Visualise a future…

    Sight is the sense most people would fear losing the most, but
    as a society we spend only 1.6 per cent of the total NHS budget
    (about £1.2bn) to prevent, detect and treat eye disease.
    Typically, eye health services are overloaded and

    Government also spends relatively little to support independent
    living for people with sight loss, in total about £1.1bn. Key
    services such as low vision, rehabilitation, social support,
    community equipment, disability benefits and accessible transport
    are generally under-funded and under-developed.

    In the absence of adequate statutory services for blind and
    partially sighted people, it is left to family and friends to help
    out – this costs some £1.5bn.(1) This informal support covers
    activities such as help in the home, shopping, reading mail and

    Another £1bn represents productivity loss to the economy,
    due to the much higher unemployment rate experienced by blind and
    partially sighted people. Three out of four people with visual
    impairment are not in paid employment, a figure which has not
    changed significantly over the past 10 years. This also explains
    the poverty and social exclusion of many blind and partially
    sighted people of working age.(2)

    Add these figures together and it gives us an estimate of
    £4.9bn annually for the cost of blindness. If central and
    local government provided quality services across the whole of the
    UK public expenditure would inevitably rise. However, targeted
    expenditure on four areas – prevention, raising awareness, early
    detection and treatment – could help to reduce the overall cost to
    society of sight loss, as well as saving sight.

    It is crucial that government invests in awareness campaigns to
    alert the public to health issues such as the proven link between
    smoking and sight loss, the importance of regular eye tests, in
    providing proven, sight-saving treatments.

    As well as this investment, which will in time pay off by
    reducing the incidence of sight problems, more expenditure is also
    required on the key areas of low vision services, community care
    and equipment, disability benefits, transport and employment
    support. These areas would assist blind and partially sighted
    people to be more independent and help some contribute to the
    economy through work.

    This investment is needed now. Sight problems are experienced
    predominantly by older people. By 2020, it is estimated that the
    number of people over 60 in the UK will increase by 24 per cent.
    The increase in the over-80 age group is sharper still. The
    incidence of visual impairment is projected to rise by about 35 per
    cent by 2020, largely accounted for by the increase in numbers of
    older people. This will mean a sharp rise in demand for services to
    prevent and treat eye disease, as well as services to support
    independent living.

    In the cases of primary and secondary eye care, services need to
    be developed and modernised in a way that makes the most efficient
    use of resources and staff skills.

    Agencies, professionals and voluntary groups are aware of the
    fragmented nature of services available to people with sight
    problems. The gaps between medical intervention, low vision
    assessment and social care input vary greatly across the UK. And
    lack of timely intervention is stated as a cause of poor
    rehabilitative outcomes.

    The Royal National Institute of the Blind attempted to start
    addressing these problems in May 2002 in partnership with Camden
    primary care trust, Islington primary care trust and their local
    authorities. They opened a state-of-the-art low vision service
    where rehabilitation workers and optometrists work together as one
    team. This provides greater value as the service is person-centred
    and allows a care plan to be designed that allows the user to make
    the best use of their residual sight and gives them a deeper
    understanding of their visual problem.

    It also makes it possible to apply this information to reduce
    the risk of falls by giving advice regarding restricted visual
    fields and the use of lighting, for example. Reducing the incidence
    of falls cuts costs both in secondary care and on the patient’s
    return to the community.

    Further benefits are that patients are less anxious about
    deterioration of vision, safety at home and about coping with
    everyday life. This increases their ability to maintain an
    independent lifestyle for longer than would be likely otherwise,
    again reducing costs. In addition, the likelihood of depression, so
    common with sight loss, is reduced.

    The RNIB, with primary care trusts, social services and local
    voluntary societies, are setting up two new pilot low vision
    services, one in Barking, Dagenham and Havering, and the other in
    Gateshead. These will open in the autumn. These are part of a wider
    programme of pilot sites that are being funded by the Department of
    Health for two years, with commitment from the PCTs to continue
    funding after this.

    This initiative came about following the publication of the
    first report of the National Eye Care Steering Group set up by the
    DoH in 2002 to review the issues around the fragmented nature of

    The pilot sites aim to provide integrated services and ensure
    easy access for all people in relation to a number of sight
    problems or eye conditions, including glaucoma, age-related macular
    degeneration, cataracts and low vision. Lessons learned from the
    pilots will be widely shared and implemented by all primary care

    As with the RNIB service in London, these low vision services
    will provide local delivery and users will also be able to take
    advantage of a specialist resource centre and social facilities
    enhancing the “one-stop shop” nature of the service. They will also
    provide a domiciliary service as well as sessions for people with
    special needs. The needs of people from ethnic minority backgrounds
    will be taken into account to ensure equal access to the

    Low vision particularly affects the older population. Seamless,
    integrated provision of both rehabilitation and low vision services
    will be crucial in meeting client needs and of even greater value
    as the number of older people in the population increases.

    Stephen Winyard is head of public policy with the Royal
    National Institute of the Blind. He is responsible for its
    lobbying, campaigning and policy activities. He recently completed
    a visiting fellowship at Nuffield College Oxford, researching the
    cost of blindness in the UK.


    Demographic change and improvements in health care are leading
    to an increasingly elderly population and longer life expectancy.
    This will mean a dramatic increase in demand for services for older
    people with sight problems by 2020. Investing now in prevention,
    raising awareness, early detection and treatment as well as key
    services is the only long-term, sustainable strategy that could
    both reduce spending and save sight.


    1. The Cost of Sight Loss in the UK, RNIB Campaign Report 23,
      contact RNIB on 0845 702 3153
    2. Beyond the Stereotypes, RNIB Campaign Report 22, from RNIB on
      0845 702 3153
    3. First Report of the National Eye Care Steering Group, from DoH
      Publications on 0870 1555 455

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