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Sight-related conditions on the rise
Written by Lloyd Mudiwa Friday, 17 October 2008 09:26
Sight problems in Ireland are set to increase by an unprecedented 180 per cent, as indicated by the Eyes of the Future Ireland report recently launched by Vision Impaired Service Providers Alliance (VISPA).
Using WHO definitions, the number of blind persons in Ireland aged 55 years plus is set to increase by 170 per cent from 3,800 to 10,300 cases over a 25-year period from 2006 to 2031.
The number of vision-impaired persons in the same age group is set to increase by 180 per cent (11,000 to 31,000 cases) over the same period.
However, it is particularly frustrating that 30,000 undetected sight-loss cases are treatable, according to VISPA, whose members comprise of Fighting Blindness, the National Council for the Blind in Ireland (NCBI) and St Joseph’s Centre for the Visually Impaired, Dublin, among others. VISPA’s study, launched at its inaugural national conference in Dublin on World Sight Day, October 9, found that a large proportion of the older population suffers from sight loss, which in many cases is almost entirely preventable with early detection and treatment, or is easily remedied by wearing prescribed spectacles.
In 2008, for instance, an estimated 30,000 people older than 45 years of age suffer from sight loss as a result of not having the appropriate spectacle correction. A review of current Irish blind registration (2007/08) data reveals information on only five of the six major causes of vision impairment referred to in the VISPA Report. The leading causes are: refractive error (RE), cataracts, glaucoma, age-related macular degeneration (AMD), diabetic eye diseases (DED), and retinitis pigmentosa (RP), which have no cure.
Moreover, Ireland’s population is still relatively young compared with that of other European countries. There are currently 9,500 people known to be legally blind in Ireland, this figure increases to 13,000 people if those known to NCBI as blind and vision impaired are included, the researchers highlight: “From the data currently available, these figures would appear to underestimate the true extent of blindness by 30 to 40 per cent.”
It is estimated the annual cost of providing comprehensive care for the main causes of vision loss and impairment is between €300 million and €550 million (based on US and Australian data, respectively). In addition, the annual cost of blindness or vision impairment to the Irish economy is estimated to be between €100 to €200 million per annum (based on UK data – mainly linked to social benefits and productivity losses).
A significant proportion of these costs relate to expenditure on healthcare service utilisation including all healthcare staff, equipment, drug costs, and procedures. Other costs arise from hospital admissions due to falls, fractured bones, accidents and depression associated with vision impairment. Due to underestimation of registration, the true cost to Ireland may be as much as €280 million per annum.
Service provision by disease type:
• Refractive error (RE)
There is no data currently available on the prevalence of RE in Ireland. However, based on extrapolation from the Australian data, it could be anticipated that 2.2 per cent of the population (30,000) aged 45 years and older would have impaired sight as a result of RE.
“Of note, however, is that in contrast to Australia, free access to optometric/optical services is not available to all. … the figure of those rendered vision impaired as a result of uncorrected refractive error is likely to be much higher than in Australia. All that is required is a conventional eye test and the provision of simple spectacles,” the VISPA researchers said.
• Cataracts
In Ireland an estimated 24.4 per cent of those over the age of 85 (11,530 people) are likely to have significant cataract issues and 1.2 per cent will be severely vision impaired as a result. In a published review of changing trends of ophthalmic surgery (Hospital In-Patient Enquiry [HIPE] data), cataract surgery accounted for 9,020 (82 per cent) of the 11,005 procedures performed in 2001, reflecting a 49 per cent increase in the number of cataract operations performed between 1994 and 2001 in public hospitals alone.
Given the private hospitals’ figures and projected rapid growth in the older population over the next 20 years, there will be increasing demand on hospitals for cataract surgery.
• Glaucoma
Glaucoma is essentially symptomless in the early to moderate stages of the disease, but early detection and treatment are essential if sight loss is to be prevented and at a cheaper cost.
The researchers remarked: “Treatment… works very well and usually involves eye drops alone.”
• Age-related macular degeneration (AMD)
The Irish blind register indicates 44 per cent of all new registrations occurred as a result of AMD. However, extrapolation from international studies, estimates those eligible for registration as a result of AMD in Ireland would be almost 7,000. Treatment may be available, if detected early.
• Diabetes retinopathy
Irish blind registration studies show DED has increased by a factor of two between 1996 (147) and 2003 (323). Assuming the prevalence of diabetes amongst Caucasian adults is two to three per cent and that two to three per cent of diabetics are vision impaired, almost 1,000 adults aged 45 and older suffer unnecessary and treatable vision impairment.
The HSE has developed a blueprint for establishing a national screening programme, yet to be rolled out nationally, the researchers noted, adding: “Rehabilitation intervention is extremely important… because the condition is progressive.”
• Retinitis pigmentosa (RP)
The researchers commented: “Important improvements in life quality for people with RP can be achieved through the provision of optical and electronic aids, and rehabilitation. The current estimates and projections of future burden have huge implications for ophthalmology service requirements and organisations providing rehabilitation and other support services in Ireland over the next 25 years,” the authors of the VISPA report observed.
Mr Brian Allen, Chairman of VISPA, said the aim of the Alliance is to raise awareness about the importance of eye healthcare and the need for people to ensure that they get regular eye tests.
“Our goal is to ensure eye health and care move up the list of priorities among the general population and that people have a responsibility for their eyesight and their eye health. It is only through widespread education and increased understanding that we can reduce avoidable sight loss,” VISPA stated.
Greater awareness of sight loss would also encourage the blind or vision impaired to access support services. To that end, the Alliance says it will be pressing for a full epidemiological ophthalmic study that builds on the Eyes of the Future Ireland report findings, recommendations and conclusions.
“We will be speaking to the Government in the coming weeks and months to ensure we get the appropriate funding and support to ensure we can meet this huge increase in demand for our services,” Mr Allen confirmed.