The purpose of the Health Needs Assessment is to describe the eye health of adults in Derby and Derbyshire, including risk factors, protective factors, prevalence of serious eye conditions, and resultant service use. It also makes recommendations in order to improve eye health and reduce inequalities. It has been written to inform the CCG led capacity review of Ophthalmology services in Derbyshire.
The eye conditions in scope are glaucoma, age-related macular degeneration, diabetic retinopathy, cataracts and minor eye conditions.
Risk and protective factors
The risk factors for eye conditions include age, ethnicity, learning disability, obesity, diabetes, smoking, hypertension, stroke, dementia, and deprivation. The prevalence of each of these is increasing, which is driving the increase in eye conditions. Some of this risk is modifiable with appropriate public health action and a focus on prevention.
Protective factors for eye health include reducing or eliminating the modifiable risk factors described above and access to routine screening and where appropriate diabetic eye screening.
Prevalence of eye conditions
The prevalence of eye health conditions is higher in Derbyshire than Derby (apart from glaucoma). When compared to England, Derbyshire rates are higher and Derby rates are lower. The number of people with all eye health conditions is projected to increase – this is due to changes in age structure of the population; increased prevalence in underlying risk factors described above; and improvements in accuracy of diagnosis and recording.
Derby and Derbyshire have higher rates of sight loss than England. Although the rates per 100,000 population are decreasing, the absolute number of people with sight loss is increasing.
Service use for ophthalmology sits across a range of providers: opticians, general practice, secondary care outpatient and inpatients. It is thought that 1% of primary care activity is for minor Eye Conditions.
For secondary care most in area outpatient and day-case referrals are to Derby Teaching Hospitals NHS Foundation Trust (FT) and Chesterfield Royal Hospital NHS FT, followed by Derbyshire Community Health Services NHS FT. A significant amount (27%) of Ophthalmology referrals of Derbyshire residents are to Out of Area providers, primarily Sheffield Teaching Hospitals NHS FT, Stockport NHS FT and Nottingham University Hospitals NHS Trust.
Activity analysis is based on in area patients only. In 2017/18 there were a total of 26,843 referrals into and 145,950 attendances at secondary care ophthalmology outpatient services (a first to follow up ratio of 4.4). The majority of referrals were from Optometrists and General Practice.
The first ophthalmology outpatient appointment may or may not include a procedure and will end with discharge, a follow up appointment or a request to the patient to arrange a follow up at a later date. Approximately 3 in 4 patients do not receive a procedure at their first appointment, and of those approximately 1 in 2 are immediately discharged. Therefore, overall approximately 1 in 3 new appointments do not receive a procedure at that appointment and are immediately discharged.
The most common outpatients procedure is Tomography evaluation of retina (25,252 procedures in 2017/18 at a cost of £2,390,543). This is a diagnostic procedure.
Minor Injury Unit activity mainly relates to the more minor conditions in particular the removal of foreign bodies and minor injuries.
The most common inpatient procedure is Insertion of prosthetic replacement for lens NEC, which is for cataracts. 98.7% of inpatient activity is provided as day-case.
Inequalities in secondary care usage
There is a weak correlation between deprivation and activity which indicate that that there are a range of variables contributing to the activity levels, likely to include the number of older people in a given area, referral practice of primary care, distance from care provider etc.
Service user feedback
Between June and September 2018, Healthwatch undertook a survey with 62 people who had been diagnosed with cataracts within the past two years. The survey found that the majority of people were very happy with their treatment, but there was potential for improvements in relating to information provision.
There are two key potential areas for change: a revised NICE Quality Standard for Serious Eye Conditions and the use of Avastin for Wet AMD.