The patient population
Medical ophthalmologists treat diverse patient populations. Patients range from those with common eye conditions such as diabetic retinopathy or age-related macular degeneration (AMD) to those with rarer conditions such as optic nerve disease (due to inflammation or intracranial tumours), sight-threatening inflammatory diseases or genetic ophthalmic conditions. About 50% of patients presenting to the ophthalmology department will not require surgery.
The two most frequently occurring eye conditions are:
Eye conditions associated with diabetes mellitus
Diabetes mellitus affects nearly 3.5 million people in the UK, or over 5% of the population. By 2025, it is estimated that 5 million people will have diabetes in the UK. The age of onset of diabetes is also reducing due to the obesity epidemic. Since the incidence of diabetic retinopathy increases with the duration of diabetes, the proportion of patients requiring treatment and screening for retinopathy is also set to increase. This will need to be appropriately met by ophthalmology services, with greater emphasis on delivering care in ambulatory settings such as polyclinics, combined with education, especially of younger patients.
The increase in demand for ophthalmology services for people with diabetes will increase as the population ages and a newer group of younger people with diabetes are diagnosed with retinopathy. This may necessitate services at hours convenient for working individuals (eg after normal office hours) and will have the dual effect of increasing capacity. Particular at-risk groups include pregnant women with retinopathy, patients with poorly controlled diabetes and people who have severe retinopathy but do not attend appointments.
Age-related macular degeneration
In the UK, about 600,000 people were estimated to have AMD in 2010. This is expected to increase to over 750,000 by 2020. The number of patients with sight loss due to AMD is expected to rise from about 220,000 in 2010 to nearly 300,000 by 2020. The number of patients with sight loss due to neovascular (wet) AMD is expected to increase from nearly 150,000 to nearly 200,000.
Prevention of disease
Due to the diabetic screening program in the UK, diabetic retinopathy is no longer the leading cause of blindness in the UK. However, the demand for secondary and primary-based diabetic services is increasing.
Reduction of disease burden of diabetic retinopathy should focus on effective public health strategies to reduce the number of new diagnoses of obesity improving diabetic control in people with diabetes through effective nutrition and weight loss.
Age-related macular degeneration
Public health strategies for age-related macular degeneration should focus on stop smoking and dietary advice, which may include nutritional supplements for the AREDS formulation for a stratified group of patients with macular degeneration. This information should be available in secondary services as well as opticians and primary care services.
Uveitis associated with juvenile idiopathic arthritis
As this is a relatively rare disease, the health promotion strategy should be concentrated in secondary or tertiary services. Here, rheumatologists can ensure that children with a new diagnosis of JIA are referred for uveitis screening within 6 weeks of diagnosis and according to a screening protocol. Families should be educated about the importance of screening (opens PDF, 58.57KB) in preventing sight loss due to undiagnosed uveitis.
People with idiopathic intracranial hypertension should have access to high-quality services where weight management interventions may be discussed in order to prevent disease.