A glaucoma equity profile: correlating disease distribution with service provision and uptake in a population in Northern England, UK

Abstract

Increasing access to services involves collaboration with optometrists, ophthalmologists, public health, and commissioners. It is no longer acceptable to rely on private high street optometry to provide primary eye care services in areas of high need. Outreach services must be developed and evaluated in areas of relative deprivation if world class eye services are to be achieved.

Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review

“…36,37,59,72,73 Older persons with visual impairment living in deprived areas are significantly less likely to take up eye examinations, suggesting an association between inequalities of older age and low SES. 37 Moreover, a study of solely female participants reported that women >65 years old and of manual social class were less likely to take up eye examinations in the UK.…”

“…72 As noted previously with age-related inequalities, some ocular conditions are more prevalent in lower socioeconomic groups; namely, glaucoma and AMD. 60,73 Those from lower SES groups have been reported to present with glaucoma at significantly later stages than those of higher SES, 59,60 although Fraser et al 60 added that family history and time since last optometry visit also played a key role in this statistic. As mentioned previously, this places more deprived individuals at a significant disadvantage and at high risk of irreversible visual loss.…”

“…Poor diet and increased rates of smoking and stress associated with lower SES are reportedly the cause of this progression of glaucoma. 60 Day et al 59 concluded that it is not acceptable to rely on high-street opticians to detect glaucoma in these areas of high deprivation and recommended the development of outreach services to tackle this concerning issue.…”

“…A review investigating inequalities accessing eye services in the UK found an association poor SES and poor attendance of eye health services [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] ; late stage of eye disease at presentation to eye services [57][58][59][60][61][62][63][64] ; uncorrected refractive error 65,66 ; increased waiting times for treatment 67,68 ; and poor treatment compliance.- 64,69 Articles meeting the inclusion criteria have been extracted and evaluated in Tables 2 and 5. There was an equal split between articles reporting no association and those reporting a significant association between poor SES and access to eye services.…”

The NHS Act of 1951; Is it time to re-act?

“…However, the commercially driven optometry model has resulted in a disparity of service provision where the socially deprived, who are known to present with more advanced disease or not at all, have the poorest access to optometry services. 5,6 Our disintegrated eye health service needs to identify ocular pathology at an earlier stage, for which targeted surveillance of the high risk may be advantageous over opportunistic screening. [7][8][9] This has already been successfully implemented in the NHS Diabetic Eye Screening Programme, 10 where the electronic transfer of patient information and imaging between community screening clinics and the Hospital Eye Service is now standard practice.…”