Sight Loss UK 2013 PDF

Sight loss UK 2013
The latest evidence

Contents
Foreword 3
Introduction 4
1. Living with sight loss and those at risk of sight loss 6
2. Cost of sight loss 12
3. Prevention of sight loss 15
4. Early reach 22
5. Independence 24
6. Inclusive society 31
7. European and world sight loss 37
Appendix A: References 38
Appendix B: Dashboard of indicators 44
2 Sight loss UK 2013

Foreword
The circumstances and experiences of blind
and partially sighted people and those at risk
of sight loss underpins everything we do at
RNIB. It is part of our foundation and fuels
our ambition to make every day better for
everyone affected by sight loss.
In 2013 the refreshed UK Vision Strategy will
be published, giving us the framework to work
together to enable as many people affected
by sight loss as possible to lead full and
active lives. In these tough times of cuts to
services the sector needs to develop a shared
understanding of the challenges and barriers
that blind and partially sighted people face.
I am pleased to present Sight loss UK 2013. RNIB’s annual evidence review describes
the realities of being blind or partially sighted in the UK today. It also sets out key
demographic and health trends. This evidence will support our work to raise the profile
of eye health and sight loss and can help us to target resources effectively to prevent
avoidable sight loss.
Sight loss UK 2013 provides colleagues working in the health, social care and voluntary
sectors with the latest data and research. We can use this evidence to speak with a
strong and unified voice to improve the experiences of blind and partially sighted
people across the UK and prevent more people from losing their sight unnecessarily.
Lesley-Anne Alexander CBE

RNIB Group Chief Executive
UK Vision Strategy Advisory Group Chair
The latest evidence 3

Introduction
This report brings together the latest evidence relating to sight loss in the UK.
“Sight loss UK 2013” is published by RNIB so that everyone working in the sight loss
sector, and professionals and policymakers throughout the UK have the most up to date
information available to inform their work and decision-making.
Indicators are arranged under different themes to help highlight what life is like for people
with experience of sight loss, their carers and for those who are at risk of sight loss.
Further detail about the indicators and the sources of evidence is given in the
introduction to each chapter. Where possible we include information about any trends
demonstrated by the indicators, but as some indicators are based on survey results
this is not always possible. Details of each indicator and full references are given in the
appendices to this report.
This document does not make policy recommendations, but the evidence will help
inform these discussions. We hope that presenting this information will highlight what
data we already have and encourage debate about how we can improve the range and
quality of evidence in the future.
Local data
The information presented in this report is at UK level. For some indicators data from
specific countries has been used if the information was not available elsewhere. Details
of the geographical coverage of each indicator can be found in Appendix B.
We also publish a sight loss data tool which provides data by region and local authority
area in England. For a copy of this resource please visit www.rnib.org.uk/datatool
Later this year RNIB will be publishing sight loss data tools for Wales, Scotland and
Northern Ireland in order to provide local data on sight loss for these countries.

Defining sight loss
Sight loss UK 2013 takes a data-led approach, and is limited to the definitions used by
source material. These definitions can be grouped into three broad categories: clinical,
administrative and self-reported.
Clinical
Sources based on clinical definitions in this report use visual acuity as their measurement.
For example definitions of blindness (severe sight loss) are often described in terms of
a best corrected visual acuity of less than 6/60 (Access Economics, 2009).
Administrative
Sources based on administrative data use information gathered by different services
that have identified people as blind or partially sighted. In some cases these are based
on clinical measures (certification), or on others measures (benefit claimants, recipients
of social care services, etc).
Self-reported
Sources that are based on self-reported definitions are surveys that rely on people with
sight loss to identify themselves. For example, RNIB’s secondary analysis of the Life
Opportunities Survey relies on self-reported sight loss.
Further information
RNIB’s Evidence and Service Impact team works to improve the impact of services.
By talking to customers we understand effective practice and disseminate this to
empower blind and partially sighted people and drive up the quality of services provided.
We work collaboratively with internal and external colleagues to ensure service standards
are documented, understood and implemented. We act as a central knowledge source on
service solutions for blind and partially sighted people, connecting the latest research
to policy, and bringing expertise across the RNIB group of charities together.
• Piflease contact RNIB’s Evidence and Service Impact team at research@rnib.org.uk

you have any questions about the information contained in this report.
• For the latest RNIB research reports and news please visit www.rnib.org.uk/research

1. Living with sight loss and those
at risk of sight loss
Indicator Result Trend
1. Sight loss – Number of people in the UK living 1.87 million Up
with sight loss that has a significant impact on their
daily lives
2. Blindness – Number of people in the UK living 224,000 Up

with severe sight loss
3. Registration – Number of people in the UK 358,000 Down

registered as blind or partially sighted
4. Children and young people – Number of 25,000 –

children aged 0–16 who are blind or partially sighted
5. Older people – Number of people in the UK aged 14.2 million Up

over 60
6. Later life – Number of people in the UK aged 1.4 million Up

over 85
7. Low income – Number of people in the UK 13.0 million Down

who are living in low income households after
housing costs
8. Diabetes – Number of people in the UK who are 3.0 million Up

diagnosed as having diabetes
9. Smoking – Proportion of adults in the UK 20 per cent Down

who smoke
10. Learning disabilities – Number of adults with a 96,500 –

learning disability who are blind or partially sighted

Sight loss affects a large number of people in the UK. In order to effectively plan or
commission any service, to assess need or develop strategy we need to know some basic
demographic information about people with sight loss and those at risk of sight loss.
Data sources
Information about how commonly the leading causes of sight loss occur has been
taken from the “Future Sight Loss UK 1” report (Access Economics, 2009). The report
provides a picture of the prevalence of sight loss based on a range of evidence. This
takes into account age, gender, ethnicity, level of sight loss and cause of sight loss.
Information about the number of people in the UK has been taken from Census 2011
(ONS, 2012a). Census statistics provide a detailed overview of the UK population and
are the basis for public service funding allocations.
Living with sight loss

Almost two million people in the UK are living with sight loss that has a significant
impact on their daily lives (Indicator 1). The leading causes of sight loss in the UK are
uncorrected refractive error, age-related macular degeneration, cataract, glaucoma and
diabetic retinopathy.
This figure includes people who are registered as blind or partially sighted and those
whose sight is just better than the levels which qualify for registration. It also includes
people who are awaiting or having treatment such as eye injections, laser treatment or
surgery which may improve their sight. And it includes people whose vision loss could
be improved by wearing correctly prescribed glasses. These people are all living with
significant sight loss. At least one-third has irreversible sight loss and some have vision
which is equivalent to people who are registered as partially sighted or blind.
The almost two million people in the UK living with sight loss all have different
severities of sight loss. There are 224,000 people living with severe sight loss or
blindness in the UK (Indicator 2). The leading cause of severe sight loss is age-related
macular degeneration.
Registered blind and partially sighted

Registers of blind and partially sighted people are maintained by local authorities to
help them plan and deliver services. There are around 360,000 registered blind and
partially sighted people in the UK (Indicator 3).

Children and young people
There are around 25,000 blind and partially sighted children between the ages of 0–16
(Indicator 4). Around half have additional disabilities and/or special educational needs.
This figure is higher than official statistics from the Department for Education.
Estimates on the number of blind and partially sighted children can vary considerably
due to different definitions and methods of collecting information. We believe that
official government statistics to be an underestimate because of problems associated
with identifying children as having sight loss, in particular those with additional
disabilities or less severe sight loss.

High risk of sight loss
RNIB recommends that everyone has a regular eye examination every two years even
if they are not aware of having any problems with vision in order to ensure that any
changes in eye health are picked up early. However, we know that some groups are at
higher risk of sight loss. Some people’s existing health conditions make sight loss more
likely, and some sight conditions are more common for people of a particular age group
or ethnicity. Some groups experience barriers to accessing health services which leads
to sight problems going undetected or treated. All these groups may be at higher risk.
Older age
The older you are, the greater your risk of sight loss (Access Economics, 2009).
According to figures from Census 2011, there are now over 14.2 million people aged
over 60 years in the UK (Indicator 5). One out of every nine people in the UK aged
60 and over is living with sight loss.
The fastest growing age group in the UK is 85 years and over (ONS, 2012b). The
number of people aged 85 and over has more than doubled over the last 25 years, and
by 2035 it is projected to more than double again. Census 2011 indicates that there are
1.4 million in the UK aged in this “oldest old” age group (Indicator 6). One out of
every three people in the UK aged 85 and over is living with sight loss.
Low income
Emerging evidence suggests that people on low incomes are at greater risk of sight loss
as a result of lower uptake of screening, referral and treatment (Johnson et al, 2011).
In 2010/11 there were 13 million people in the UK living in low income after housing
costs (Indicator 7). Low income is defined as someone living in a household with an
income below 60 per cent of the median net disposable income either before or after
housing costs.
Diabetes
People with diabetes are at risk of developing diabetic eye disease. The only national
screening programme related to eye health is focused on retinal screening for people
diagnosed with diabetes (NSC, 2012).
Over 3 million people in the UK are diagnosed as having diabetes (Indicator 8). This
is an underestimate of the true number of people living with diabetes as this figure
only includes people with diagnosed diabetes on GP patient lists and does not include
anyone with undiagnosed diabetes. It is estimated that there are around 850,000
people in the UK who have diabetes but have not been diagnosed (Diabetes UK, 2012).

Smoking
There is a strong link between smoking and several eye diseases, including age-related
macular degeneration, the UK’s leading cause of severe sight loss (Thornton, Edwards,
Mitchell et al, 2005). Research has confirmed the harmful effects of smoking on eyesight,
particularly in the development of age-related macular degeneration and cataracts
(Kelly et al, 2005; Khan et al, 2006).
Around 20 per cent of adults in the UK are smokers (Indicator 9).
Learning disabilities
In the UK an estimated one million adults and 410,000 children and young people aged
0–19 have a learning disability. People with a learning disability are much more likely
than the general population to have sight loss. There are an estimated 96,500 blind and
partially sighted people aged 20 and over who also have a learning disability in the UK
(Indicator 10).
Minority ethnic groups

People from black and minority ethnic communities may be at greater risk of some of the
leading causes of sight loss. Although some people from minority ethnic groups may have
a greater risk of eye disease, the evidence suggests that they do not receive the same
level of access to eye care services (Access Economics, 2009; Johnson et al, 2011).
Other health conditions
There is a link between sight loss and some other conditions or health problems.
As sight loss and dementia are both linked to age, there is a proportion of people that
have both conditions. These people have complex needs as visual impairment may
exacerbate confusion caused by some of forms of dementia such as Alzheimer’s
disease. As the population ages the proportion of people with both conditions is likely
to increase (Thomas Pocklington Trust, 2007).
There is growing evidence about the link between sight loss and falls (Boyce, 2011a).
In 2008 there were an estimated 37,000 falls that required hospital treatment that were
linked to sight loss (Access Economics, 2009).
10
Facts and figures
Almost two million people in the UK are living with sight loss:
• 1,564,000 in England
• 99,000 in Wales
• 157,000 in Scotland
• 47,000 in Northern Ireland
Severity of sight loss:

• 1,185,000 people are living with mild sight loss
• 458,000 people are living with moderate sight loss
• 224,000 people are living with severe sight loss
Age of people living with sight loss:

• 23 per cent aged 0 to 64 years
• 31 per cent aged 85 years and over
Projected increase in people living with sight loss:

• 2.3 million by 2020
Registration by UK country:
• 299,000 in England
• 16,500 in Wales
Registration by age in England:

• 0.4 per cent aged 0 to 4
• 64.8 per cent aged 75 or over

2. Cost of sight loss
11. Healthcare costs – Total direct NHS expenditure £2.64 billion Up
on eye health
12. Primary care costs – Expenditure on providing £496 million –

primary eye care services, which includes NHS
sight tests
13. Inpatient costs – Expenditure on providing £536 million –

inpatient ophthalmology services
14. Outpatient costs – Expenditure on providing £677 million –

outpatient ophthalmology services
15. Cost of care – Cost of providing residential and £370 million Up

community care to blind and partially sighted people
16. Indirect costs – Total cost of unpaid care, £5.3 billion Up

reduced employment and other indirect costs to the
UK economy as a result of sight loss
There are a number of different costs associated with the provision of eye health
services: with inpatient procedures and outpatient appointments and with the ongoing
treatment of eye conditions, including prescriptions and medications. There are also
indirect costs, including the cost of providing informal care to those living with sight
loss, often provided by family or friends.
Data sources
A range of data sources tell us about different elements of expenditure in the NHS.
Data published by the NHS in England, Scotland and Wales provides us with the total
expenditure for eye or vision problems. In England budget data can be broken down
into specific elements of expenditure, for example prescription costs or hospital costs,
which gives us an indication of how expenditure on eye health is allocated.

Modelled data from the “Future Sight Loss UK 1” report (Access Economics, 2009) also
provides us with some information on the wider costs of sight loss. These include extra
costs incurred by local authorities in providing residential and community care and the
indirect costs associated with the provision of informal care and economic inactivity.
Direct costs
Healthcare costs
The total expenditure on healthcare linked to eye health in the UK is £2.64 billion
(Indicator 11). This includes expenditure on hospital care such as inpatient admissions
and outpatient appointments; expenditure on providing NHS sight tests for eligible
patients; and expenditure on medications and prescriptions related to the treatment
of the eye.
Expenditure related to eye health is recorded in the official statistics under the “problems
of vision” category. In England it is now possible to break this expenditure down further.
• E£496
xpenditure on primary care services, such as the provision of NHS sight tests, was
million (Indicator 12).
• E(Indicator
xpenditure on providing NHS inpatient ophthalmology procedures was £536 million
13).
• E£677
xpenditure on providing NHS outpatient ophthalmology appointments was
million (Indicator 14).

Residential and community care costs
The cost of providing residential and community care services to blind and partially
sighted people in 2013 is estimated to be around £370 million (Indicator 15). This
includes services provided at a local level by councils responsible for social care.
Indirect costs
The indirect cost of sight loss to the UK economy in 2013 is estimated to be around
£5.3 billion (Indicator 16). This represents an increase of over £200 million on the
indirect costs of sight loss compared to estimates for 2012.
The largest proportion of these indirect costs is linked to the provision of informal care.
In most cases this will be unpaid care or support provided by a family member, friend
or neighbour to someone who is blind or partially sighted. This type of unpaid care will
cost the UK economy around £2.5 billion in 2013. Lower employment rates and the cost
of specialist equipment and modifications are also significant factors in the indirect cost
of sight loss.
Facts and figures

NHS expenditure on problems of vision in the UK:
• £2,255 million in England
• £119 million in Wales
• £216 million in Scotland
• £52 million in Northern Ireland (estimated)
Breakdown of NHS expenditure in England on “problems of vision”:

• 30.0 per cent on outpatients
• 23.8 per cent on inpatients
• 22.0 per cent on primary care
• 9.0 per cent on primary care prescribing
• 7.5 per cent on other secondary care
• 5.3 per cent on community care, social care and care provided
in other settings
• 2.3 per cent on Accident and Emergency
• 0.1 per cent on prevention and health promotion

3. Prevention of sight loss
17. Sight tests – Number of NHS sight tests per year 15.4 million Up
18. Rate of sight tests – Rate of NHS sight tests Up

per 100,000 people in:
a) England a) 23,559
b) Wales b) 25,510
c) Scotland c) 36,400
d) Northern Ireland d) 24,069
19. Low income sight tests – Number of people 1,927,000 Down

recorded as having an NHS sight test under one
of the low income eligibility criteria
20. Outpatients – Total number of NHS outpatient 7.67 million Up

ophthalmology appointments
21. New outpatients – Number of NHS outpatient 2.01 million Down

ophthalmology appointments for new patients
22. DNAs – Percentage of new outpatients who did Up

not attend their appointment:
a) Wales a) 5.8 per cent
b) Scotland b) 9.0 per cent
c) Northern Ireland c) 7.0 per cent
23. Inpatients – Number of NHS ophthalmology 720,000 Down

inpatients and day cases
24. Waiting times – Percentage of NHS Down

ophthalmology referrals which require treatment that
were not completed within the 18 weeks referral to
treatment guidelines for:
a) admitted patients a) 6.3 per cent
b) non-admitted patients b) 2.5 per cent
25. Age-related macular degeneration (AMD) – £155 million Up

Expenditure on Lucentis injections

26. Diabetic retinopathy: uptake – Proportion of 80.9 per cent Up
people offered screening who were screened
27. Diabetic retinopathy: coverage – Proportion 73.9 per cent Up

of all people diagnosed with diabetes who were
screened
28. Cataract – Number of NHS cataract operations 396,000 Down
29. Glaucoma – Total spend on glaucoma £132.3 million Up

prescriptions
30. Certification – Number of new Certificates of 25,079 Up

Vision Impairment issued in 2011/12
31. Rate of certification – Number of new CVIs –

per 100,000 people in 2010/11:
a) AMD for those aged 65 and over a) 109.4
b) Glaucoma for those aged 40 and over b) 11.8
c) Diabetic eye disease for those aged 12 and over c) 3.59
d) All cases for all age groups d) 43.1
Sight is the sense that people fear losing the most (College of Optometrists, 2011).
Sight loss and eye health costs the UK economy at least £8 billion each year. Thousands
of people unnecessarily lose their sight each year (Public Health England, 2013).
Despite these facts, only £2.2 million was spent by the NHS on prevention and public
awareness on eye health in England in 2011/12 (DH, 2013a).
Data sources
All data in this section has been taken from official statistics. Health service data in the
UK is published separately in England, Wales, Scotland and Northern Ireland. In some
cases this data is comparable and therefore we can collate it in order to provide a UK
overview. However some datasets are published in some areas and not others, and in
these instances only data for those areas has been used.

Sight tests
RNIB recommends that everyone has a regular eye examination every two years, even
if they are not aware of having any problems with vision, in order to ensure that any
changes in eye health are picked up early.
People are eligible for a free NHS sight test under a number of different criteria.
For example people aged 60 or over; aged under 16, or under 19 and in full-time
education; live in Scotland; in receipt of certain benefits such as income support or
family credit; diagnosed with diabetes or glaucoma.
Published data on sight tests only highlights those paid for by the NHS. Some eye tests
are privately funded either by individuals or employers. We do not have any current
information on how many privately funded eye tests are conducted.
In 2011/12 there were 15.4 million NHS sight tests in the UK (Indicator 17). The
number of NHS funded sight tests has been increasing in recent years – there were over
3 per cent more NHS sight tests in 2011/12 than in the previous year.
The rate of NHS sight tests per year has also been increasing (Indicator 18):
• 23,559 NHS sight tests for every 100,000 people in England

• 25,510 NHS sight tests for every 100,000 people in Wales
• 36,400 NHS sight tests for every 100,000 people in Scotland
• 24,069 NHS sight tests for every 100,000 people in Northern Ireland.
However the number of people recorded as having an NHS eye test as a result of one
of the low income eligibility criteria decreased in 2011/12. There was a 3 per cent
reduction (50,000 fewer sight tests) in England and Wales for people under the “Income
support”, “tax credits” or “low income certificate” eligibility criteria (Indicator 19). This
may be as a result of these people being recorded under different eligibility criteria.
However, there is evidence to suggest that factors such as the retail element of sight
tests and the cost of glasses may act as a disincentive to those of low incomes (Hayden,
Trudinger et al, 2012).
Hospital care
There were 7.67 million NHS outpatient ophthalmology appointments in 2011/12
(Indicator 20). This is a slight increase on the previous year, with around 200,000 more
appointments. Of this total, 2.01 million people were new patients attending an eye
clinic for the first time (Indicator 21). This is a slight decrease in the number of new
patients from the previous year, with 40,000 people fewer people attending an eye
clinic for the first time.

The increase in repeat appointments and the decrease in new appointments highlights
the growing burden on the NHS in terms of patient follow-up. As the population ages
and people live longer, the length of time people are likely to be living with an eye
condition also increases. Prevention of sight loss will become more and more cost
effective in the future.
In Scotland, Wales and Northern Ireland there is information published each year
on how many people do not attend their outpatient ophthalmology appointment.
At present, this data is not published in England. The percentage of patients who
do not attend their first appointment is important because this potentially impacts
on the timely diagnosis and early treatment. In all three countries the percentage
of new patients who did not attend their appointment has increased (Indicator 22):
• 5.8 per cent of new patients in Wales did not attend their appointment
• 9.0 per cent of new patients in Scotland did not attend their appointment
• 7.0 per cent of new patients in Northern Ireland did not attend their appointment.
In 2011/12, there were 720,000 NHS inpatient ophthalmology inpatient episodes
(Indicator 23). This is a slight decease on the previous year, with 7,000 fewer inpatients
episodes when compared to 2010/11.
Waiting times
Government targets suggest that the time taken from initial referral to treatment should
be no greater than 18 weeks. In 2012, 480,000 patients started admitted treatment
in England under the ophthalmology speciality. Of these patients 6.3 per cent did not
start their treatment within the 18 week guidelines (Indicator 24a). This equates to
around 30,000 patients in England who did not start their treatment within 18 weeks.
A further 998,000 patients started non-admitted ophthalmic treatment in 2012. Of
these patients 2.5 per cent did not start their treatment within the 18 week guidelines
(Indicator 24b). This equates to a further 25,000 patients in England who did not start
their treatment within 18 weeks.
At the end of 2012 an additional 270,000 patients were waiting to start their
ophthalmic treatment.
Treatments
Age-related macular degeneration
In 2011 the cost of prescribing Lucentis, a proven treatment for wet AMD, was £155
million for the NHS in England (Indicator 25). In total £26 million more was spent
on Lucentis compared to the previous year.

Diabetic eye disease
The diabetic retinopathy screening programme is the only eye health screening
programme in the UK. The aim of screening is to reduce sight loss caused by diabetic
retinopathy by facilitating early diagnosis and treatment. Screening is offered to
most patients who have been identified as having diabetes, however a proportion
are excluded from screening. We have included two indicators in the report because
the uptake of screening (proportion of those screened) could increase as a result of a
decrease in coverage (proportion of people with diabetes who are offered screening).
In 2011/12, the proportion of people who were offered screening and who were
actually screened was 80.9 per cent (Indicator 26). The proportion of people with
diabetes who were screened in England was 73.9 per cent (Indicator 27). This equates
to 248,000 people with diabetes who were excluded from screening.
Both the proportion of coverage and uptake in 2011/12 were an improvement on
comparable figures for the previous year.
Cataract
There were 396,000 cataract operations performed in the NHS in 2011/12
(Indicator 28). This represents a slight decrease in the number of operations from
the previous year, with 5,000 fewer cataract procedures performed in the UK then
in 2010/11 and 10,000 fewer than in 2009/10.
Glaucoma
The most common treatment for glaucoma is the prescription of eye drops to reduce
intraocular pressure (RNIB, 2012). In 2011 the total spend on community-based
glaucoma prescriptions was £132 million (Indicator 29). This represents a £3 million
increase from 2010.
This figure is an underestimate because it does not include prescriptions that were
dispensed in hospitals. It is also not a true reflection of the overall net cost of glaucoma
prescriptions because it does not take into account expenditure related to the
dispensing of prescriptions or income related to prescription charges.
Certification
A Certificate of Vision Impairment (CVI) formally certifies a person as either sight
impaired (partially sighted) or severely sight impaired (blind). The purpose of the CVI
is to provide someone with sight loss a reliable and formal route to social care services.
Each CVI form is completed by a consultant ophthalmologist in an eye clinic and a
copy is sent to the patient, their GP, the local social services department and the
Certifications Office at Moorfields Eye Hospital. Upon receipt of the CVI, the social
services offer registration and other relevant advice and services (Boyce, 2012).

This is why the Public Health Outcomes Framework – which sets out the desired
outcomes for public health and how these will be measured – uses certification to
measure avoidable sight loss in England (Public Health England, 2013). There are four
indicators within the Public Health Indicator for Avoidable Sight Loss: the overall rate of
certification (all ages) and rates of certification as a result of AMD (ages 65 and over),
glaucoma (ages 40 and over) and diabetic retinopathy (ages 12 and over).
In 2011/12 25,079 Certificates of Vision Impairment were issued in England and Wales
(Indicator 30).

The rate of certification by specific diagnosis can help us to track some of the leading
causes of avoidable sight loss. In England in the year 2010/11 the rates of certification
(Indicator 31) were:
• 43.1 out of every 100,000 people of all ages were newly certified
• 1of09.4 out of every 100,000 people aged 65 and over were certified as a result
AMD
• 1of1.8glaucoma
out of every 100,000 people aged 40 and over were certified as a result
• 3of.6diabetic
out of every 100,000 people aged 12 and over were certified as a result
eye disease.
Facts and figures

NHS sight tests:
• 12,306,000 in England
• 767,000 in Wales
• 1,914,000 in Scotland
Number of ophthalmology outpatients:

• 6,807,224 in England
• 330,272 in Wales
Number of ophthalmology inpatients:

• 620,278 in England
• 33,083 in Wales

4. Early reach
32. Early intervention – Percentage of hospitals 48 per cent –
that have some form of support in their eye clinics
33. Qualified support – Percentage of hospitals 27 per cent –

that have qualified support in their eye clinics
34. Rehabilitation – Number of Rehabilitation 600 –

Officers
The provision of emotional and practical support at the right time can help people who
are experiencing sight loss to retain their independence and access the support they need.
Patient experience in the eye clinic is crucial. It is here that people receive their
diagnosis, undergo treatment and potentially go through the process of receiving
a Certificate of Vision Impairment. Support at any of these stages is invaluable to
someone experiencing sight loss (Boyce, 2011b). Equally when someone experiences
sight loss it is also vital for them to have support in their home and in their local area.
Data sources
There is no official published record of what support is available in eye clinics or
in the community. In the absence of any official statistics, RNIB and the Social Care
Association have mapped a range of local provision in order to build up a national
picture of support services. The results of this mapping work form the basis of the
data in this section.
Eye clinics
We estimate that around 48 per cent of eye clinics in the UK offer some kind of support
to patients (Indicator 32). This includes all types of support, such as Eye Clinic Liaison
Officers (ECLOs), volunteers, patient support services and specialist ophthalmic nurses
who have an element of patient support built into their role.
Some hospitals provide support from staff or volunteers that have been accredited
and trained to provide high quality emotional and practical support. We estimate that
around 27 per cent of eye clinics have accredited and trained support available to
patients (Indicator 33).

Rehabilitation
Visual impairment rehabilitation is an early intervention delivered by specialist
professionals. They help people to maximise their functional vision and skills for
confident daily living. If someone has unmet needs after receiving early intervention
services they should be offered a Community Care Assessment to determine whether
they are eligible for social care.
The Adult UK sight loss pathway describes best practice for provision (UKVS, 2012).
Further details of this pathway can be found on the UK Vision Strategy website:
www.vision2020uk.org.uk/ukvisionstrategy
One of the professional groups contributing to delivery of the early intervention
pathway are qualified Rehabilitation Officers. They are specially trained in supporting
people to retain their independence when they have experienced sight loss. There are
an estimated 600 Rehabilitation Officers currently employed in the UK providing early
intervention support to blind and partially sighted people (Indicator 34).

5. Independence
35. Depression – Proportion of people with sight 34 per cent –
loss who say that they feel unhappy or depressed
36. Health – Proportion of people with sight loss 55 per cent –

who are dissatisfied with their health
37. Dissatisfied – Proportion of people with sight 25 per cent –

loss who say that they are dissatisfied with their
life overall
38. Free time – Proportion of people living with 34 per cent –

sight loss who say that they have little or no choice
over how they spend their free time
39. Mobility – Proportion of people living with sight 49 per cent –

loss who say that they experience difficulties getting
into or moving around buildings
40. Reliance – Proportion of people with sight 80 per cent –

loss who say that they receive support from family
members
41. No choice – Proportion of people with sight loss 20 per cent –

who say that they rarely or never have a say over the
help or assistance they receive
42. Social care – Number of blind and partially 36,085 Down

sighted people in receipt of adult social care services
in England
43. Hardship – Proportion of people with sight loss 41 per cent –

who say that they have some or great difficulty in
making ends meet
44. Income – Proportion of people with sight loss 49 per cent –

who say that they live in a household with a total
income of less than £300 a week

45. Warmth – Proportion of people living with sight 14 per cent –
loss who say that they could not afford to keep their
home adequately warm
46. DLA – Number of blind and partially sighted 72,200 Up

people claiming Disability Living Allowance
47. Attendance Allowance – Number of blind 54,500 Down

and partially sighted people claiming Attendance
Allowance
48. Educational attainment – Proportion of Up

pupils with a primary SEN of visual impairment
who achieved:
a) “Good level of development” in early years a) 35 per cent
teacher assessments
b) Five or more GCSE grades A*–C, including Maths b) 44 per cent
and English
49. Unmet need – Proportion of local authority Two out of –

Visual Impairment services that say they are unable every five
to meet the needs of at least one group of children
and young people
50. Further education – Number of adult learners 14,900 Down

in Further Education who are known to have
a visual impairment
51. Higher education – Number of students 3,520 Down

in Higher Education who are known to have
a visual impairment
52. Labour market – Proportion of people with 66 per cent –

sight loss who say that they experience restrictions
in being able to access and fully participate in
employment
53. Employment – Percentage employment rate 46.9 per cent Down

of people who are “long term disabled with a seeing
difficulty”

Blind and partially sighted people should be able to make informed choices about their
lives. Access to support and services should enhance independence and wellbeing,
including financial assistance to cover extra costs of sight loss and opportunities to
learn, work and develop skills and interests.
Data sources
One of the main sources of data used in this section is a secondary analysis of
two large government surveys that were published in the “Circumstances of people with
sight loss” report (McManus and Lord, 2012). Both “Understanding Society” and the
“Life Opportunities Survey” allow us to identify a sample of people with sight loss and
investigate their circumstances. The main advantage of using these surveys is that we
can compare the situation of people with sight loss to the general population – these
comparisons are made robust by taking into account variations in age and gender. Any
comparisons made between people with sight and people without sight loss in this
report have been adjusted for age and gender.
It is important to note that that the percentages from the “Circumstances of people
with sight loss” report (McManus and Lord, 2012) are for the population of people
living with sight loss as a whole. If we were to focus on people who reported more
severe sight loss then we invariably find their circumstances to be worse (McManus,
Lord and Slade, 2013).
Wellbeing
Evidence suggests that there is a strong link between sight loss and reduced
psychological wellbeing, particularly amongst older people who develop sight loss later
in life (Hodge, Barr and Knox, 2010). People living with sight loss report lower feelings
of wellbeing, reduced self-confidence and lower satisfaction with their overall health.
Over one-third of people living with sight loss say that they feel unhappy or depressed
(Indicator 35). People with sight loss were seven times more likely than non-disabled
people to feel unhappy or depressed.
More than half of people living with sight loss say that they are dissatisfied with their
health (Indicator 36). People with sight loss were four times more likely than those
with no impairment to be dissatisfied with their health.
One-quarter of people living with light loss say that they are unhappy with their life
overall (Indicator 37). People with sight loss were three times more likely than those
with no impairment to be unhappy with life overall.

Social inclusion and mobility
Over one-third of people with sight loss say that they have little or no choice about
how they spend their free time (Indicator 38). This includes activities such as going on
holiday, playing sport, visiting friends or family or undertaking voluntary work. People
with sight loss were five times more likely than people without a disability to feel as if
they had no choice over how they spent their free time.
Half of people with sight loss experienced difficulties getting into and moving around
buildings (Indicator 39). People with sight loss were six times more likely than people
with no disability to have experienced difficulties getting into buildings.
Support
Many blind and partially sighted people require support in order to remain independent.
Sometimes this is provided by social services, but typically it is provided on an informal
basis by family, friends and neighbours. The cost of this informal care is billions of
pounds each year (Access Economics, 2009).
80 per cent of people living with sight loss said that they received help from family
members (Indicator 40). Other common forms of support were from friends or
neighbours (26 per cent) and paid help inside or outside the home (16 per cent and
17 per cent respectively).
20 per cent of people living with sight loss said that they rarely or never have a say over
the help or assistance they receive (Indicator 41).
Social services also provide formal packages of care to blind and partially sighted
people. The type of support provided by social services includes equipment, adaptations
and home care. 36,085 blind and partially sighted people were in receipt of support
from social services in England in 2011/12 (Indicator 42). This represents a 26 per
cent decrease in the number of blind and partially sighted people receiving adult social
services since 2008/09.
Income and benefits

Income
People with sight loss are far more likely than the general population to experience
financial hardship. The current economic recession is likely to have had a
disproportionate and negative impact on blind and partially sighted people (Slade,
Lord and McManus, 2012). Over two-fifths of people living with sight loss say that
they have some or great difficulty in making ends meet (Indicator 43). After taking
age and gender into account, people with sight loss were twice as likely as those with
no impairment to face great difficulty making ends meet.

Household income is one of the main methods for calculating low income and poverty
in the UK (DWP, 2013). Around half of people living with sight loss live in a household
where the weekly income is less than £300 (Indicator 44). After adjusting for age and
gender, people with sight loss were twice as likely as those with no impairment to live
in a household with an income of less than £300 a week.
As a result of low incomes, 14 per cent of people with sight loss could not afford to
keep their home adequately warm (Indicator 45). After adjusting for age and gender,
people with sight loss were over twice as likely as those with no impairment to be
unable to keep their home adequately warm.
Benefits
One of the most important benefits paid to blind and partially sighted people is
Disability Living Allowance (DLA). This benefit helps with the extra costs caused
by a disability, and is paid at different rates depending on the level of help an
individual needs.
As of August 2012 there were 72,000 Disability Living Allowance claimants recorded
under the “blindness” classification (Indicator 46). This represents a slight increase
in the number of claimants from the previous year. However, this is likely to be an
underestimate as there may be other people with sight loss who are in receipt of DLA
but who are recorded as having a different disability such as a learning disability or
hearing impairment.
From April 2013, Personal Independence Payment (PIP) will replace DLA for people
aged 16 to 64. RNIB and other disability organisations have serious concerns about
the impact this change will have on blind and partially sighted people and people with
other disabilities. For more information please see the Hardest Hit campaign website:
http://thehardesthit.wordpress.com
A key entitlement for older blind and partially sighted people is Attendance Allowance.
As of August 2012 there were 54,500 blind and partially sighted people claiming
Attendance Allowance (Indicator 47). This represents a slight decrease in the number
of claimants from the previous year.
Education
An estimated 25,000 children in Britain are blind or partially sighted. Around half have
additional disabilities and/or special educational needs.
The Department for Education only publish attainment data by a pupil’s primary (main)
special educational need (SEN). This means that we cannot identify:

1) pupils whose secondary SEN is a vision impairment (about a third of pupils with VI); and,
2) pupils with a vision impairment and another SEN.
This prevents us from highlighting the impact that these additional needs may have
on progress and attainment. Yet there is strong evidence that children with vision
impairment plus another SEN/disability are especially disadvantaged in education and
other outcomes (Harris, Keil, Lord and McManus, 2013; Bassett, 2010; Chanfreau and
Cebulla, 2009). The following information on attainment therefore, does not apply
to all pupils with vision impairment and does not take the effect of other disabilities
into account.
• 3level
5 per cent of pupils with a primary SEN of visual impairment achieved a “good
of development” in Early Years Foundation Stage teacher assessments
(Indicator 48a). This compares to 63 per cent of pupils with no identified SEN.
• 44 per cent of pupils with a primary SEN of visual impairment achieved five or more
GCSEs grades A* to C, including Maths and English (Indicator 48b). This compares
to 70 per cent of pupils with no identified SEN.
Two in five local authority Visual Impairment services say they are currently unable
to meet the needs of at least one group of children and young people (Indicator 49).
Young people in FE or other post-school settings are the main group whose needs VI
services are unable to meet. The most common reasons given were insufficient staff
in the VI team or local authority policy (Keil, 2013).
In further education 14,900 adult learners aged 19 and over are recorded as having
a visual impairment in England (Indicator 50).
In higher education 3,520 students are recorded as having a visual impairment
in England (Indicator 51). Of these, 2,755 were undergraduates and 765 were
postgraduates.
Employment
Blind and partially sighted people face a range of barriers in accessing employment
opportunities. Restrictions such as a lack of access to education and training
opportunities, transport and attitudes of employers have all been identified as barriers
to obtaining and retaining work (Douglas et al, 2009).
Two-thirds of people living with sight loss say that they experience restrictions in being
able to access and fully participate in employment (Indicator 52).
The Labour Force Survey (LFS) is a large scale survey carried out on behalf of the UK
government. It can help us track how many people with sight loss are in employment.

In 2012, the proportion of people “long term disabled with a seeing difficulty” in
employment was 46.9 per cent (Indicator 53). This represents a 1.9 per cent reduction
in the employment rate.
The Labour Force Survey uses different criteria for identifying people with sight
problems than a report such as “Network 1000”. According to figures from “Network
1000” only 33 per cent of registered blind and partially sighted people of working age
are in employment (Douglas et al, 2009). The LFS covers a wider range of sight loss and
includes people whose sight loss would not be eligible for registration, but which would
still have a significant impact on daily lives.
Facts and figures

Proportion of people in employment (including self employed):
• 46.9 per cent – long term disabled with a seeing difficulty
• 50.6 per cent – other long term disabled
• 77 per cent – not disabled
• 71.7 per cent – all people of working age

6. Inclusive society
54. Travel* – Proportion of blind and partially sighted 61 per cent –
people who need help to get out of the house
55. Trains* – Proportion of blind and partially 53 per cent –

sighted people who are not able to travel on trains
as much as they would like
56. Buses* – Proportion of blind and partially 42 per cent –

sighted people who are not able to travel on buses
57. Shopping* – Proportion of blind and partially 82 per cent –

sighted people who need help to go shopping
58. Everyday necessities – Proportion of people 50 per cent –

living with sight loss who say that they need help to
shop for everyday necessities
59. Online shopping* – Proportion of blind and 62 per cent –

partially sighted people who were not able to shop
online as much as they would like
60. Money* – Proportion of blind and partially 50 per cent –

sighted people who need help to manage
their money
61. Cash – Proportion of blind and partially sighted 11 per cent –

who can use a cash machine on their own
62. Reading – Proportion of the top 1,000 books Up

in 2011 that can be accessed by blind and partially
sighted people:
a) Traditional alternative formats only a) 17 per cent
b) Including eBooks b) 76 per cent
(2011)

63. eBooks* – Proportion of blind and partially 27 per cent –
sighted people who read books that have read an
eBook or have used an eBook device
64. Television – Proportion of TV programmes that 23.1 per cent Down

are broadcast with audio description (2012)
65. AD usage* – Proportion of blind and partially 54 per cent –

sighted people who say that they have watched a
television programme using audio description
66. Computers* – Percentage of blind and partially –

sighted people who use a computer
a) 18–64 years a) 74 per cent
b) 65 and over b) 43 per cent
67. Digital exclusion – Proportion of older blind 87 per cent –

and partially sighted people aged 65 and over who
say that they have never used the internet
68. Mobile phones* – Percentage of blind and –

partially sighted people who use a mobile phone
*Based on results of interviews with 201 blind and partially sighted RNIB customers.
Blind and partially sighted people face restrictions and barriers in accessing goods
and services. Tasks that most of us take for granted, such as catching a bus, shopping
for everyday necessities, knowing how much money is in your bank account, reading
books, finding out what’s on television and being able to access computers and mobile
phones can provide major challenges for blind and partially sighted people.

Data sources
The major source of evidence in this section is primary research which investigates the
circumstances and experiences of blind and partially sighted. For example, the “Update
on inclusive society 2013” report (Slade, 2013) provides an update on the barriers faced
by blind and partially sighted people to travel, shopping and money; and how blind and
partially sighted people are accessing technology, television and reading.
Travel
Travel is a crucial element of independence and inclusion, but for many blind and
partially sighted people travelling is a challenge. This can result in blind and partially
sighted people being trapped at home and can lead to isolation, reduced wellbeing and
low confidence. We need to be able to travel to get to work, to meet with family and
friends, go shopping, play an active role in civic life, and many other things.
Nearly two-thirds of blind and partially sighted people say that because of their sight
loss they need help to get out of the house (Indicator 54).
Over half of blind and partially sighted people say that they are not able to travel by
train as much as they would like (Indicator 55). The most common barrier to train travel
identified by respondents was their sight loss. Other related barriers are:
• not being able to see where to get off

• lack of confidence
• getting to the train station
• lack of help or assistance.
Over two-fifths of blind and partially sighted people say that they are not able to travel
by bus as much as they would like (Indicator 56). The most common barrier to bus
travel identified by respondents was their sight loss. Other related barriers are:
• identifying and hailing the right bus

• not being able to see where to get off
• lack of confidence
• lack of help or assistance
• poor accessibility, such as lack of audible announcements.

Shopping
Shopping for everyday necessities can be an important aspect of daily living, and it is
one of the key reasons why people leave their house (Douglas et al, 2006). In addition,
the “Network 1000” report highlights that shopping is one of the most important
leisure activities for blind and partially sighted people outside of the home.
Over three-quarters of blind and partially sighted people say that because of their
sight loss they need someone to help them with shopping (Indicator 57). Key barriers
identified by respondents were:
• seeing prices or reading labels

• travelling to the shops
• lack of confidence.
Half of people who are living with sight loss need assistance in shopping for everyday
necessities (Indicator 58). Compared to people without a disability, people with sight
loss are 20 times more likely to require assistance with shopping for these everyday items.
Online shopping is becoming an increasingly popular in the UK. However, nearly two-
thirds of blind and partially sighted people say that they are not able to shop online as
much as they would like (Indicator 59). The most common barrier to online shopping
identified by blind and partially sighted people is their sight loss. Other key barriers
include:
• do not know how to shop online

• lack of information
• concerns about internet safety
• financial constraints related to expense of buying equipment.
Money
The ability to control your own personal finances is a key element of an inclusive
society. Being able to identify what money is in your wallet or purse, getting account
details and statements in accessible formats, having access to your own money at
cash machines and utilising online banking facilities can all be challenges for blind and
partially sighed people.
Half of blind and partially sighted people say that they need help to manage their
money because of their sight loss (Indicator 60).

Using a cash machine is now many people’s preferred method to access cash.
Only 11 per cent of blind and partially sighted people say that they can independently
use a cash machine (Indicator 61). Key barriers include difficulties accessing the
information on the screen, differences in the layout and of the menu options and
security concerns.
Reading
Nine out of ten blind and partially sighted people say that they read books, and reading
for leisure is important for many people with sight loss. People access written material
in a number of different ways including audio with a human voice, synthetic speech,
hard copy braille and large print (Slade, 2013). However book readers can face limited
choices as the titles they want to read may not be available in their preferred format
(Greenwood, White and Creaser, 2011).
In an analysis of the top 1,000 books in 2011, only 17 per cent were found to be
accessible in the traditional alternative formats – that is human speech audio, hard copy
braille and hard copy large print. If we include accessible eBooks then the proportion
of the top 1,000 books in 2011 that are available in alternative formats increases to
76 per cent (Indicator 62).
One-quarter of blind and partially sighted people who read books have either read an
eBook or used an eBook device, such as the Amazon Kindle or Apple iPad (Indicator 63).
Television
Research has shown that watching television is a high priority for blind and partially
sighted people (Douglas et al, 2006). The ability to watch, enjoy and talk about TV
is key to social inclusion.
One of the key ways that television can be made more inclusive is through audio
description (AD). Audio description is a commentary added to TV programmes that
gives people information about the things they might not be able to see, such as
body language, expressions and movements. In 2012 around 23 per cent of television
programmes were broadcast with AD (Indicator 64). This figure is based on channels
that have audio description obligations, rather than across every available channel.
The proportion of television programmes broadcast with AD has slightly decreased
since the previous year. This is primarily because more channels now have obligations
to broadcast TV programmes with AD, and so the additional programmes included as
a result of these newer channels have lowered the overall average.
Over half of blind and partially sighted people say that they have watched a television
programme with audio description (Indicator 65).

Technology
Using technology, in particular computers and mobile phones, has become a key
skill for everyday living, education and employment. Technology has the potential
to be empowering for blind and partially sighted people of all ages. However,
technology can also be extremely challenging for many blind and partially sighted
people, particularly those who have developed sight loss in older age.
As in the general population, computer usage amongst blind and partially sighted
people is linked to age. Younger blind and partially sighted people are much more likely
to use a computer than those of retirement age. Around three-quarters of blind and
partially sighted people aged 18–64 say that they use a computer, compared to under
half of those aged 65 and over (Indicator 66). Nearly nine out of ten blind and partially
sighted people aged 65 and over have never used the internet (Indicator 67).
Similarly, mobile phone usage is linked to age. Younger blind and partially sighted
people are more likely to use a mobile phone than those who are older, although the
difference is less marked than for computer usage. Around 85 per cent of blind and
partially sighted people aged 18-64 say that they use a mobile phone, compared to
around two-thirds of those aged 65 and over (Indicator 68).

7. European and world sight loss
69. Global sight loss – Number of people living 285 million No
with sight loss worldwide change
70. European sight loss – Number of people living 30 million –

with sight loss in Europe
According to the latest estimates from the World Health Organisation, there are 285
million people living with sight loss worldwide. Around 39 million people are blind and
246 million are partially sighted (Indicator 69).
Developing countries have significantly higher levels of sight loss. Around 90 per cent
of global sight loss occurs in developing countries, with cataract being the leading cause
of sight loss in these countries. The World Health Organisation estimates that
80 per cent of global sight loss can be avoided or treated.
It is estimated that there are over 30 million blind and partially sighted people in
geographical Europe (Indicator 70).

Appendix A: References
Further information and links to all the references listed in this section can
be found at RNIB’s Knowledge and Research Hub: www.rnib.org.uk/research
Access Economics (2009) Future Sight Loss UK 1: The economic impact of partial sight
and blindness in the UK adult population. RNIB.
ASH (2013) Smoking statistics: who smokes and how much. Action on Smoking
and Health.
Bassett P (2010) Educational attainment and progress of young blind and partially
sighted pupils in England. RNIB.
Boyce T (2011a) Falls: costs, numbers and links with visual impairment. RNIB.
Boyce T (2011b) Innovation and quality in sight loss and blindness services: Eye Clinic
Liaison Officers. RNIB.
Boyce T (2012) The Certification and Registration Processes: Stages, barriers and
delays. RNIB.
BSO (2012) Prescription Cost Analysis, Northern Ireland, 2011. Health and Social Care
Business Services Organisation.
BSO (2013) Information on NHS sight tests in Northern Ireland obtained from emails
received from statisticians working in Northern Ireland’s Health and Social Care Business
Services Organisation in March 2013.
Byron C, Blake M and Bridges S (2013) Secondary analysis of Adult Social Care Data.
Natcen report for RNIB. To be published in September 2013.

Chanfreau J and Cebulla A (2009) Educational attainment of blind and partially sighted
pupils. NatCen report for RNIB.
College of Optometrists (2011) Britain’s Eye Health in Focus. College of Optometrists.
Creaser C (2012) Accessibility of the top 1000 titles of 2011. RNIB.

DfE (2012) Children with special educational needs 2012: an analysis. Department
for Education.

DH (2013a) Programme Budgeting benchmarking tool, 2011/12. Department for Health.
DH (2013b) NHS Consultant-led Referral to Treatment (RTT) Waiting Times Statistics

for England: 2012 Annual Report. Department for Health.
DHSSPS (2012a) Prevalence Data in the Quality and Outcomes Framework, 2011/12,
Northern Ireland. Department of Health, Social Services and Public Safety.
DHSSPS (2012b) Northern Ireland Hospital Statistics: Outpatient Activity, 2011/12.

Department of Health, Social Services and Public Safety.
DHSSPS (2012c) Northern Ireland Hospital Statistics: Inpatient and Day Case Activity,
2011/12. Department of Health, Social Services and Public Safety.
Diabetes UK (2012) Diabetes in the UK 2012: Key statistics on diabetes. Diabetes UK.
Douglas G, Corcoran C and Pavey S (2006) Network 1000: Opinions and circumstances
of blind and partially sighted people in Great Britain. Visual Impairment Centre for
Teaching and Research, University of Birmingham.
Douglas G, Pavey S, Clements B and Corcoran C (2009) Network 1000. Visually

impaired people’s access to employment. Visual Impairment Centre for Teaching and
Research, University of Birmingham for Vision2020 UK.
DWP (2012) Households Below Average Income. Department for Work and Pensions.
DWP (2013a) Benefit claimants – Disability Living Allowance by disabling condition.

Department for Work and Pensions.
DWP (2013b) Benefit payments 5 per cent data – Attendance Allowance. Department
for Work and Pensions.
EBU (2013) Key facts and figures concerning blindness and sight loss. European
Blind Union.
Edwards A (2011) Barriers to financial inclusion: factors affecting the independent

use of banking services for blind and partially sighted people. RNIB.
Edwards A (2012) Tackling digital exclusion – Older blind and partially sighted people
and the internet. RNIB.

Emerson E and Robertson J (2011) The estimated prevalence of visual impairment
among people with learning disabilities in the UK. Learning Disabilities Observatory
report for RNIB and Seeability.
Greenwood H, White S and Creaser C (2011) Availability of accessible publications. RNIB.
Harris J, Keil S, Lord C and McManus S (2013) Sight impaired at age seven: secondary
analysis of the Millennium Cohort Survey. RLSB, RNIB and NatCen.
Hayden C, Trudinger D, Niblett V, Hurrell DL, Donohoe S, Richardson I and Applebee E

(2012) The barriers and enablers that affect access to primary and secondary eye care
across the UK. Shared Intelligence report for RNIB.
HESA (2013) Figures taken from the 2011/12 HESA Student Records, and the
breakdown for blind and partially sighted students was obtained by RNIB via
correspondence with the Higher Education Statistics Agency in April 2013.
Hewett R (2013) Investigation of data relating to blind and partially sighted people
in the Quarterly Labour Force Survey: October 2009 to September 2012. RNIB.
Hodge S, Barr W and Knox P (2010) Evaluation of emotional support and counselling
within an integrated low vision service. Liverpool University.
HSCIC (2011) Registered Blind and Partially Sighted People – England, Year ending
31 March 2011. Health and Social Care Information Centre.
HSCIC (2012a) Disease prevalence: Quality and Outcomes Framework (QOF) for April
2011 – March 2012, England. Health and Social Care Information Centre.
HSCIC (2012b) General Ophthalmic Services Activity Statistics: England, 2011–2012.

Health and Social Care Information Centre.
HSCIC (2012c) Hospital Episode Statistics, Outpatient Activity – England, 2011–12.

HSCIC (2012d) Hospital Episode Statistics, Admitted Patient Care – England, 2011–12.
HSCIC (2012e) Hospital Prescribing – England, 2011. Health and Social Care
Information Centre.
HSCIC (2012f) Prescription Cost Analysis, England, 2011. Health and Social Care
Information Centre.

ISD (2012a) Quality & Outcomes Framework (QOF) for April 2011–March 2012,
Scotland. Information Services Division, NHS National Services Scotland.
ISD (2012b) Expenditure on ophthalmic services, by NHS sector, by board: 2011/12

(report R830). Information Services Division, NHS National Services Scotland.
ISD (2012c) Ophthalmic Workload Statistics: Scotland, 2011/12. Information Services

Division, NHS National Services Scotland.
ISD (2012d) Outpatient Activity: Summary for Scotland, 2011/12. Information Services
Division, NHS National Services Scotland.
ISD (2012e) Inpatient and Day Case Activity: Summary for Scotland, 2011/12.
Information Services Division, NHS National Services Scotland.
ISD (2012f) Prescription Cost Analysis, Scotland, 2011. Information Services Division,
NHS National Services Scotland.
Johnson M, Cross V, Scase M, Szczepura A, Clay D, Wesley H, Claringbull K, Simkiss P,

Leamon S (2011) A review of evidence to evaluate the effectiveness of current models
and intervention strategies to promote primary and secondary eye health care. RNIB.
Keil S (2012) RNIB survey of VI services in England and Wales 2012: report for
England. RNIB.
Kelly S, Thornton J, Edwards R, et al (2005) Smoking and cataract: review of causal

association. J Cataract Refract Surg. 2005 Dec;31(12):2395-404.
Khan, J et al (2006) Smoking and age related macular degeneration: the number
of pack years of cigarette smoking is a major determinant of risk for both geographic
atrophy and choroidal neovascularisation. Br J Ophthalmol. 2006 Jan;90(1):75-80.
McManus S and Lord C (2012) Circumstances of people with sight loss: secondary analysis
of Understanding Society and the Life Opportunities Survey. Natcen report for RNIB.
McManus S, Lord C and Slade J (2013) Wellbeing across the life course. Natcen report
for RNIB. To be published in September 2013.
Morris M and Smith P (2008) Educational provision for blind and partially sighted
children and young people in Britain: 2007. National Foundation for Educational
Research (NFER) for RNIB.
NHS Wales (2012) Patient Episode Database for Wales. NHS Wales.

NSC (2012) English National Screening Programme for Diabetic Retinopathy: Summary
Report, 2011/12. UK National Screening Committee.
Ofcom (2013) Television Access Services: Final report on 2012. Ofcom.
ONS (2012a) 2011 Census, Population and Household Estimates for the United
Kingdom. Office for National Statistics.
ONS (2012b) Focus on Older People, Population Ageing in the United Kingdom and
Europe. Office for National Statistics.
Public Health England (2013) Public Health Outcomes Framework Data Tool. Public
Health England.
RNIB (2011) Expenditure figures for 2009/10 were obtained by RNIB Northern Ireland
via correspondence with the Department of Health, Social Services and Public Safety.
RNIB (2012) Understanding Glaucoma. RNIB.
RNIB (2013a) Number of adults and children certified with sight impairment and severe
sight impairment in England and Wales: April 2011–March 2012. RNIB.
RNIB (2013b) UK eye clinic support: mapping provision. RNIB. To be published in

June 2013.
SCA (2012) Estimated number of ROVIs currently working in the UK. Social Care
Association.
Scottish Government (2010) Registered Blind and Partially Sighted Persons, Scotland
2010. Scottish Government.
SFA (2012) Equality and Diversity data report, 2008/09 to 2010/11. Skills Funding Agency.
Slade J (2013) Update on inclusive society 2013. RNIB.
Slade J, Lord C and McManus S (2012) The financial situation of people with sight loss.
RNIB and Natcen poster, presented at the UK Vision conference in June 2012.
Thomas Pocklington Trust (2007) Occasional Paper Number 11: Dementia and serious
sight loss. Thomas Pocklington Trust.
Thornton J, Edwards R, Mitchell P et al., Smoking and age-related macular

degeneration: a review of association. Eye. 2005;19;935–944.

UKVS (2012) Adult UK sight loss pathway. UK Vision Strategy.
Welsh Government (2012a) Local Authority Registers of People with Disabilities

at 31 March 2012. Welsh Government.
Welsh Government (2012b) Patients on Quality and Outcomes Framework (QOF)

by local health board and disease registers. Welsh Government.
Welsh Government (2012c) Ophthalmic Statistics for Wales, 2011–12. Welsh Government.
Welsh Government (2012d) Outpatient activity. Welsh Government.
Welsh Government (2012e) Prescription Cost Analysis, Wales, 2011. Welsh Government.
Welsh Government (2013) NHS programme budgets: Wales, 2011/12. Welsh Government.
WHO (2012) Visual impairment and blindness fact sheet. World Health Organisation.

44
Appendix B: Dashboard of indicators
Living with sight loss and those at risk of sight loss
Indicator Sight loss UK Previous Trend Area Source
2013 estimate estimate
1. Sight loss – Number 1.87 million 1.86 million Up UK Access Economics (2009)
of people in the UK living (2011) (2010) and ONS (2012a)
with sight loss that has a
significant impact on their
daily lives
2. Blindness – Number of 224,000 (2011) 218,000 (2008) Up UK Access Economics (2009)

people in the UK living with and ONS (2012a)
severe sight loss
3. Registration – Number of 358,000 368,000 Down UK HSCIC (2011)

people in the UK registered as (Wales; (Wales; Scottish Government
blind or partially sighted 2011/12; 2010/11; (2010)
England, England, Welsh Government (2012a)
2010/11; 2007/08;
Registrations in Northern
Scotland, Scotland,
Ireland have been
2009/10) 2008/09)
estimated based on the
proportion of registrations
in other countries.
Sight loss UK 2013

4. Children and young 25,000 Not available – Britain Morris and Smith (2008)
people – Number of children
aged 0–16 who are blind or
The latest evidence

partially sighted
5. Older people – Number of 14.2 million 13.8 million Up UK ONS (2012a)

people in the UK aged over 60 (2011) (2009)
6. Later life – Number of 1.40 million 1.37 million Up UK ONS (2012a)

people in the UK aged over 85 (2011) (2009)
7. Low income – Number 13.0 million 13.5 million Down UK DWP (2012)
of people in the UK who (2010/11) (2009/10)
Low income is defined as
are living in low income
people living in households
households after housing costs
with incomes below 60
per cent of contemporary
median net disposable
household income after
housing costs
45
46
Living with sight loss and those at risk of sight loss
8. Diabetes – Number of 3.0 million 2.9 million Up UK HSCIC (2012a)
people in the UK who are (2011/12) (2010/11) Welsh Government (2012b)
diagnosed as having diabetes ISD (2012a)
DHSSPS (2012a)
9. Smoking – Proportion of 20 per cent 21 per cent Down Britain ASH (2013)
adults in the UK who smoke (2011) (2009)
10. Learning disabilities 96,500 Not available – UK Emerson and Robertson
– Number of adults with a (2011)
learning disability who are
blind or partially sighted
Sight loss UK 2013

Cost of sight loss
11. Healthcare costs – Total £2.64 billion £2.51 billion Up UK DH (2013a)
The latest evidence

direct NHS expenditure on (2011/12) (2010/11) ISD (2012b)
eye health Welsh Government (2013)
RNIB (2011)
Actual expenditure
figures in Northern
Ireland from 2009/10
have been adjusted based
on percentage increases
in other countries for
subsequent years
12. Primary care costs – £496 million Not available – England DH (2013a)
Expenditure on providing (2011/12)
primary eye care services,
which includes NHS sight tests
13. Inpatient costs – £536 million Not available – England DH (2013a)

inpatient ophthalmology
services
47
48
Cost of sight loss
14. Outpatient costs – £677 million Not available – England DH (2013a)
outpatient ophthalmology
services
15. Cost of care – Cost of £370 million £355 million Up UK Access Economics (2009)
providing residential and (2013) (2012)
community care to blind and
partially sighted people
16. Indirect costs – Total £5.3 billion £5.1 billion Up UK Access Economics (2009)
cost of unpaid care, reduced (2013) (2012)
employment and other
indirect costs on UK economy
as a result of sight loss
Sight loss UK 2013

Prevention of sight loss
17. Sight tests – Number of 15.4 million 14.9 million Up UK HSCIC (2012b)
The latest evidence

NHS sight tests per year (2011/12) (2010/11)
18. Rate of sight tests – Up UK HSCIC (2012b)

Rate of NHS sight tests per Welsh Government (2012c)
100,000 people in: ISD (2012c)
BSO (2013)
a) England a) 23,559 a) 22,856
b) Wales b) 25,510 b) 24,760
c) Scotland c) 36,400 c) 34,600
d) Northern Ireland d) 24,069 d) 23,638
(2011/12) (2010/11)
19. Low income sight tests 1,927,000 1,981,000 Down England HSCIC (2012b)
– Number of people recorded (2011/12) (2010/11) and Welsh Government (2012c)
as having an NHS sight test Wales
Patient eligibility for
under one of the low income
inclusion in “low income”
eligibility criteria
group:
• Adults receiving income
support
• Adults receiving tax
credits
• Low income certificate
49
holders (HC2)
50
20. Outpatients – Total 7.67 million 7.46 million Up UK NHSIC (2012c)
number of NHS outpatient (2011/12) (2010/11) Welsh Government (2012d)
ophthalmology appointments ISD (2012d)
DHSSPS (2012b)
21. New outpatients – 2.01 million 2.05 million Down UK NHSIC (2012c)
Number of NHS outpatient (2011/12) (2010/11) Welsh Government (2012d)
ophthalmology appointments ISD (2012d)
for new patients DHSSPS (2012b)
22. DNAs – Percentage of Up Wales, Welsh Government (2012d)

new outpatients who did not Scotland ISD (2012d)
attend their appointment: and DHSSPS (2012b)
Northern
a) Wales a) 5.8 per cent a) 5.4 per cent
Ireland
b) Scotland b) 9.0 per cent b) 8.9 per cent
c) Northern Ireland c) 7.0 per cent c) 6.8 per cent
(2011/12) (2010/11)
23. Inpatients – Number of 720,000 727,000 Down UK NHSIC (2012d)

NHS ophthalmology inpatients (2011/12) (2010/11) NHS Wales (2012)
and day cases ISD (2012e)
Sight loss UK 2013

DHSSPS (2012c)
24. Waiting times – Down England DH (2013b)
Percentage of NHS
ophthalmology referrals which
The latest evidence

require treatment that were
not completed within the 18
weeks referral to treatment
guidelines for:
a) admitted patients a) 6.3 per cent a) 8.0 per cent
b) non-admitted patients b) 2.5 per cent b) 3.0 per cent
(2012) (2011)
25. Age-related macular £155 million £129 million Up England HSCIC (2012e)
degeneration (AMD) – (2011) (2010)
Expenditure on Lucentis
injections
26. Diabetic retinopathy: 80.9 per cent 79.3 per cent Up England NSC (2012)
uptake – Proportion of (2011/12) (2010/11)
people offered screening who
were screened
51
52
27. Diabetic retinopathy: 73.9 per cent 72.6 per cent Up England NSC (2012)
coverage – Proportion (2011/12) (2010/11)
of people diagnosed with
diabetes who were screened
28. Cataract – Number of 396,000 401,000 Down UK HSCIC (2012d)

NHS cataract operations (2011/12) (2010/11) NHS Wales (2012)
ISD (2012e)
DHSSPS (2012c)
29. Glaucoma – Total spend £132.3 million £129.4 million Up UK HSCIC (2012f)
on glaucoma prescriptions (2011) (2010) Welsh Government
(2012e)
ISD (2012f)
BSO (2012)
30. Certification – Number 25,079 23,926 Up England RNIB (2013a)

of new Certificates of Vision (2011/12) (2010/11) and
Impairment issued in 2011/12 Wales
Sight loss UK 2013

31. Rate of certification Not available – England Public Health England
– Number of new CVIs per (2013)
100,000 people in 2010/11:
The latest evidence

a) AMD for those aged 65 a) 109.4
and over
b) Glaucoma for those aged b) 11.8
40 and over
c) Diabetic eye disease for c) 3.59
those aged 12 and over
d) All causes for all age groups d) 43.1
(2010/11)
Early reach
32. Early intervention – 48 per cent Not available – UK RNIB (2013b)
Percentage of hospitals that (April 2013)
have some form of support
in their eye clinics
53
54
Early reach
33. Qualified support – 27 per cent Not available – UK RNIB (2013b)
Percentage of hospitals that (April 2013)
have qualified support in their
eye clinics
34. Rehabilitation – Number 600 Not available – UK SCA (2012)

of Rehabilitation Officers (May 2012)
Independence
35. Depression – Proportion 34 per cent Not available – Britain McManus and Lord
of people with sight loss who (2012)
say that they feel unhappy or
depressed
36. Health – Proportion of 55 per cent Not available – Britain McManus and Lord
people with sight loss who are (2012)
dissatisfied with their health
Sight loss UK 2013

37. Dissatisfied – Proportion 25 per cent Not available – Britain McManus and Lord
say that they are dissatisfied
The latest evidence

with their life overall
38. Free time – Proportion of 34 per cent Not available – Britain McManus and Lord
people living with sight loss (2012)
who say that they have little
or no choice over how they
spend their free time
39. Mobility – Proportion of 49 per cent Not available – Britain McManus and Lord
who say that they experience
difficulties getting into or
moving around buildings
40. Reliance – Proportion of 80 per cent Not available – Britain McManus and Lord
people with sight loss who say (2012)
that they receive support from
family members
55
56
Independence
41. No choice – Proportion 20 per cent Not available – Britain McManus and Lord
say that they rarely or never
have a say over the help or
assistance they receive
42. Social care – Number 36,085 48,665 Down England Byron, Blake and Bridges
of blind and partially sighted (2011/12) (2008/09) (2013)
people in receipt of adult
social care services in England
43. Hardship – Proportion of 41 per cent Not available – Britain McManus and Lord
that they have some or great
difficulty in making ends meet
44. Income – Proportion of 49 per cent Not available – Britain McManus and Lord
that they live in a household
with a total income of less
than £300 a week
Sight loss UK 2013

45. Warmth – Proportion of 14 per cent Not available – Britain McManus and Lord
who say that they could not
The latest evidence

afford to keep their home
adequately warm
46. DLA – Number of blind 72,200 69,800 Up Britain DWP (2013a)

and partially sighted people (August 2012) (May 2011)
claiming Disability Living
Allowance
47. Attendance Allowance – 54.500 56,900 Down Britain DWP (2013b)

Number of blind and partially (August 2012) (May 2011)
sighted people claiming
Attendance Allowance
48. Educational attainment Up England DfE (2012)
– Proportion of pupils with
a primary SEN of visual
impairment who achieved:
a) “Good level of a) 35 per cent a) 32 per cent
development” in early years
teacher assessments
b) Five or more GCSE grades b) 43.9 per cent b) 39.4 per cent
A*–C, including Maths and (2011) (2010)
57
English
58
Independence
49. Unmet need – Proportion Two out of Not available – England Keil (2012)
of local authority Visual every five
Impairment services that say
they are unable to meet the
needs of at least one group of
children and young people
50. Further education – 14,900 17,360 Down England SFA (2012)

Number of adult learners (2010/11) (2009/10)
in Further Education who
are known to have a visual
impairment
51. Higher education – 3,520 3,615 Down England HESA (2013)

Number of students in Higher (2011/12) (2010/11)
Education who are known to
have a visual impairment
52. Labour market – 66 per cent Not available – Britain McManus and Lord
Proportion of people with (2012)
sight loss who say that they
experience restrictions in
being able to access and fully
participate in employment
Sight loss UK 2013

53. Employment – 46.9 per cent 48.8 per cent Down UK Hewett (2013)
Percentage employment (2012) (2010)
rate of people who are “long
The latest evidence

term disabled with a seeing
difficulty”
Inclusion
54. Travel – Proportion of 61 per cent Not available – UK Slade (2013)
blind and partially sighted
people who need help to get
out of the house
55. Trains – Proportion of blind 53 per cent Not available – UK Slade (2013)
and partially sighted people who
are not able to travel on trains as
much as they would like
56. Buses – Proportion of blind 42 per cent Not available – UK Slade (2013)
and partially sighted people who
are not able to travel on buses as
much as they would like
59
60
Inclusion
57. Shopping – Proportion 82 per cent Not available – UK Slade (2013)
of blind and partially sighted
people who need help to go
shopping
58. Everyday necessities – 50 per cent Not available – UK McManus and Lord
Proportion of people living (2013)
with sight loss who say that
they need help to shop for
everyday necessities
59. Online shopping – 62 per cent Not available – UK Slade (2013)

Proportion of blind and
partially sighted people who
were not able to shop online
60. Money – Proportion of 50 per cent Not available – UK Slade (2013)

people who need help to
manage their money
Sight loss UK 2013

Inclusion
61. Cash – Proportion of blind 11 per cent Not available – England Edwards (2011)
The latest evidence

and partially sighted people
who can use a cash machine
on their own
62. Reading – Proportion of Up UK Creaser (2012)

the top 1,000 books in 2011 Traditional alternative
that can be accessed by blind formats are human
and partially sighted people: speech (ie read by
a) traditional alternative a) 17 per cent a) 15 per cent human voice) audio, hard
formats only copy braille and hard
b) including eBooks b) 76 per cent b) 54 per cent copy large print
(2011) (2010)
To qualify as an
accessible eBook the title
must be capable of being
read in audio or large
print without additional
access technology, or
read as electronic braille
with the additional of an
electronic braille display,
without sighted
61
assistance
62
63. eBooks – Proportion of 27 per cent Not available – UK Slade (2013)
people who read books that
have read an eBook or have
used an eBook device
64. Television – Proportion 23.1 per cent 24.1 per cent Down UK Ofcom (2013)
of TV programmes that (2012) (2011) Figure based on channels
are broadcast with audio that have audio
description description obligations,
rather than across every
available channel
65. AD usage – Proportion 54 per cent Not available – UK Slade (2013)

people who read books that
say that they have watched
a television programme using
audio description
Sight loss UK 2013

66. Computers – Percentage Not available – UK Slade (2013)
people who use a computer:
The latest evidence

67. Digital exclusion – 87 per cent Not available – UK Edwards (2012)

Proportion of blind and
partially sighted people aged
65 and over who say that they
have never used the internet
68. Mobile phones – Not available – UK Slade (2013)

Percentage of blind and
partially sighted people who
use a mobile phone:
63
64
European and world sight loss
69. Global sight loss – 285 million 285 million No Global WHO (2012)
Number of people living with change
sight loss worldwide
70. European sight loss – 30 million Not available – Europe EBU (2013)
Number of people living with
sight loss in Europe
Sight loss UK 2013

Notes

NB magazine for professionals
All the latest news, views and developments in the
eye health and sight loss sectors are at your fingertips.
All in one place.
Read NB magazine free at rnib.org.uk/nbmagazine
or call 0303 123 9999
© RNIB May 2013

Registered charity number 226227

NB poster_A3.indd 1 07/05/2013 14:22
The UK Vision Strategy 2013–2018
Five years after launching the
UK Vision Strategy, the Strategy
has been refreshed to ensure it
continues to prioritise the most
important issues from 2013
onwards.
The refreshed outcomes:
Strategy Outcome 1
Everyone in the UK looks after their
eyes and their sight.
Strategy Outcome 2
Everyone with an eye condition
receives timely treatment and, if
permanent sight loss occurs, early
and appropriate services and support
are available and accessible to all.
Strategy Outcome 3
A society in which people with sight
loss can fully participate.
We now need your help in turning the Strategy into a reality
Find out how you can get involved

Visit our website www.vision2020uk.org.uk/ukvisionstrategy or email us at
ukvisionstrategy@rnib.org.uk Follow us on Twitter @UK_Vision
Sight loss UK 2013 is an annual evidence review, based on 70 key indicators that
show us what life is like for people with experience of sight loss, their carers and
those at risk of sight loss.
This data summary provides the latest evidence related to the lives of people
with sight loss and information about the factors affecting people at risk of sight
loss. The aim is to assist the strategic thinking across the sector and help us work
together to improve the lives of blind and partially sighted people and take the
steps we need to prevent avoidable sight loss.
Royal National Institute of Blind People

Evidence and Service Impact team
105 Judd Street
London WC1H 9NE
0303 123 9999
research@rnib.org.uk
rnib.org.uk/research
© RNIB May 2013 Registered charity no. 226227

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Sight loss UK 2013

The latest evidence

1. Living with sight loss and those at risk of sight loss 6

2. Cost of sight loss 12

3. Prevention of sight loss 15

7. European and world sight loss 37

Appendix B: Dashboard of indicators 44

2 Sight loss UK 2013

Lesley-Anne Alexander CBE

The latest evidence 3

4 Sight loss UK 2013

• Piflease contact RNIB’s Evidence and Service Impact team at research@rnib.org.uk

The latest evidence 5

2. Blindness – Number of people in the UK living 224,000 Up

3. Registration – Number of people in the UK 358,000 Down

4. Children and young people – Number of 25,000 –

5. Older people – Number of people in the UK aged 14.2 million Up

6. Later life – Number of people in the UK aged 1.4 million Up

7. Low income – Number of people in the UK 13.0 million Down

8. Diabetes – Number of people in the UK who are 3.0 million Up

9. Smoking – Proportion of adults in the UK 20 per cent Down

10. Learning disabilities – Number of adults with a 96,500 –

6 Sight loss UK 2013

Living with sight loss

Registered blind and partially sighted

The latest evidence 7

8 Sight loss UK 2013

The latest evidence 9

Minority ethnic groups

Severity of sight loss:

Age of people living with sight loss:

Projected increase in people living with sight loss:

Registration by age in England:

The latest evidence 11

12. Primary care costs – Expenditure on providing £496 million –

13. Inpatient costs – Expenditure on providing £536 million –

14. Outpatient costs – Expenditure on providing £677 million –

15. Cost of care – Cost of providing residential and £370 million Up

16. Indirect costs – Total cost of unpaid care, £5.3 billion Up

12 Sight loss UK 2013

The latest evidence 13

Facts and figures

Breakdown of NHS expenditure in England on “problems of vision”:

14 Sight loss UK 2013

18. Rate of sight tests – Rate of NHS sight tests Up

19. Low income sight tests – Number of people 1,927,000 Down

20. Outpatients – Total number of NHS outpatient 7.67 million Up

21. New outpatients – Number of NHS outpatient 2.01 million Down

22. DNAs – Percentage of new outpatients who did Up

23. Inpatients – Number of NHS ophthalmology 720,000 Down

24. Waiting times – Percentage of NHS Down

25. Age-related macular degeneration (AMD) – £155 million Up

The latest evidence 15

27. Diabetic retinopathy: coverage – Proportion 73.9 per cent Up

28. Cataract – Number of NHS cataract operations 396,000 Down

29. Glaucoma – Total spend on glaucoma £132.3 million Up

30. Certification – Number of new Certificates of 25,079 Up

31. Rate of certification – Number of new CVIs –

16 Sight loss UK 2013

• 23,559 NHS sight tests for every 100,000 people in England

The latest evidence 17

18 Sight loss UK 2013

The latest evidence 19

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The latest evidence 39