Seeing the gap: health inequalities in ophthalmology
By Primary Care Journal-
Increased screen usage throughout the pandemic has not been kind to our eyes. More than one in three people in the UK have reported deteriorating eyesight over the past year due to increased time spent indoors and extra screen time, according to an online poll conducted by YouGov for Fight for Sight.
Failing sight has major implications for public health. Poor vision increases isolation, limits physical activity, increases risk of accidents and contributes to mental health conditions. According to The College of Optometrists (COO), the prevalence of poor eyesight in the UK is largely unknown. As such, it is not a public health priority and treatment remains expensive and inaccessible to those that need it most.
Recognizing the problem
Uncorrected refracted error (URE) is the most common eye disorder which prohibits people from seeing clearly. It can be easily fixed by eyeglass lenses or contact lenses following a sight test. If the solution to failing vision is often so simple, why is there such a strong association between deprivation and poor eyesight?
While eyesight is commonly known to deteriorate with age, evidence from Public Health England demonstrates that health inequalities in eyesight cut across age. In each age bracket data from the 2012 Annual Report of the Chief Medical Officer shows that prevalence is significantly greater in areas of socioeconomic deprivation. The report further states that the prevalence of deafness and blindness is almost doubled between the least and most deprived people.
A report by the COO found that access to treatment is the most common barrier. Despite high levels of NHS funding for sight tests, lower socio-economic groups remain less likely to access eye services than those in affluent groups.
This problem is not only isolated to eye health. The Institute for Fiscal Studies has shown that the more socioeconomically advantaged will present to healthcare providers at an earlier stage of illness, and therefore consume the vast majority of preventative healthcare. Concurrently, the less socioeconomically advantaged will consume more healthcare at any given age because they are more unwell.
The Journal of Public Health demonstrates that geographical location to optical practises is a major problem. Conducting studies in Leeds and London, a 2014 study found that if an optical practise was more than 800 yards away from a patient’s residence, the chances of the patient attending an eye test were drastically reduced.
Public perception matters and the fact that primary eye healthcare is delivered in commercial premises is off putting. Studies from focus groups demonstrate that fear of having to spend money is a huge barrier. Cost is another issue. The Royal Society of Public Health (RSPH) reported that while general ophthalmic services are heavily subsidised, additional fees hinder uptake of services in deprived areas.
From secondary to primary care
The RSPH’s report suggests that in order to support the financial viability of primary eyecare for those of low socioeconomic status, additional funding is required. However, ‘This would require a significant shift of activity from secondary to primary care locations. ’ By integrating opticians into the NHS as primary care professionals, the report argues, patients will be more likely to attend appointments.
However, the COO notes that removing the commercial gains of the current model is unlikely to be feasible and that given persistent and austere cuts to the NHS over the past ten years, it is completely unrealistic.
It is clear the current model for ophthalmology is not adequate to meet the needs of all patients. Bringing ophthalmology into the NHS could offer a cultural and financial solution but clearly more data is needed to demonstrate what this new model might look like. When more people begin to see the unequal gap in eyecare provision, a brighter picture awaits us all.
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