Many pharmacy customers will have some form of sight or hearing loss that makes it difficult for them to communicate, so it is important to find ways to help them understand and be understood.

Current figures put the total number of people in the UK with sight loss at over 2 million, yet many of these are living needlessly with their sight loss as most cases can be diagnosed with a simple eye test and successfully treated with appropriate prescription glasses or cataract surgery.¹

Hearing loss is also widespread. Estimates indicate that more than 70 per cent of people aged over 70 years and 40 per cent of over-50s in the UK are living with some degree of hearing loss.²

According to the Royal National Institute of Blind People (RNIB), the number of people in the UK with sight loss is predicted to increase dramatically. “As we get older we are increasingly likely to experience sight loss, and the UK population is ageing,” the RNIB explains. “In addition, there is a growing incidence in key underlying causes of sight loss, such as obesity and diabetes. This means that, without action, the numbers of people with sight problems in the UK are likely to increase dramatically over the next 25 years.”

By 2020 it is predicted that the number of people with sight loss will have risen to over 2.25 million and by 2050 this number looks set to spiral to nearly 4 million.¹

Sight loss can affect customers of all ages but is particularly common in older people, as risk increases with age. Around 20 per cent of people aged 70 years and half of those aged 90 years and over are estimated to be living with sight loss.¹ Women are more likely to be affected by sight loss than men and people from black and ethnic minority communities are also at higher risk of some of the major causes of blindness, such as diabetes.¹

Among the potential contributors to sight loss, age-related macular degeneration (AMD) currently ranks as the leading cause of blindness in adults in the UK, but other significant causes include glaucoma, cataracts and diabetic retinopathy.¹

Key risk factors for sight loss

Risk factors for sight loss include any element that contributes to development of the underlying causative condition. In the case of AMD, recognised risk factors include age, smoking and sunlight exposure.

Customers are more likely to develop the commonest type of glaucoma – primary open angle glaucoma (POAG) – if they are older (aged 40 years or above), of African descent, have a close family history of glaucoma, are short-sighted or suffer from concomitant diabetes.

As with most eye conditions, ageing is also the major risk factor for cataract development. Other potential contributory factors include diabetes, trauma, certain medications (e.g. steroids) or occular surgery for other eye conditions. Evidence is also emerging to suggest that cataract risk may be influenced by smoking, lifelong exposure to sunlight and a diet lacking in antioxidant vitamins.

Where diabetic retinopathy is concerned, any of the well-known factors that raise diabetes risk also increase the chance of developing this ocular complication. People from South Asian communities are at particularly high risk of both type 2 diabetes and retinopathy.

Assessing the risk of sight loss for an individual customer in the pharmacy setting can be complicated, with multiple risk factors and concomitant conditions potentially at play. To aid in the process, the RNIB has developed a sight loss data tool (rnib.org.uk/knowledge-and-research-hub-key-information-and-statistics/sight-loss-data-tool). This is a useful and easily accessible vehicle that provides key information about blind and partially sighted people and, importantly, highlights those at risk of sight loss at a local level throughout the country.

Cataract risk may be influenced by smoking

Substantial impact

Sight loss can have a substantial impact on a customer’s quality of life and is directly linked to reduced wellbeing, and fuelling feelings of isolation and loneliness – already an issue for many elderly individuals.

Around half of blind and partially sighted people report feeling moderately or completely cut off from people and things around them. Sight loss also trebles the risk of depression among elderly people (compared to older individuals with good vision) and one-third of older individuals with sight loss also suffer from co-morbid depression.

Yet, despite these stark realities of vision loss, shortcomings are evident in the current provision of both emotional and practical support to diagnosed sight loss sufferers in the UK. This highlights the important void that community pharmacy can help to fill by providing care, support and advice for any customer suffering with visual impairment.^1,3

Preserving healthy vision

Although age and genetic factors that raise the risk of sight loss cannot be modified, the RNIB advocates protecting the eyes from UV light, eating a healthy balanced diet and stopping smoking as general steps that anyone can take to keep their eyes healthy and help preserve vision. While study findings are inconclusive, there is also some evidence to suggest that vitamins A, C and E and zinc may help in slowing the progression of AMD in patients already diagnosed with the disease.

For patients with diabetes, pharmacists can promote lifestyle changes and self-care measures to help reduce the risk of retinopathy development and/or prevent the condition from worsening. This advice should emphasise the importance of tight control of glucose, blood pressure and cholesterol levels, physical fitness, maintenance of a healthy weight and smoking cessation.

Regular retinal screening is vital for any patient with diabetes and customers should be strongly encouraged to attend these appointments. Early detection and treatment of retinopathy is the single most effective measure in preventing sight loss due to diabetes. Indeed, across all eye conditions, it is important to challenge customer perceptions that no sight loss symptoms equates to healthy eyes. Conditions like glaucoma and diabetic retinopathy can progress significantly before patients notice any symptoms and AMD can cause irretrievable sight loss if not acted upon early.

Highlighting the importance of regular sight tests, the RNIB stresses that, “early detection does not mean as soon as the individual notices first symptoms of sight loss; it means before individuals realise there is something wrong with their sight”.

Barriers to eye testing

Simple eye tests can diagnose the common eye conditions refractive error and cataract, which together account for two-thirds of all sight loss cases in older adults. Glasses can then be prescribed to correct the refractive error or surgery carried out to remove the cataracts. So with most common eye problems easily solvable, why do so many people fail to get their sight tested regularly?

According to the RNIB, most people should have their eyes tested at least every two years and certain groups – such as those with diabetes or a family history of primary open-angle glaucoma – will require more regular, routine screening. Yet the latest data published by the UK Vision Strategy indicate that uptake is falling short of optimal levels. In 2012/13 the rate of NHS sight tests was 23,235 per 100,000 people, equivalent to 12 million sight tests.⁴

Adults aged 60 years and over were responsible for 44 per cent of these tests but, worryingly, diabetes/glaucoma sufferers and close relatives of glaucoma suffers ≥40 years of age made up just 7 and 6 per cent of sight tests respectively.⁴

A collaborative survey carried out by the RNIB in conjunction with Age Concern identified three key barriers to uptake of eye testing in the UK⁵:
• People were unlikely to have an eye test if they didn’t have any problems with their vision, assuming that sight tests are for people who already have problems
• Worries about the cost of glasses and eye tests were particularly prevalent among low income groups
• Transport problems and access to eye tests can be a barrier for very elderly patients, particularly those with mobility issues.

According to Richard Wormald, consultant ophthalmologist at Moorfield’s Eye Hospital: “Poorer older people are less likely to access eye care services. They are also more likely to present too late with advanced glaucoma, to have treatment for cataract at a more advanced stage of sight loss, and to have severe diabetic retinopathy…There is good evidence of substantial unmet need (not always perceived) or avoidable sight loss among elderly people in Britain.”⁵

Hearing loss

Similar to the issues encountered with sight loss, pharmacy teams have an equally important role to play in providing care and support for customers with hearing loss. A recent survey, carried out by Action on Hearing Loss, explored the experiences of over 600 people with hearing loss when accessing healthcare.⁶ Over half had sought a consultation with a pharmacist.

Overall, one in eight respondents reported feeling unclear about a pharmacy-supplied diagnosis or medication. The commonest reasons for this were the pharmacist not always speaking clearly and not making sure the patient had understood what was being said.