ConclusionCompared to their peers without VI, older people with VI are more than twice as likely to need help in managing medication. In clinical practice in primary care, patients' needs for practical support in taking prescribed treatment must be recognised. Strategies for effective medication self-management should be explored.

Purpose: In this paper we highlight the impact which the disruption of secondary care ophthalmic services, resulting from COVID-19, has had on Sight Impairment (SI) and Severe Sight Impairment (SSI) certification in Northern Ireland. Methods: Regional data on SI and SSI certification in the period after the onset of the lockdown (19 March 2020-18 June 2020) were compared to the period immediately before lockdown (1 January 2020-18 March 2020) and to the same periods in 2019. Change documented was compared to post-lockdown reductions in primary and secondary ophthalmic care activity. Results: In 2019, during the 3-month period (19 March 2019-18 June 2019), 115 individuals were certified as sight impaired (SI 36, SSI 75, unspecified 4). Of those certified, 65 were female, 49 male. Principal causes of certification were: Age-related macular degeneration (AMD) (N = 45), glaucoma (N = 20) and diabetic eye disease (DED) (N = 10). Mean VA, recorded from the better eye of those certified, was 0.96 LogMAR. In the 3 months following the onset of lockdown (19 March 2020-18 June 2020), only 37 individuals were certified (SI 6, SSI 31), 12 female and 25 male. AMD was the most frequent cause of sight impairment (N = 20). There were only two DED certifications and one due to glaucoma. Mean VA in the better eye of those certified was 1.15LogMAR. The numbers of CVI certifications completed following the introduction of COVID-19 lockdown fell by 68%, compared to the 2019 data. There was a significant reduction in the proportion of female certifications (p = 0.01), and in certifications due to glaucoma (p = 0.02). The proportion of those certified as SSI as opposed to SI in the period after the onset of lockdown rose from 68% in 2019 to 84% in 2020. The mean VA of those certified in the period after the onset of lockdown, when compared to those certified in the other three periods, was worse by between 0.21 and 0.19 LogMAR (p = 0.06). Reductions reflected change in overall primary and secondary ophthalmic care activity. Conclusions: It is inconceivable that COVID-19 has reduced the incidence of sight-threatening eye disease. We must therefore assume that a flood of newly presenting sight loss will present once the pandemic has passed. New presentations will include those who would normally have attended during the lockdown period, and patients who, had they accessed ophthalmic care at the appropriate time, would have been saved from severe levels of blindness. The implications of the predicted increase in demand for medical, social and low vision related services are huge.

Certification and registration of those who are sight impaired (SI) provides commissioners, and the providers of health and social care support to those with vision loss, with quantifiable data on the extent of blindness and sight impairment within a community. In this article, we outline the results of a comprehensive review of certification/registration pathways and processes in Northern Ireland and highlight achievements to date. The Developing Eyecare Partnership (DEP) CVI Task Group established by the Health and Social Care Board (HSCB) reviewed all certification/registration processes, pathways and issues that may have contributed to regional under certification/registration. This was undertaken to ensure timely certification/registration of those who may benefit from being certified as either Severely Sight Impaired (SSI) or SI, and in so doing improving patient pathways and access to services. Activity included a review of all available epidemiological data collected in the 2-year periods before and after the introduction of the new pathway (January 1, 2018). This work has resulted in changes to the terminology used in relevant Northern Ireland legislation and other documentation concerning certification/registration. It has also resulted in the creation of more timely and efficient referral pathways and improvements in the quality of information available on certification and the process. Increased awareness of the certification process by health and social care professionals has resulted in a 22.5% increase in certifications over the 2-year period, before COVID-19. Certification rates are now comparable with those from other areas of the United Kingdom. The workings of the DEP CVI group, over a 5-year period, have increased awareness about SI and SSI Certification among patients and Health and Social Care Providers and have improved the quality of local epidemiological data on vision impairment. A patient-based evaluation of the new pathway is planned for 2020.

PurposeTo determine the number of patients with diabetes mellitus (PwDM) who were certified as visually impaired (CVI) over the past 5 years in Northern Ireland, UK.MethodsCVI data were collected from 11 sites and 50 eye‐specialists using pre‐defined CVI forms. Eye‐specialists must provide patient demographics and vision information such as visual acuity and diagnosis for certification purposes. Data were transcribed into Microsoft Excel before analysis was undertaken to produce an annual CVI report for eye and healthcare professionals. Our analysis determined the contribution of diabetes and diabetic eye disease (DED) to the sight‐impairment burden between 2014 and 2018.ResultsIn 2014, 332 CVIs were registered: 184 as severely sight impaired (SSI) and 142 sight impaired (SI). Of the 24 who had diabetes, 19 were certified due to diabetic retinopathy (DR) and 2 to diabetic macular oedema (DMO). Between 2015 and 2017 the number of CVIs increased to 412, 428 and 453 respectively with PwDM having grown to 48, 43 and 41, respectively. PwDM were also certified due to AMD and glaucoma (range of 2%–31% and 2–4% respectively) from 2015 to 2017. After an intense education campaign, in 2018, the total CVI submissions increased to 575; of these 368 were SSI and 196 were SI. The number of people who were certified as having diabetes more than doubled in 2018 to 107 of these, 51 (48%) were certified due to DED. AMD was found to be the second largest cause of visual impairment in PwDM at 40%, the remaining people had other ophthalmic issues such as keratoconus and optic atrophy.ConclusionsPwDM were previously underrepresented in the sight impaired registers in Northern Ireland. Since the awareness campaign and introduction of improved pre‐defined forms in 2018, Northern Ireland is now on par with certification rates in the rest of the UK. This information provides insight into the epidemiology of sight impairment in Northern Ireland while providing appropriate data for policymaking and service planning purposes.

Purpose: To determine the number of people being certified as either severely sight impaired or sight impaired due to diabetic eye disease (DED) in Northern Ireland (NI). Methods: Sight impairment data have been collected for the 6-year period of 2014–2019, these data included age, gender, certification status, visual acuity, and type of eye disease. All data were entered into an Excel database and analyzed using Stata to ascertain the number of total certifications and diabetic eye disease certifications per year. Results: The number of total certifications in NI increased year on year as has the number of diabetic eye disease certifications. The number of diabetic eye disease certifications rose from 12.6 per million in 2014 to 17.4 per million in 2019, with a peak of 27 per million in 2018. There were more males than females registered due to diabetic eye disease. Diabetic eye disease's proportional representation of total certifications of visual impairment remained relatively stable during the 6-year period. Conclusions: In the 6-year period, the overall number of certifications has increased from 2014 to 2019, as have the number of certifications due to DED. This may be attributed to the improvement of certification and diabetic eye care pathways. People with diabetes who are certified are more likely to be younger and male. More research with medical data needs to be conducted in the future.