An overview of CVI in England, Wales and Northern Ireland

Clinicians from Moorfields Eye Hospital, Singleton Hospital and Belfast Health & Social Care Trust have outlined developments in certification of vision impairment across England, Wales and Northern Ireland.

As part of an editorial in Eye, authors outlined that around 25,000 Certificates of Vision Impairment (CVI) are provided each year across England and Wales.

While this number dropped during COVID-19, annual numbers had recovered to pre-pandemic levels by 2022–2023.

The authors highlighted that the single largest cause of certification is age-related macular degeneration (AMD) followed by glaucoma. Within the working age population, the largest cause of CVI is hereditary eye disease.

Evidence suggests that an “unacceptably large proportion” of eligible patients are not being offered CVI in a timely manner, the researchers noted.

The editorial outlines proposed changes to the CVI form in England, including ensuring compliance with the NHS Accessible Information Standard, enabling electronic completion of the form and adding questions in the visual function section to inform social care assessments. This section would also be used to check for Charles Bonnet symptoms.

The researchers noted that low vision accredited optometrists in Wales are now able to provide CVIs for eligible patients within their own homes.

“This is anticipated to improve equity of CVI access and substantially reduce delays,” the authors shared.

The editorial presented data from Northern Ireland showing that in 2023, 823 individuals were certified as sight impaired or severely sight impaired.

“AMD consistently accounts for over 50% of certifications, with glaucoma and diabetic eye disease accounting for between 8% and 12% of certifications,” the authors shared.

They added that a new regional electronic certification system will be introduced this year, which will be linked to the Encompass regional electronic patient care record.

In their concluding remarks, the authors highlighted the importance of awareness of CVI alongside staff training.

“Proactive or semi-automated ways of identifying eligible patients from their electronic records could be helpful,” they shared.