Rapid Assessment of Avoidable Blindness in England Hannah Kuper Robert Lindfield

Overview Review of previous studies Description of RAAB Information from RAAB Adapting RAAB to the UK

Review of previous studies Most recent prevalence surveys in the UK: – North London Eye Study – MRC Study of Older People – 2003 (GP-based) – EPIC Study, Norfolk – not population based (current) Issues – No up-to-date information – Changes in public health indicators have place greater emphasis on eye health – Limited information available to assess need – Tools like NEHEM/Future Sight Loss UK out of date

What is a RAAB survey? Developed in low income countries using methodology adapted from immunisation surveys Rapid – usually less than 6 weeks: – Limited age group (>50 years) – Limited examination (screening) Focus on visual loss Provides robust information about: – Prevalence of visual loss – Causes of visual loss Acts as a core to allow ‘bolt-on’ additional surveys (e.g. DR)

Technique Two stage sampling: – One: select a cluster (could be ward, GP practice, other) – Two: select individuals from the cluster In low income settings this is done by walking from house to house Probably not possible in England Ophthalmic teams examine each individual using: Simple screening vision chart (illiterate e-chart) Basic ocular examination including pinhole and dilated examination for those who need it. Data entry into standardised software package – Automated reports with prevalence estimates

Range of RAAB surveys Low income: Zambia, Malawi, Kenya, Tanzania, Uganda, Ethiopia, Eritrea, Gambia, Burkina Faso, Bangladesh, Middle income: Brazil, Mexico, Philippines, India, South Africa Upper middle income: Argentina, Russia, Many have been published in peer-reviewed journals No-one has attempted a RAAB in a high income country

What we want to do..... A rapid screening of eye health in a location that is representative of the wider population of England – Focus on over 60s – Limited ocular examination To identify the leading causes of visual loss in England To assess the socio-economic determinants of visual loss in England To assess the prevalence and causes of visual loss in specific populations (e.g. Nursing Home residents) To review access to eye health services amongst users

Method Adapt RAAB methodology – Use technology (e.g. PEEK) – Focus on over 60’s – Work with GPs to invite individuals to examination clinics – Collect additional information on a variety of different aspects of care NB – remains simple and straightforward (no complex examinations)

Locations Potential - Suffolk – Mix of urban/rural – High proportion of older people – Mix of prosperity – Buy in from local public health department – HOWEVER: Predominantly white population

Next steps Meeting of interested parties – aim for June 2014 Development of consortium Bids to funders