Number of Adults and Children Certified with Sight Impairment and Severe Sight Impairment

Number of adults and children certified with sight impairment and severe sight impairment in England and Wales: April 2012 to March 2013

1 Background This research briefing presents the findings from analysis of the CVI data in England and Wales covering the period 2012 to 2013. The briefing is the fifth in a series of reports examining CVI data. The research is part of an RNIB research grant awarded to Moorfields Eye Hospital to support the ongoing analysis of CVI data.

The Certifications Office, based at Moorfields Eye Hospital in London, undertakes annual collection and analysis of epidemiological data contained on the CVI form. The work is conducted under the auspices of the Royal College of Ophthalmologists.

The certificate of vision impairment (CVI) was introduced in England in September 2005 and in Wales in April 2007. It is used by Consultant ophthalmologists to formally certify a person as either severely sight impaired (SSI; blind) or sight impaired (SI; partially sighted).

2 Method The method used to collect and analyse the CVI data is described in detail in CVI Report No 3: Number of adults and children certified with sight impairment and severe sight impairment in England and Wales: April 2010–March 2011.

CVI data 2012–2013 v1.0 Page 1 of 5 In brief, the Certification Office at Moorfields Eye Hospital queried the CVI database to retrieve all certificates with dates of certification between 1st April 2012 and 31st March 2013. The variables under examination were:

 Country of certification: England or Wales;  Visual status: SSI, SI or unrecorded;  Age group: 0–17 years, 18–64 years, 65–74 years, 75 years and over;  Diagnosis: Age-related macular degeneration (AMD), glaucoma and diabetic eye disease (coded using the International Classification of Disease (ICD-10).

The total number of certifications was calculated for all ages in England and Wales. The number of adults (18 years and above) and children (0 to 17 years old) certified in each country was also calculated.

The number and proportion of certifications due to AMD, glaucoma and diabetic eye disease was calculated according to the categories specified in the Public Health Outcomes Framework for England Preventable sight loss indicator. That is, new CVIs due to AMD in people aged 65+ years; new CVIs due to glaucoma in people aged 40+ years; and new CVIs due to diabetic eye disease in people aged 12+ years.

Crude rates of certification were based on the Office for National Statistics report: Annual Mid-year Population Estimates for England and Wales, 2012 (published 26 June 2013).

3 Key messages from the research 3.1 Certification figures: England During the year ending 31st March 2013, the total number of CVIs in England was 22,647. Compared with the same 12-month period in 2011 to 2012, this was a decrease of 969 (4 per cent) certificates. The CVIs in England comprised:

CVI data 2012–2013 v1.0 Page 2 of 5  21,230 adult certifications, of which 9,197 (43 per cent) were certified SSI and 11,643 (55 per cent) were certified SI. 390 (2 per cent) did not specify visual status.

 1,280 child certifications of which 533 (42 per cent) were certified SSI and 716 (56 per cent) were certified SI. 31 (2 per cent did not specify visual status).

3.2 Certification figures: Wales The total number of CVIs in Wales from April 2012 to March 2013 was 1,362. This was a decrease of 101 (7 per cent) certifications compared with the same period in 2011 to 2012. The CVIs in Wales comprised:

 1,302 adult certifications of which 602 (46 per cent) were certified SSI and 660 (51 per cent) were certified SI. 40 (3 per cent) did not specify visual status).

 55 child certifications of which 18 (33 per cent) were certified SSI and 32 (58 per cent) were certified SI; 5 forms (nine per cent) did not specify visual status.

3.3 Certification and age The age profiles of certification were similar in England and Wales. Approximately 6 per cent of certifications were children and young people aged 0 to 17 years. People aged 75 years and over represented the vast majority of those certified, accounting for nearly two-thirds of all certifications. Adults aged 18 to 64 years old accounted for approximately one-in-five certifications.

The percentages of certifications for each age group are given here:

 0–17 years: six per cent in England and four per cent in Wales;  18–64 years: 20 per cent in England and 18 per cent in Wales;  65–74 years: 10 per cent in England and 12 per cent in Wales;

CVI data 2012–2013 v1.0 Page 3 of 5  75 years and over: 64 per cent in England and 66 per cent in Wales.

3.4 Certification and diagnosis Certifications in England indicated the following diagnoses:

 The number of new CVIs due to AMD in people aged 65+ years was 9,453. This is approximately 42 per cent of certifications;  The number of new CVIs due to glaucoma in people aged 40+ years was 3,291. This is approximately 15 per cent of certifications;  The number of new CVIs due to diabetic eye disease in people aged 12+ years was 1,592. This is approximately 7 per cent of certifications;

Certifications in Wales indicated the following diagnoses:

 The number of new CVIs due to AMD in people aged 65+ years was 642. This is approximately 47 per cent of certifications;  The number of new CVIs due to glaucoma in people aged 40+ years was 192. This is approximately 14 per cent of certifications;  The number of new CVIs due to diabetic eye disease in people aged 12+ years was 98. This is approximately 7 per cent of certifications;

4 In Summary During the period 1st April 2012 to 31st March 2013, the total number of people in England certified blind or partially sighted was 22,647. The crude rate of certification was 42.3 per 100,000 of the population.

The total number of certifications in Wales from the 1st April 2012 to 31st March 2013 was 1,362, giving in a crude rate of certification of 44.3 per 100,000 of the population.

CVI data 2012–2013 v1.0 Page 4 of 5 As with previous years, the age profile of certification was similar in England and Wales. Older adults comprise the majority of individuals certified with a visual impairment in England and Wales. The majority of people were certified sight impaired.

AMD continues to be largest cause of certification in England and Wales. A large number of adults continue to lose their sight due to glaucoma and diabetic eye disease.

5 Acknowledgements The Certifications Office at Moorfields Eye Hospital NHS Foundation Trust performed the collection and analysis of the CVI data.

The data captured by the CVI are Department of Health copyright and this work was made possible by collaboration with the Royal College of Ophthalmologists.

Office for National Statistics. Annual Mid-year Population Estimates for England and Wales, 2012. Accessed online May 2014: http://www.ons.gov.uk/ons/dcp171778_315456.pdf. Office for National Statistics provides estimates of resident population, under the Open Government Licence v1.0.

6 Further information Authors: Shaun Leamon and Malen Davies, RNIB. Email: [email protected]

For more information about RNIB research please visit: http://www.rnib.org.uk/knowledge-and-research-hub

For more information about the work of the Certifications Office at Moorfields Eye Hospital visit: http://ecvi.moorfields.nhs.uk/

RNIB, 2014 Registered charity number 226227

CVI data 2012–2013 v1.0 Page 5 of 5