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PHE publishes first ever Vision Atlas for England

Public Health England (PHE) have published the first ever Vision Atlas, looking at the geographical variation in risk factors and healthcare for eye health across England.

The new vision atlas represents the first PHE output solely focused on eye health.

The atlas brings together 32 indicators across the whole vision patient pathway, from describing populations at risk of poor eye health, through screening to healthcare services, and health outcomes. The atlas provides new analyses of hospital eye services including outpatient appointments, intravitreal injections, cataract and retinal detachment surgery.

As with all Atlases of Variation as well as providing up to date analysis PHE has worked closely with expert clinicians to provide the context, reasons for variations, options for actions and resources for healthcare providers and commissioners.

This Atlas presents data and advice to support CCGs, ICS, commissioner and providers in tackling the key issues in eye care to support the National Eye Care Restoration and Transformation Programme to rapidly recover eye services and to drive forward long-term developments and solutions to improve services and cater for future demand.

This Atlas brings together key information for local areas on actions they can take to tackle the key risk factors for eye disease – preterm birth, smoking, obesity, physical activity, and diabetes.

The Atlas also presents provisional data for 2020 and 2021 that show significant reductions in outpatient attendances and procedures for eye health during the pandemic.

Link to vision atlas:

Atlas of variation in risk factors and healthcare for vision in England

PHE Atlas of Variation in risk factors and heathcare for vision in England

If you are interested in finding out more:

  • Find out about the public health role of orthoptists here.

  • More information about the advanced and extended roles taken on by orthoptists is available on our CAG pages.

  • Read the full Atlas of Variation in vision here.

Key themes

In the past decade, the introduction of new interventions for previously untreatable eye chronic conditions has transformed service provision and clinical practice, generating multiple episodes of care. These have all contributed to the rising rates of service activity and their variations for example for outpatient attendances and intravitreal injection procedures. Ophthalmology is now the largest outpatient speciality in England. The atlas shows there were 9 million outpatient attendances for vision in 2019/20.

The atlas covers the years immediately prior to the coronavirus (COVID-19) pandemic, providing a baseline and resource for monitoring the impact of the actions to be taken subsequently for the recovery and transformation of eye health services, their organisation and delivery; and the implementation of integrated care systems.

The older you are, the greater the risk of sight loss. Of the 9 million all vision outpatient attendances in England 56% were for people aged 65 years and older. Men and women in the 85 to 89 year old age group have the highest age-specific population rates for outpatient attendances. Overall, nearly 1 in 4 individual people in the 85 to 89 age group had a vision outpatient appointment in 2019/20.

Highlights from indicators

indicators with high numbers:

  • In 2019/20 there were 9 million outpatient attendances for vision in England
  • 4 million individual patients of all ages attended appointments during 2019/20
  • In 2019/20 there were 2.2 million outpatient first attendances for vision in England
  • In 2019/20 there were over 380,000 cataract surgeries in those aged 65 year and over in England

indicators with increasing rates:

  • All vision outpatient attendances have seen an increase of 37.6% in attendances from 2009/10 to 2019/20
  • The England rate of all intravitreal injection therapy procedures in people aged 60 years and over has more than double in the past 7 years (over 600,000 in 2019/20)
  • The England rate of admission to hospital for all cataract surgery in people aged 65 years and over has seen an increase of 16% from 2014/15 to 2019/20.
  • The England rate of all rhegmatogenous retinal detachment surgery in people aged 18 years and over has seen an increase of 36% from 2014/15 to 2019/20.

indicators with high CCG variation:

  • Variation in rate of all intravitreal injection therapy procedures in people aged 60 years and over (2019/20) was 188.6-fold difference between CCGs. Although it should be noted differences in organisational practice are likely to be the major, systematic factor contributing to the variation.
  • Variation in rate of first intravitreal injection therapy procedures in people aged 60 years and over (2019/20) was 29.5-fold difference between CCGs
  • Variation in rate of registered blind or partially sighted people aged 75 years and over (2019/20) was 26.2 fold difference between UTLAs

Covid period decreases:

  • In 2020 there were 6.5 million all vision outpatient attendances, a 29% decrease from 2019
  • In 2020 there were 1.4 million all vision outpatient first attendances, a 38% decrease from 2019
  • There were 550,000 intravitreal injections in 2020, a 9% decrease on 2019. However, in the same time period the number of first intravitreal injections decreased by 19% (a decrease of 7,200)
  • Cataract surgery has decreased by over 40% in the year 2020 compared to the previous year. In the 2020 there were 227,000 admissions for cataract surgery compared to 392,000 in 2019
  • Rhegmatogenous retinal detachment surgery decreased in 2020 by 11% when compared to the previous year with 1,200 fewer surgeries being carried out

Age:

  • Of the 9 million vision outpatient attendances in 2019/20, 5 million of them were seen in the over 65s which is 56% of all vision outpatient attendances.
  • In 2019/20, 3.4 million people attended a vision outpatient appointment. The over 65 age group made up 51% of all vision outpatients, this age group makes up 17% of the population.

Indicator summaries

All vision outpatient attendances

  • All vision outpatient attendances have seen an increase of 37.6% in attendances from 2009/10 to 2019/20.
  • In 2019/20 there were 9 million outpatient attendances for vision in England, 15,960 per 100,000 population.
  • CCG values ranged from 9,821 to 24,131 per 100,000 population, a 2.5-fold difference between CCGs.
  • The median rate increased significantly from 2013/14 to 2019/20.
  • In 2020 there were 6.5 million all vision outpatient attendances, a 29% decrease from 2019.

All vision outpatient attendances (persons based)

  • Many patients require regular ongoing follow-up appointments and treatments to prevent further sight loss.
  • Approximately 3.4 million individual patients of all ages attended appointments during 2019/20, 5,969 per 100,000 population.
  • CCG values ranged from 4,404 to 8,248 per 100,000 population, which is a 1.9-fold difference between CCGs.
  • The median rate increased significantly from 2013/14 to 2019/20. Both the 95th to 5th percentile gap and the 75th to 25th percentile gap widened significantly.

All vision outpatient first attendances

  • First attendance rates are a proxy indicator of new demand for services in any one year.
  • In 2019/20 there were 2.2 million outpatient first attendances for vision in England, 3,803 per 100,000 population.
  • CCG values ranged from 2,266 to 8,027 per 100,000 population, which is a 3.5-fold difference between CCGs.
  • In 2020 there were 1.4 million all vision outpatient first attendances, a 38% decrease from 2019.

All intravitreal injection therapy procedures in people aged 60 years and over

  • Patients classified as having medium and low risk clinical conditions had their management delayed or rescheduled for at least 3 to 6 months later. This is reflected in the significant reduction in activity for first and all episodes during the first wave of the pandemic (April to June 2020).
  • Approximately 608,000 intravitreal injection procedures were performed for persons aged 60 years and over in 2019/20, 4,411 per 100,000 population.
  • CCG values ranged from 49 to 9,277 per 100,000 population, which is a 188.6-fold difference between CCGs. Although it should be noted differences in organisational practice are likely to be the major, systematic factor contributing to the variation.
  • The median rate increased significantly from 2013/14 to 2019/20. Both the 95th to 5th percentile gap and the 75th to 25th percentile gap widened significantly.

First intravitreal injection therapy procedures in people aged 60 years and over

  • Approximately 38,800 first procedures were performed on persons aged 60 years and over during 2019/20, 281.7 per 100,000 population.
  • CCG values ranged from 16.6 to 490.2 per 100,000 population, which is a 29.5-fold difference between CCGs.
  • The was no significant change in the median rate increased significantly from 2013/14 to 2019/20.

Admission to hospital for cataract surgery in people aged 65 years and over by CCG (2019/20)

  • Since the onset of the coronavirus (COVID-19) pandemic in March 2020, clinical activity has been prioritised to manage conditions at high risk of losing sight, with all routine care including cataract surgery delayed. Inevitably, as seen in figure 3.1 of the atlas, this resulted in a sharp drop in surgical activity during the first (April to June 2020) and second (December 2020 to February 2021) wave of the pandemic
  • Approximately 384,000 (3,660 per 100,000 population) cataract surgeries were performed for persons aged 65 years and over in 2019/20,
  • CCG values ranged from 2,462 to 5,299 per 100,000 population, which is a 2.2-fold difference between CCGs.
  • The median rate increased significantly from 2013/14 to 2019/20.

Admission to hospital for first cataract surgery in people aged 65 years and over by CCG (2019/20)

  • The England value for 2019/20 was 2,086 per 100,000 population.
  • CCG values ranged from 1,371 to 2,943 per 100,000 population, which is a 2.1-fold difference between CCGs.
  • The median increased significantly from 1,948 per 100,000 population in 2013/14 to 2,152 per 100,000 population in 2019/20.

Admission to hospital for second cataract surgery within 12 months in people aged 65 years and over by CCG (2019/20)

  • Over 123,000 operations were performed on the second eye within 12 months of the first eye operation. This represents 32% of all cataract operations performed in 2019/20 (384,000)
  • The England value for 2019/20 was 1,175 per 100,000 population.
  • CCG values ranged from 584 to 2,053 per 100,000 population, which is a 3.5-fold difference between CCGs.

Rate of rhegmatogenous retinal detachment surgery in people aged 18 years and over by CCG (2019/20)

  • The England value for 2019/20 was 23.5 per 100,000 population.
  • CCG values ranged from 6 to 40.5 per 100,000 population, which is an 8.9-fold difference between CCGs.
  • The median increased significantly from 18.8 per 100,000 population in 2013/14 to 23.4 per 100,000 population in 2019/20.

Percentage of those offered diabetic eye screening who attend a routine digital screening event (where images were captured) in people aged 12 years and over by CCG

During the latest period (2018/19), CCG values ranged from 73.8% to 92.1%, which is a 1.2-fold difference between CCGs.

The England value for 2018/19 was 83.2%

Overall, uptake of diabetic eye screening met the acceptable standard in the financial year beginning 2018

Percentage of urgent referrals for diabetic eye disease (referred proliferative diabetic retinopathy [R3A]) seen within 6 weeks of screening event in people aged 12 years and over by DESP area

  • DESP area values ranged from 33.3% to 94.6%, which is a 2.8-fold difference between DESP areas.
  • The England value for 2018/19 was 77.9%.
  • Approximately half DESP areas met the acceptable standard.

Percentage of routine referrals for diabetic eye disease (referred pre-proliferative diabetic retinopathy [R2] or maculopathy [M1]) seen within 13 weeks of screening event in people aged 12 years and over by DESP area

  • DESP area values ranged from 15.3% to 88.4%, which is a 5.8-fold difference between DESP areas.
  • The England value for 2018/19 was 53.2%.
  • The mean England value for review of routine referrals within 13 weeks was below the acceptable standard of 70%, with marked variation across England.

Incidence rate of uveal, retinal and conjunctival cancers by Cancer Alliance (2013-2018)

  • It is possible that variation in the reported incidence may reflect previously undetected variation in the quality of submissions to the National Cancer Registrations Dataset.
  • Cancer alliance values ranged from 0.8 to 1.7 per 100,000 population, which is a 2.2-fold difference between cancer alliances.
  • The England value for 2013-2018 was 1.2 per 100,000 population.
  • Ethnicity and skin type are important risk factors for ocular tumours in adults. The variation seen within England may be partly explained by differences in demography throughout the country and in differences in patient’s willingness to seek hospital care.
2021-08-17T11:03:33+01:00