Diabetic EyeDisease (c)

2011-12 2012-13

(a) in persons aged 65 or over (b) in persons aged 40 or over (c) in persons aged 12 or over Source: Moorfields Eye Hospital

At 31 December 2013 there were 781 ophthalmic practitioners recorded on HB performers’ lists.

At 30 September 2012 there were 144 (wte) ophthalmology doctors directly employed by the NHS in Wales.

Workforce

More about the population’s knowledge of service and access to services - National Survey 2014-15 questions should help

Understanding patterns of referral to hospital services better – improving Referrals database

More about outcomes for people with sight loss / sight problems

What we don’t know

Measuring outcomes - examplesü More people have regular sight tests   ü More people aware of the importance of survey data of eye healthü More optometry practices providing the full range of extended eye care services in the community

ü   More people are aware of the most appropriate point to access eye care services if they have an eye problem that needs urgent attention

ü Reduced inequalities in access to optometry servicesü More people at high risk of eye disease accessing eye care services in the community including people with diabetes, people with a family history of glaucoma and people from ethnic minority groups

ü    More people in residential care having regular sight testsü    More children in special schools having sight tests in schoolü More children having their vision screened on school entry…plus others.http://wales.gov.uk/topics/health/publications/health/strategies/eye_plan/?lang=en

Eye care statistics T&F group

Questions?