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Correspondence to Dr Abraham Olvera-Barrios, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK; [email protected]
WHAT IS ALREADY KNOWN ON THIS TOPIC
People with diabetes in England undergo annual diabetic eye screening, which triggers prompt referral to eye hospital services, and diabetes-related treatment regimens are covered as part of universal healthcare.
Certification of visual impairment (CVI) is a valuable tool to provide assistance for patients and also to measure the causes and rates of visual disability in the UK. Certification is voluntary and must be started by an ophthalmologist. The CVI due to diabetic retinopathy (DR) has decreased over the last 20 years. Since 2010, DR was no longer leading cause of CVI in England.
WHAT THIS STUDY ADDS
We have found a marked under-registration of visual impairment (VI) of 84% in patients with DR at the largest centre for ophthalmic treatment in England.
Estimating nationwide prevalence of VI on patients with DR with the CVI could substantially underestimate the problem.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
Using rates of vision impairment in addition to rates of certification would provide valuable and complementary data towards the goal of preventing diabetes-related blindness, particularly by increasing the size of the dataset available.
Epidemiological studies assessing the causes of blindness should consider using point-of-care structured visual acuity data at different timepoints to provide more accurate estimates of the causes blindness.
Resources and public health strategies to target individuals at higher risk of blindness could be in need of reallocation if the primary causes of blindness are different thanfrom the estimations derived from CVI registries. Further work may also be needed to understand under-registration, and the complex interplay between patient choice and health systems.
Introduction
The number of blind people in the UK has been documented since 1851.1 2 Reports on causes of low vision in England and Wales began in 1950.1–3 From the 1930s, the BD8-designated forms signed by an ophthalmologist were required to certify someone as blind or visually impaired.4 5 The certification is voluntary and there is no statutory requirement for it to be offered. In November 2003, the BD8 form was replaced by the certification of vision impairment (CVI).6 In 2013, an eye health indicator was...