1. Low Vision Services Jenny Lindsay Co-Deputy Head of Optometry
Belfast Health and Social Care Trust

2. Definitions
A person with low vision is one who has an impairment of visual function for whom full remediation is not possible by conventional spectacles, contact lenses or medical intervention and which causes restriction in that person's everyday life.
A low vision service is a rehabilitative or habilitative process, which provides a range of services for people with low vision to enable them to make use of their eyesight to achieve maximum potential.
(Low Vision Services Consensus Group Document, 1999)

3. Epidemiology N. Ireland has an ageing population
Visual impairment increases with age
0-15yrs, 7/100,000 population reg B or PS
75-84yrs, 431/100,000 population reg B or PS
85+yrs, 946/100,000 population reg B or PS
(Evans et al, 1995 and 1996)
people with visual impairment in N. Ireland (NISRA)

4. Standards 1 (DOH, 2007)
Multi-disciplinary, multi-agency approach (health, social care and voluntary providers)
Flexible and able to meet the needs of those with additional disabilities e.g. learning disabilities
Accessible (referral and location)
Personnel suitably trained or undergo training programme leading to accreditation
Service improvement, monitoring and evaluation of the service – include user opinions

5. Standards 2 (DOH, 2007) Comprehensive range of services –
Functional visual assessment
Range of optical, non-optical and electronic aids available
Training and/or therapy
Links to other services (home assessment and mobility, education and employment services)
Access to support, advice and counselling

6. Service models “Traditional” hospital optometry low vision clinic
“One stop shop” e.g. Birmingham Focus, RNIB Judd Street, Gateshead
Community model e.g. Welsh Low Vision Scheme
Main advantage is ease of access
More challenging cases difficult to manage
Initial set-up and accreditation
To date no reliable research to compare outcomes or cost-effectiveness with different models

7. Northern Ireland
2 bases Royal Victoria Hospital and Altnagelvin Area Hospital
Outreach services at 12 other locations throughout N. Ireland
Weekly clinic at University of Ulster, Coleraine
Joint optometric and rehabilitation assessments
Wide range of visual function tests and low vision aids
67% of LVAs loaned at initial appointments are illuminated stand magnifiers and 63% ≤x5 magnification (Lindsay et al, 2004)

8. Benefits and Challenges
69% use LVAs regularly, 96% benefited from rehab support and 96% overall reported benefit from attending the LVC (Lindsay et al, 2004)
Number of LVC appointments risen from 2500 to 5000 in last 10 years
Waiting times 6 months in some locations
Future – do we extend current service or look at alternative ways of providing low vision services?