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Independent publication by 20 / 09 / 2015 #0338 raconteur.net National Eye Health Week 02 Starting tomorrow, National Eye Health Week focuses on the importance of eyecare in the UK, where many neglect their sight It's more than an eye test 03 A thorough eye test at regular intervals can not only check your eyesight, it can detect signs of serious illness Choosing the right contacts 06 Contact lenses are a popular way of correcting vision, but what types are available and how do you choose? Specs with a 'psycho-punch' 07 Wearing glasses can not only change people's perception of you, it can also alter the way you think about yourself Although this publication is funded through advertising and sponsorship, all editorial is without bias and sponsored features are clearly labelled. For an upcoming schedule, partnership inquiries or feedback, please call +44 (0)20 3428 5230 or e-mail info@raconteur.net Raconteur is a leading publisher of special-interest content and research. Its publications and articles cover a wide range of topics, including business, finance, sustainability, healthcare, lifestyle and technology. Raconteur special reports are published exclusively in The Times and The Sunday Times as well as online at raconteur.net The information contained in this publication has been obtained from sources the Proprietors believe to be correct. However, no legal liability can be accepted for any errors. No part of this publication may be reproduced without the prior consent of the Publisher. © Raconteur Media BUSINESS CULTURE FINANCE HEALTHCARE LIFESTYLE SUSTAINABILITY TECHNOLOGY INFOGRAPHICS raconteur.net/vision-2015 Distributed in Published in association with LILIAN ANEKWE Consumer health editor at BMJ Group, she is an award-winning medical journalist who has written for New Scientist and New Statesman. JOSH SIMS Freelance writer, he con- tributes to the Financial Times, Wallpaper* and Esquire, and is editor of Viewpoint. LORENA TONARELLI Healthcare journalist, she writes for The Inde- pendent, The Guardian and The Economist, as well as magazines and websites. MARIE WILKINSON Design director of Cutler and Gross, she heads up the creative team for licences with Victoria Beckham, Maison Martin Margiela, Alberta Fer- retti, and most recently Sportmax and Giles. DANNY BUCKLAND Award-winning health journalist, he writes for national newspapers and magazines, and blogs on health innovation and technology. NICKY COLLINSON Freelance writer and editor specialising in the optical sector, she was communications consultant for the British Contact Lens Association. NIGEL HAWKES Science and health jour- nalist, formerly with The Observer and The Times, he is a regular contribu- tor to the British Medical Journal. CONTRIBUTORS RACONTEUR Publishing Manager Conie Rose Wechsler Digital and Social Manager Rebecca McCormick Head of Production Natalia Rosek Design Vjay Lad Grant Chapman Kellie Jerrard Production Editor Benjamin Chiou Managing Editor Peter Archer Seeing the best way forward Provision of eyecare, which appears fragmented and under-resourced, must be increased to meet rising demand from an ageing population OVERVIEW NIGEL HAWKES F ew fears match that of going blind. We value sight more than any other sense and the loss of it is dreaded more than other long-term health conditions such as dementia, heart disease, Parkinson's disease or having to use a wheel - chair, research by the Royal National Insti- tute of Blind People (RNIB) has found. But it is a fear that has to be faced by an ever-grow- ing number of people as the population ages. The numbers living with some degree of sight loss are expected to double from two to four million by 2050. The longer we live the more likely we are to suffer sight loss, with a fifth of over-75s handi - capped by it to some degree. Despite this, sight loss and eye health have a lower priority in health funding than lots of other conditions. "Because you don't die from it, it tends to be trumped by cardiovas - cular disease and cancer, even in areas where they assess the need and eyecare scores quite highly," says Clara Eaglen, eye health cam- paigns manager at the RNIB. A year ago, NHS England raised expec- tations for eyecare with a Call to Action, a report that outlined the issues and called for responses to a series of questions. Nu- merous bodies dutifully responded by the September 2014 deadline in the hope that this might be a chance for eyecare to enjoy a moment in the sun. What followed was a disappointment. NHS England adopted the policy of localism outlined in its Five-Year Forward View and has never responded direct - ly to the ideas its Call to Action provoked. The idea of a National Direc- tor for Eyecare, strong- ly supported by many respondents, fell on deaf ears. "It's a bit of a shame," says Ms Eaglen. NHS England says: "All key feedback put forward by various parties has been incorpo - rated across the fundamental elements of the Five-Year Forward View and the NHS Eng- land Business Plan, and shared with regional eyecare teams to help with the production of David Parkins, president of the College of Optometrists, believes that change is fi- nally happening. He chairs the Clinical Council for Eye Health Commissioning for England, a body set up to provide leader - ship and help co-ordinate the patchwork quilt of overlapping responsibilities. "Given the cur- rent capacity issues in ophthal- mology services and pressures on general practice, the status quo is not sustainable," he says. "The key now is to learn from good examples and replicate them at scale where it makes sense to do so. We cannot afford to keep reinventing the wheel." Eye health services cost the NHS in England around £2.3 bil - lion a year, £500 million of which is spent on sight tests and £1.4 billion on elective care in hos- pitals. The most tractable of eye conditions is cataract, which can be corrected by surgery that costs under £1,000 per eye. It's the commonest operation carried out by the NHS and gets good results. But cash pressures are mounting. local business." In plain English, this means that local teams have been told to pick up the baton and run with it. Regional eyecare teams are one of a plethora of advisory, consul - tative and executive bodies en- trusted with our sight. Few servic- es in the NHS are as fragmented. NHS England is responsible for sight tests, but if anything slightly complicated emerges, such as the need for follow-up tests for glau - coma, it's the job of the 200-plus clinical commissioning groups (CCGs) to pay. While 90 per cent of hospital referrals to ophthal - mology departments originate with optometrists, the people who do eye tests and mostly oper- ate out of optical practices on the high street, they seldom hear the outcome as there is no systematic system for feedback. GPs deal with minor eye com - plaints, such as conjunctivitis, but anything more complicated has to be referred to a hospital where services are "chaotic and rushed" to quote a recent report by the Eye Health Network for London. There is an almost threefold variation in the number of operations carried out in dif - ferent areas of England, which cannot pos- sibly be explained by a difference in patient numbers. Half of CCGs impose thresholds on who can have an operation and one in three make no provision for treating the second eye. The Royal College of Ophthalmologists' commissioning guide to cataract surgery, published in February, reported that an as - tonishing 90 per cent of commissioning poli- cies contained criteria that followed "neither national guidance nor scientific evidence". Waiting times, which were slashed from two years in 2000 to four months in 2008, are creeping up again. And while waiting for cataract surgery doesn't put eyesight at risk, delays in glaucoma appointments may. The condition is caused by pressure in the eye and affects around 2 per cent of the popula - tion. It causes no pain or symptoms so needs to be detected in eye tests and can then be controlled. But if delays occur, the opportu- nity may be lost. A question in the Welsh Assembly revealed that in 2014 there were at least 26 serious in- cidents of people suffering deterioration of eyesight while on an NHS waiting list. Treatment for wet age-related macular degeneration is one of the success stories of the past decade. But many CCGs believe more could be done. In February, 120 of them joined in a call to allow the replacement of Lucentis, a drug that costs the NHS £245 mil - lion a year, with the similar, but much cheap- er, Avastin. However, Avastin is unlicensed for use in the eye and, although trials show it is roughly equivalent in efficacy, regulators in the UK are reluctant to give the green light to off-label or unlicensed use. The key now is to learn from good examples and replicate them has scale where it makes sense to do so Share this article on social media via raconteur.net PROJECTED NUMBER OF PEOPLE WITH SIGHT LOSS IN THE UK of sight loss can be avoided 50%+ Source: RNIB people aged over 65 are living with sight loss 1/7 Source: Access Economics Source: Access Economics/RNIB 1.9m 2010 2.3m 2020 2.9m 2030 3.5m 2040 4m 2050 Vision. Taken seriously. Vision. Taken seriously VISION

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