Up to 75 per cent of sight loss in Ireland is preventable, according to David Keegan, ophthalmic surgeon at the Mater Hospital, Dublin and member of the National Coalition for Vision Health in Ireland. The new coalition of patients’ organisations, voluntary groups and eye specialists believes that public awareness campaigns and clearer “pathways” to diagnosis and treatment of eye conditions once identified are required to prevent unnecessary sight loss.
The four main eye diseases that can be treated and managed if diagnosed early are diabetic retinopathy (DR), cataracts, age-related macular degeneration (AMD) and glaucoma. All of these conditions are more likely to occur as people age and with Ireland’s ageing population, they are all on the increase.
Des Kenny, Chief Executive of the National Council for the Blind in Ireland (NCBI) says it is crucial that we pay much more attention to our eye health as we grow older. “Many older people – particularly in nursing homes – don’t have their eyes tested routinely and their glasses upgraded. The State offers free eye tests to everyone over 70 every two years... and everyone over fifty should also have their eyes checked every two years,” he says. Internationally, five per cent of people in their 60s suffer from age-related eye conditions. This rises to one in 14 for those in their 70s and almost every second person from eighty upwards has some age-related eye condition.
The National Coalition for Vision Health in Ireland was formed last year to develop a strategy for eye health in advance of the forthcoming HSE’s National Programme for Eye Care. “We want to work with hospitals to reduce the number of people reaching the NCBI services who shouldn’t be if the primary health services were carefully developed,” says Kenny.
David Keegan says “the problem now is that people present late with eye problems which results in sight loss that may or may not be recoverable”. Keegan recommends that people over 40 with a family history of glaucoma, age-related macular degeneration or diabetes retinopathy have their eyes checked every year by their optician. “People accept sight loss as a part of ageing but our message is – don’t ignore symptoms of sight loss,” says Keegan.
Age-related Macular Degeneration is the most common form of age-related sight loss – Keegan is keen to point out how essential treatment is for the wet form of AMD. “The arrival of injections allows us to arrest the progression of this condition but if it has developed, we are not so good at reversing its progression,” he says. A Danish study found the incidence of legal blindness attributed to AMD decreased by 50 per cent over a ten-year period when a more structured approach to vision health was adopted.
The expert group acknowledges that some eye care services have already been improved, such as the new diabetic retinopathy screening programme. “This screening programme is calling all diabetes patients over 12 and will identify those with sight-threatening diabetes retinopathy and refer them for treatment,” says Keegan. “It will take two years to roll out to the 145,000 patients with diabetes but other countries have shown the benefits of such screening programmes.” Once diagnosed, those with RD are treated with either laser surgery or injections into their eyes.
Glaucoma is another serious eye disease that can be symptomless for some time. “We would recommend those who have a history of glaucoma in their family have their eyes checked annually,” says Keegan. Other risk factors for glaucoma are short-sightedness, diabetes and being of African origin. Here again, early diagnosis is crucial to prevent sight loss and allow the condition to be managed correctly.
Cataracts are another problem that require better management within the public health services. Public patients can wait for up to nine months to be assessed for cataracts and then may wait a further nine months for surgery, according to Keegan.
In terms of the “pathway” for diagnosis and treatment, the National Coalition for Vision Health in Ireland has already submitted its suggestions to the forthcoming HSE’s National Programme for Eye Care. The coalition believes that their National Vision Strategy – with its key aim to prevent avoidable sight loss – will complement the forthcoming National Programme for Eye Care.
The key issue for public patients is whether this forthcoming eye care programme will give people timely access to diagnosis and treatment, once a potential problem is picked up by a GP or optician.
“The point is that if we invest in awareness programmes for preventable eye disease and interventions for those diagnosed with the conditions, we will save in the long term because people will be able to work longer and not be reliant on social welfare,” says Kenny.
Or as David Keegan puts it: "The cost of blindness avoidance – through investment in education campaigns and resources for treatment will lead to a long term economic gain and that's without even talking about the personal gains to all the people who continue to have their sight."
TREATABLE EYE DISEASES IN IRELAND
n Diabetic Retinopathy: This condition develops when the blood vessels in the retina leak. The main treatments are laser surgery or injections into the eyes to block the growth of abnormal blood vessels.
n Age-related Macular Degeneration: There are two forms – dry and wet. Dry AMD, which is more common, develops slowly, eventually leading to loss of vision. Wet AMD results in sudden sight loss and is reversible if treated quickly with surgery or injections into the eyes. n Cataracts: This happens when the eye's lens becomes cloudy, causing impaired vision. Cataracts can be surgically removed and replaced with an artificial lens.
n Glaucoma: The commonest form is symptom free until there is permanent loss of vision. It happens with increased pressure within the eyeball which causes damage to the delicate nerve cells and results in the loss of "all round" sight outside the central vision. If left untreated, it feels like you are looking through a tube. n See also: National Council for the Blind Ireland website, ncbi.ie or LoCall 1850 334353.
