An overview of the Welsh Low Vision Service Barbara Ryan, Tom H Margrain, John M Wild Cardiff School of Optometry and Vision Sciences, Cardiff University, Wales and Richard N Roberts The National Assembly Government, Wales

Survey of low vision services in the UK Ryan and Culham 1999 RNIB and Moorfields Eye Hospital services patchy and fragmented provision not in areas of highest prevalence people having to travel long distances waiting times up to a year Fragmented Vision

Our better vision Users views sought in twenty focus groups followed by a questionnaire people found low vision services a positive experience but difficult to access – not automatically referred – long waiting times – difficult to get to Ryan and McCloughlan 1999 RNIB and Herriot-Watt University

prevalence of visual impairment in Wales is nearly 10% higher than in the UK

Survey in Wales Furze, Margrain and Wigham 2001 Cardiff University The main problem with low vision services in Wales was access to the service: - restricted by a convoluted referral route

Optometrist GP Ophthalmologist Low Vision Service

Survey in Wales Furze, Margrain and Wigham 2001 Cardiff University The main problem with low vision services in Wales was access to the service: - restricted by a convoluted referral route - waiting times in some parts of Wales were 18 months

Survey in Wales Furze, Margrain and Wigham 2001 Cardiff University The main problem with low vision services in Wales was access to the service: - geographical distribution of services frequently required people to travel 100 miles or more (round trip)

Welsh Low Vision Service primary care (optometry practices) all Wales

Welsh Low Vision Service started in July 2004 funded by The Welsh Assembly Government co-ordinated administratively by Carmarthenshire Local Health Board (LHB)

–close to home –waiting time less than 2 weeks –referred by: GP social services voluntary sector ophthalmologist teacher optometrist friend self Ease of Access

Practitioners trained and accredited by Cardiff University. –web-based theoretical modules with on-line MCQs –practical training sessions –practical assessment Training and Accreditation

Assessment equipment supplied LogMAR distance Visual Acuity Chart Pelli- Robson Contrast Sensitivity Chart LogMAR Kay Picture Chart Bailey-Lovie Near Acuity Threshold Chart McClure Reading Test type (white) +/ cross cyl +/ cross cyl pair of Halberg clips

Low vision aids

standard record card used following an assessment faxed to Carmarthenshire LHB key data entered onto database and order generated. LVAs sent to practice and issued on loan all appointments and LVAs are free to people using the service Process

Holistic –Work closely with other established local services (secondary care, social services, education, employment, voluntary) –Vision Passport Share information Empowerment

Holistic – rehabilitation workers given additional training in low vision therapy –Children’s Low Vision Advocate

First 6 months 105 primary eye care professionals accredited (about ¼ of those in Wales) 95 optometrists; 9 dispensing opticians; and 1 ophthalmic medical practitioner providing the service in 121 practices 1161 people assessed in first 6 months

warmly received by people using the service and linking with it waiting times for majority, less than 2 weeks another 85 practitioners currently training Early indications

in many areas boundary between health and social services have been removed earlier access to social services children receiving low vision assessments in Wales for first time Early indications

Future For the foreseeable future everyone in Wales who needs to will be able to access a low vision service within a couple of weeks which is: close to their home; in well equipped practices; provided by trained and accredited staff; and with good links other local services

The effectiveness of the service is being constantly monitored: –cost –waiting times –distance travelled –prescribing rates –referrals –measure of effectiveness The service will continue to evolve to meet the needs of people using it Future