Rapid Assessment of Avoidable Blindness in England

Hannah KuperRobert Lindfield

Overview

• Review of previous studies• Description of RAAB• Information from RAAB• Adapting RAAB to the UK

Review of previous studies

• Most recent prevalence surveys in the UK:– North London Eye Study - 1999– MRC Study of Older People – 2003 (GP-based)– EPIC Study, Norfolk – not population based (current)

• Issues– No up-to-date information– Changes in public health indicators have place greater

emphasis on eye health– Limited information available to assess need– Tools like NEHEM/Future Sight Loss UK out of date

What is a RAAB survey?• Developed in low income countries using

methodology adapted from immunisation surveys• Rapid – usually less than 6 weeks:– Limited age group (>50 years)– Limited examination (screening)

• Focus on visual loss• Provides robust information about:– Prevalence of visual loss– Causes of visual loss

• Acts as a core to allow ‘bolt-on’ additional surveys (e.g. DR)

Technique• Two stage sampling:– One: select a cluster (could be ward, GP practice, other)– Two: select individuals from the cluster• In low income settings this is done by walking from

house to house• Probably not possible in England

• Ophthalmic teams examine each individual using:• Simple screening vision chart (illiterate e-chart)• Basic ocular examination including pinhole and dilated

examination for those who need it.

• Data entry into standardised software package– Automated reports with prevalence estimates

Range of RAAB surveys

• Low income: Zambia, Malawi, Kenya, Tanzania, Uganda, Ethiopia, Eritrea, Gambia, Burkina Faso, Bangladesh,

• Middle income: Brazil, Mexico, Philippines, India, South Africa

• Upper middle income: Argentina, Russia,

• Many have been published in peer-reviewed journals• No-one has attempted a RAAB in a high income

country

What we want to do.....• A rapid screening of eye health in a location that is

representative of the wider population of England– Focus on over 60s– Limited ocular examination

• To identify the leading causes of visual loss in England• To assess the socio-economic determinants of visual loss in

England• To assess the prevalence and causes of visual loss in specific

populations (e.g. Nursing Home residents)• To review access to eye health services amongst users

Method• Adapt RAAB methodology

– Use technology (e.g. PEEK)– Focus on over 60’s– Work with GPs to invite individuals to examination clinics– Collect additional information on a variety of different aspects of care

• NB – remains simple and straightforward (no complex examinations)

Locations• Potential - Suffolk

– Mix of urban/rural– High proportion of older people– Mix of prosperity– Buy in from local public health department

– HOWEVER:• Predominantly white population

Next steps• Meeting of interested parties – aim for June 2014• Development of consortium• Bids to funders