Leading causes of certifiable visual loss in England and Wales during the year ending 31 March 2013.

PURPOSE: The last article on causes of sight impairment (SI) in England and Wales was for April 2007-March 2008. This report updates these figures for April 2012-March 2013. METHODS: In England and Wales, registration for SI is initiated by completion of a certificate of vision impairment (CVI). The main cause of visual impairment was ascertained for certificates completed April 2012-March 2013. A proportional comparison against April 2007-March 2008 was made. RESULTS: We received 24 009 CVIs of which 10 410 were for severe sight impairment (SSI) and 13 129 were for SI. These numbers were slightly higher than those observed in April 2007-March 2008 (9823 SSI; 12 607 SI). The ratio SI:SSI has remained static with 55% of all certifications being SI. The proportion of certificates without a single main cause has fallen slightly (16.6 to 14%). The proportion of certificates with a main cause of degeneration of the macula and posterior pole (mostly age-related macular degeneration (AMD)) decreased from 58.6 to 50% SSI and from 57.2 to 52.5% SI. Glaucoma remains the second most common cause (11% SSI; 7.6% SI) but hereditary retinal disorders overtook diabetes as third leading cause of SSI. CONCLUSION: AMD is still by far the leading cause of certifications for sight impairment in England and Wales (both SI and SSI). Proportionate changes have been observed since 2008, but it is important to note that a proportionate increase in one condition will impact on others.

Certification for vision impairment: researching perceptions, processes and practicalities in health and social care professionals and patients.

OBJECTIVES: To explore the patient experience, and the role of ophthalmologists and other health and social care professionals in the certification and registration processes and examine the main barriers to the timely certification of patients. DESIGN: Qualitative study. SETTING: Telephone interviews with health and social care professionals and patients in three areas in England. PARTICIPANTS: 43 health and social care professionals who are part of the certification or registration process. 46 patients certified as severely sight impaired (blind) or sight impaired (partially sighted) within the previous 12 months. RESULTS: Certification and registration are life changing for patients and the help they receive can substantially improve their lives. Despite this, ophthalmologists often found it difficult to ascertain when it is appropriate to certify patients, particularly for people with long-term conditions. Ophthalmologists varied in their comprehension of the certification process and many regarded certification as the 'final stage' in treatment. Administrative procedures meant the process of certification and registration could vary from a few weeks to many months. The avoidable delays in completing certification can be helped by Eye Clinic Liaison Officers (ECLO). CONCLUSIONS: A better understanding of the certification and registration processes can help improve standards of support and service provision for people who are severely sighted impaired or sight impaired. Better education and support are required for ophthalmologists in recognising the importance of timely referral for rehabilitative support through certification and registration. ECLOs can improve the process of certification and registration. Finally, better education is needed for patients on the benefits of certification and registration.

Causes of certifications for severe sight impairment (blind) and sight impairment (partial sight) in children in England and Wales.

AIM: To explore and describe trends in the principal disorders/conditions ('cause') for severe sight impairment (SSI) (blind) and sight impairment (SI) (partial sight) certification in children in England and Wales since 1999. METHODS: We obtained certification data for SI and SSI from a national database for all individuals aged 16 years or less at the time of certification in England and Wales for the years 1999/2000 and for the years 2007/2008-2009/2010. RESULTS: In total, there were 861 certifications in the year 1999/2000, rising to 1040 certifications in 2009/2010. The commonest single causes of SSI certification in 1999/2000 were cerebral visual impairment (23.2%) and optic nerve disorders (23.2%). The commonest single causes of SI certification in the same year comprised nystagmus (16.7%) and optic nerve disorders (15.5%). Cerebral visual impairment was the commonest single cause of SSI in children in England and Wales annually between 2007/2008 and 2009/2010 accounting for 21%-31% of certifications. The commonest causes of SI certification in 2009/2010 were congenital globe anomalies (18.4%) and retinal dystrophy (16.6%). The proportion of SI and SSI due to optic nerve disorders has decreased since 1999/2000. CONCLUSIONS: Our findings suggest that in England and Wales, cerebral visual impairment is now the commonest cause of paediatric SSI certification and hereditary retinal dystrophy and congenital globe anomalies are the commonest causes of SI certification.

The redeployment of blind and partially sighted staff in the banking industry.

UK banks have traditionally employed blind and partially sighted people as telephonists. The introduction of new technology and organisational restructuring has lead to a decrease in the need for clerical staff. Banks are faced with the dilemma of what to do with blind and partially sighted telephonists. Many are considering the options and preferring to deal with individual cases at a local level as they become pressing rather than take a co-ordinated approach. This paper describes how one Bank decided to tackle this challenge at a corporate level through a company wide redeployment project, assisted by the Royal National Institute for the Blind (RNIB). Data collection, assessments, job analysis and technical investigations are described. The central role of training both for project participants and personnel staff is discussed and the responsibilities of project Case Managers are reported. So far over 100 members of staff have been relocated, supplied with new equipment, had their current job expanded or been placed in a new job. Some other wide ranging results such as changes to Bank policy are discussed. The conclusion highlights some of the challenges encountered and suggests how the lessons learned through the project might be applied to other situations.

Developing a computerized information system for visually disabled people to assist with job placement.

Unlike several other countries, the UK does not have a national occupational database describing jobs in terms of skill and other factors. Neither is there a nationally recognized method for assessing the functional skills which job seekers have to offer. If these two types of assessment were based on the same criteria, individuals could accurately match their profile to occupations or vacancies. Assistance with job placement is one of the most popular services offered by Royal National Institute for the Blind (RNIB) Employment Network to visually disabled people. Yet resources are stretched and the Network is considering computerizing its occupational information and job-matching activity to increase efficiency. By drawing upon a comparison of existing systems and recommendations in the literature this paper offers suggestions for the development of this system. Factors for consideration at the design stage are discussed, and the paper concludes with a programme for development, evaluation and implementation. The need to ensure quality standards through staff training and appropriate procedures is stressed.