Eye health (health and wellbeing needs in South Tyneside)

• Monitoring changes in hospital activity to predict future demand
• Ensuring access to services
• Systematic approach to prevention

Prevention is an absolutely key priority

• Risk factors for eye disease to be included in all relevant health promotion work
• A concerted effort should be made to establish the reasons for low uptake of eye test, and then to promote greater uptake in the under 16 and over 60 age groups.
• The CCG should provide specific training for GPs on eye disease prevention
• All stakeholders should stress the benefits of seeking assistance as soon as visual problems occur.

Rehabilitation and Re-ablement

• A low vision service would improve access to the kind of aids which allow people to regain a degree of independence.
• If someone loses sight through trauma resulting in a long hospital stay, they should be provided with re-ablement support while still in hospital.
• Adjusting to life with a visual impairment often involves a period of bereavement and people who are sight-impaired are at an increased risk of common mental health conditions such as anxiety or depression.
• Commissioners should ensure that there is an opportunity for patients to be referral into counselling where appropriate, at different stages in the care pathway.
• Services should meet needs of family and carers too and link people into third sector organisations that can provide ongoing support.

Eye care pathway

• It is recommended that a stakeholder workshop be convened, with service users, GPs, Optometrists, and Secondary Care clinicians to review and optimise current referral pathways, and to consider whether communication between clinicians in all areas of care can be improved.

Those at risk

Impact of risk factors and lifestyle on eye health

The Eye Health Needs Assessment includes details of how modifiable and non-modifiable factors may impact on the risk of eye conditions in individuals. These include age, socio-economic status, ethnicity, smoking, alcohol, and various conditions including learning disability, dementia, obesity, diabetes, stroke, and hypertension. Visual loss also increases the risk of falls, and depression (6).

Association of Eye Health with Other Co Morbidities

• 60% of stroke survivors have some residual visual dysfunction following a stroke.
• Uncontrolled high blood pressure can cause retinal damage
• Around 2.5% of people over the age of 75 will have dementia and significant sight loss
• Older people with sight loss are almost three times more likely to experience depression than people with good vision.
• Adults with learning disabilities are ten times more likely to be visually impaired than the general population. treatment, and to have developed visual impairment
• People with hearing loss are at increased risk of having undiagnosed eye conditions which lead to visual impairment
• People with visual loss are 1.7 times more likely to have a fall and 1.9 times more likely to have multiple falls. Of the total cost of treating all accidental falls in the UK, around 21% is spent on the population with visual impairment

Local Risk Factor Prevalence

Population

The population included in this HNA is the resident population of South Tyneside. ONS data population estimates and projections have been used to consider current and future trends in risk factor prevalence, epidemiology and demand for eye care services. South Tyneside, in 2014, had an estimated total population of 148,700, of which 28,800 were 65 years and over and 3,900 were 85 years and over. The total population of South Tyneside is forecast to grow at a much slower rate than the England population as a whole (a 4% projected increase between 2015 and 2030 compared to a 10% rise across England), but the population of older people will continue to grow at a much faster rate. The risk of experiencing eye health conditions increases with age and so it is the change in the size of the older population that will determine demand on eye health care services. Between 2015 and 2020 there it is forecast that there will be an 8% increase in the population 65 years and over in South Tyneside, and a 15% increase among those 85 years and over. Between 2015 and 2030 the equivalent growth will be 34% and 43% respectively.

Deprivation

There is a substantial amount of evidence which shows that people living in the most deprived areas have worse health and health indicators than those in the most affluent areas. People in deprived areas are likely to have a higher exposure to negative influences on health, and to lack resources to avoid their effects.

The 2015 Indices of Multiple Deprivation (IMD) list South Tyneside as the 23^rd most deprived local authority in England out of 326 local authorities. The borough has 102 small area geographies, 22 of which are ranked within the 10% most deprived in England. Moreover, 40% of the South Tyneside population lives within the most deprived fifth of all areas across England. The rankings are a compilation of indicators from 7 domains shown in the figure below.

Smoking

The proportion of adults that smoke in South Tyneside fell between 2012 and 2015 from 21.8% to 17.4%, whilst in routine and manual group smoking prevalence has fallen from 28.4% to 27.1% over the same period.

Diabetes, Physical Activity and Obesity in Adults

• In South Tyneside, 26% of adults were classed as obese and a further 42% were classed as overweight; this is higher than the England prevalence of 23% obese and 41% overweight (source: Active People Survey, 2012).
• Obesity is associated with a range of health problems including Type 2 Diabetes, which in turn increases risk of a range of eye conditions
• Recorded prevalence of diabetes in South Tyneside is 6.9% (around 8,780 persons aged 17 and over) compared to a prevalence of 6.2% in England