COVID 19: Meeting the eye health needs of vulnerable individuals during the next stages of the pandemic

Domiciliary eye care is a specialised area of optometry and optics experienced in dealing with high risk patients (including those being barrier-nursed) and rigorous infection control. It provides eye care services to those who are unable to visit a High Street practice unaccompanied due to a physical or mental illness or disability. Within this group patients will have varying needs depending on the type of illness or disability. Some will have both sight and hearing loss as well as other long-term conditions or disabilities.

Coronavirus (COVID-19)

Under the current COVID-19 public health measures, the UK health systems have identified shielded populations of extremely clinically vulnerable adults comprising approximately 2.5 million people, currently:

• 2.2 million England¹
• 40,000 Northern Ireland²
  
• 170,000 Scotland³
• 121,000 Wales⁴

In addition, there are potentially over twice as many clinically vulnerable adults who have been advised to physically isolate or who may have chosen to do so on their own risk assessment.^a

Nevertheless, the eye health needs of both groups, as well as of those unable to leave home for non-COVID reasons, continue and have, arguably, become even more crucial during this period of social isolation. A condition which may have been safe to postpone ten weeks ago may now have become acute, especially for chronic eye diseases which may not be immediately obvious to patients or carers or ongoing conditions which need regular support.⁵

More than two million people in the UK live with sight loss that is severe enough to have a significant impact on their daily lives; around 79% of these people are over age 64, with one in every three people age 85 and over living with sight loss. 

It should be noted that these at risk populations are living in a variety of settings; in England of the nearly 842,000 adults (working and older) receiving local authority provided or organised long term care, just under 70% live in community settings (primarily their own home) with just over 25% of the over 65 group living in residential or nursing care.⁶

Many of these patients will have other health or social conditions which are exacerbated by vision or eye problems, such as loneliness, cognitive impairment or condition and individuals in lower socio-economic groups will have a 60% higher prevalence than those in the higher economic groups and 30% more severity of disease.⁷ In rural and coastal areas older age groups can comprise up to 40% of the population and generally one in five single pensioners lives in poverty.⁸

For many of these people eye health and eye care will be crucial to their ongoing wellbeing, independence and mental health. Much more is now known about COVID-19 and how it spreads. As a result, eye care can now be safely provided in private homes and care home settings using remote first and safety first principles and where face-to-face care is required using personal protective equipment (PPE) and additional infection control procedures to safeguard patients, carers and eye care professionals.

Call to action and guidance

As the UK governments ease lockdown restrictions and the health services moves into its second phase response in all four UK countries, the Optical Confederation's Domiciliary Eyecare Committee calls upon governments, the NHS (including the Health and Social Care Board, Northern Ireland) local authorities and care home providers to work with skilled domiciliary eye care providers to ensure that clinically vulnerable and extremely clinically vulnerable patients are not denied the eye and vision care they need in these very challenging times.

To support this, the Optical Confederation’s Domiciliary Eyecare Committee has produced guidance for health and care providers and others, which links to essential government and public health advice and guidance produced by the General Optical Council, the College of Optometrists and the Association of British Dispensing Opticians.  

5 June 2020

Notes

a. It is estimated that 8·43 million people in the UK are in the high-risk group, of whom 5·77 million are older than 70 years of age, and 2·66 million have one or more underlying condition and are 70 years or younger – A Banerjee et al. Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort study. The Lancet 12 May 2020.

1. Coronavirus shielded patient list open data set, England. NHS Digital. 20 May 2020
2. Urgent Written Statement to the Assembly by Health Minister Robin Swann, 19 March 2020 – Health andSocial Planning for the period mid-March to mid-April 2020 during the delay phase for coronavirus
3. Coronavirus in Scotland. Coronavirus in Scotland. March 2020.
4. Written Statement: Coronavirus (COVID-19) – Shielding Update. Vaughan Gething, Minister for Health and Social Services. 5 May 2020
5. OFNC Statement: Meeting essential eye care needs during the pandemic. 27 May 2020
6. Adult Social Care Activity and Finance Report, England - 2018-19. NHS Digital. October 2019
7. Department of Health (2012). Report. Long-term conditions compendium of Information: 3rd edition
8. Pensioner Poverty. Joseph Rowntree Foundation.