1. Gwyneth Thomas, Health Statistics and Analysis, Welsh Government Chair of Together for Health: Eye Health Care Delivery Plan Statistics Group Statistical summary ofophthalmic services in Wales

2. 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

3. 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….

4. 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

5. 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?

6. 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?

7. What we do know…

8. 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.

9. Number of sight tests paid for by the NHS, by year General Ophthalmic Service sight tests

10. GOS sight tests per 1,000 population 15 and under60 and over

11. 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

12. Eye health examinations Wales 15 and under Tests per 10,000 populationAccredited premises

13. 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.

14. 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 patients145,300 scheduled appointments115,300 results reported

15. 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.

16. 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

17. Number of admissions for hospital eye care in Wales Increases in AMD treatment, falls in cataracts

18. 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).

19. 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

20. 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)

21. 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)

22. 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

23. 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

24. 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

25. Measuring outcomes - examples  More people have regular sight tests  More people aware of the importance of survey data of eye health  More optometry practices providing the full range of extended eye care services in the community More people are aware of the most appropriate point to access eye care services if they have an eye problem that needs urgent attention  Reduced inequalities in access to optometry services  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 More people in residential care having regular sight tests More children in special schools having sight tests in school  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

26. Questions?