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Trends in certifications of overall vision impairment and that due to diabetic retinopathy/maculopathy in England and Wales, 2009/10 to 2019/20: a retrospective database analysis

Becky Thomas Orcid Logo, Rebecca John, Catey Bunce Orcid Logo, Wen Xing, Antra Zekite, Declan Flanagan, Gwyn Samuel Williams, Rhianon Reynolds, David Owens Orcid Logo

BMJ Open, Volume: 15, Issue: 1, Start page: e090597

Swansea University Authors: Becky Thomas Orcid Logo, David Owens Orcid Logo

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DOI (Published version): 10.1136/bmjopen-2024-090597

Abstract

Objectives: This study aims to report the trends in the certification of both sight impairment (SI) and severe sight impairment (SSI) in England and Wales during the period of 2010 to 2020, prior to the COVID-19 pandemic. The focus is on diabetic retinopathy/maculopathy as the key causative factor....

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Published in: BMJ Open
ISSN: 2044-6055 2044-6055
Published: BMJ Publishing Group Ltd 2025
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The focus is on diabetic retinopathy/maculopathy as the key causative factor. Design: Retrospective database analysis. Setting: England and Wales. Participants: Individuals certified as SI or SSI. Outcome measures: Trends in certification of vision impairment in England and Wales due to any cause, with specific attention to diabetic retinopathy. Methods: Certifications of vision impairment made by ophthalmologists in England and Wales were recorded and copies were sent to Moorfields Eye Hospital for epidemiological analysis. All certificates completed in England and Wales over an 11-year period, from April 2009 to March 2020, were queried and analysed on an annual basis. This analysis included all causes, and where both the main cause was diabetic eye disease or where diabetic eye disease was a contributory cause among multiple pathologies. Poisson regression was employed to analyse changes in trends over time for certifications of vision impairment. Results: In England, from 2010 to 2020, there was a small but significant reduction (p&lt;0.001) in the overall rate of certifications for SI and SSI due to any cause, from 43.4 certifications per 100&#x2009;000 people to 41.7 per 100 000 people. Conversely, in Wales, an initial decline was observed, with a decrease from 50.6 to 40.1 per 100&#x2009;000 people from 2009/2010 to 2014/2015, respectively. This rate subsequently increased to 51.8 per 100&#x2009;000 by 2019/2020; however, this was not statistically significant (p=0.087). Individuals in Wales had a 9% higher certification rate compared with those in England (1.09 (95% CI 1.07, 1.10)). For diabetic retinopathy, certifications in England significantly decreased from 72.8 to 41.3 per 100&#x2009;000 people over the study period; in Wales, the certification rate initially declined from 82.3 to 47.1 per 100&#x2009;000 by 2016/2017 before increasing to 55.5 per 100&#x2009;000 in 2019/2020. Despite this fluctuation, there was a significant decrease in certifications due to diabetic retinopathy in Wales during the study period. Conclusions: The findings underscore the importance of understanding regional variations in certification rates, particularly in the context of diabetic retinopathy. Despite fluctuations in Wales, the overall reduction in certifications due to diabetic retinopathy in both regions suggests a critical need for ongoing public health initiatives aimed at preventing vision impairment linked to diabetes. However, to provide a true reflection of the burden of vision impairment and its various causes, ensuring that all eligible people are certified is a prerequisite. 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spelling 2025-02-05T12:27:25.3733202 v2 68646 2025-01-03 Trends in certifications of overall vision impairment and that due to diabetic retinopathy/maculopathy in England and Wales, 2009/10 to 2019/20: a retrospective database analysis e83b45ec71428bd748ce201048f43d6a 0000-0002-2970-6352 Becky Thomas Becky Thomas true false 2fd4b7c3f82c6d3bd546eff61ff944e9 0000-0003-1002-1238 David Owens David Owens true false 2025-01-03 MEDS Objectives: This study aims to report the trends in the certification of both sight impairment (SI) and severe sight impairment (SSI) in England and Wales during the period of 2010 to 2020, prior to the COVID-19 pandemic. The focus is on diabetic retinopathy/maculopathy as the key causative factor. Design: Retrospective database analysis. Setting: England and Wales. Participants: Individuals certified as SI or SSI. Outcome measures: Trends in certification of vision impairment in England and Wales due to any cause, with specific attention to diabetic retinopathy. Methods: Certifications of vision impairment made by ophthalmologists in England and Wales were recorded and copies were sent to Moorfields Eye Hospital for epidemiological analysis. All certificates completed in England and Wales over an 11-year period, from April 2009 to March 2020, were queried and analysed on an annual basis. This analysis included all causes, and where both the main cause was diabetic eye disease or where diabetic eye disease was a contributory cause among multiple pathologies. Poisson regression was employed to analyse changes in trends over time for certifications of vision impairment. Results: In England, from 2010 to 2020, there was a small but significant reduction (p<0.001) in the overall rate of certifications for SI and SSI due to any cause, from 43.4 certifications per 100 000 people to 41.7 per 100 000 people. Conversely, in Wales, an initial decline was observed, with a decrease from 50.6 to 40.1 per 100 000 people from 2009/2010 to 2014/2015, respectively. This rate subsequently increased to 51.8 per 100 000 by 2019/2020; however, this was not statistically significant (p=0.087). Individuals in Wales had a 9% higher certification rate compared with those in England (1.09 (95% CI 1.07, 1.10)). For diabetic retinopathy, certifications in England significantly decreased from 72.8 to 41.3 per 100 000 people over the study period; in Wales, the certification rate initially declined from 82.3 to 47.1 per 100 000 by 2016/2017 before increasing to 55.5 per 100 000 in 2019/2020. Despite this fluctuation, there was a significant decrease in certifications due to diabetic retinopathy in Wales during the study period. Conclusions: The findings underscore the importance of understanding regional variations in certification rates, particularly in the context of diabetic retinopathy. Despite fluctuations in Wales, the overall reduction in certifications due to diabetic retinopathy in both regions suggests a critical need for ongoing public health initiatives aimed at preventing vision impairment linked to diabetes. However, to provide a true reflection of the burden of vision impairment and its various causes, ensuring that all eligible people are certified is a prerequisite. Continuing attempts to limit the incidence of vision impairment due to diabetic retinopathy remain a priority. Journal Article BMJ Open 15 1 e090597 BMJ Publishing Group Ltd 2044-6055 2044-6055 21 1 2025 2025-01-21 10.1136/bmjopen-2024-090597 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) Swansea University 2025-02-05T12:27:25.3733202 2025-01-03T12:58:21.9239541 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Becky Thomas 0000-0002-2970-6352 1 Rebecca John 2 Catey Bunce 0000-0002-0935-3713 3 Wen Xing 4 Antra Zekite 5 Declan Flanagan 6 Gwyn Samuel Williams 7 Rhianon Reynolds 8 David Owens 0000-0003-1002-1238 9 68646__33501__9b7e62b77fe34cf39a50d48733cfef77.pdf 68646.VOR.pdf 2025-02-05T12:05:02.9337118 Output 434426 application/pdf Version of Record true © Author(s) (or their employer(s)) 2025. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license. true eng http://creativecommons.org/licenses/by-nc/4.0/ 298 Moorfield's Eye Hospital
title Trends in certifications of overall vision impairment and that due to diabetic retinopathy/maculopathy in England and Wales, 2009/10 to 2019/20: a retrospective database analysis
spellingShingle Trends in certifications of overall vision impairment and that due to diabetic retinopathy/maculopathy in England and Wales, 2009/10 to 2019/20: a retrospective database analysis
Becky Thomas
David Owens
title_short Trends in certifications of overall vision impairment and that due to diabetic retinopathy/maculopathy in England and Wales, 2009/10 to 2019/20: a retrospective database analysis
title_full Trends in certifications of overall vision impairment and that due to diabetic retinopathy/maculopathy in England and Wales, 2009/10 to 2019/20: a retrospective database analysis
title_fullStr Trends in certifications of overall vision impairment and that due to diabetic retinopathy/maculopathy in England and Wales, 2009/10 to 2019/20: a retrospective database analysis
title_full_unstemmed Trends in certifications of overall vision impairment and that due to diabetic retinopathy/maculopathy in England and Wales, 2009/10 to 2019/20: a retrospective database analysis
title_sort Trends in certifications of overall vision impairment and that due to diabetic retinopathy/maculopathy in England and Wales, 2009/10 to 2019/20: a retrospective database analysis
author_id_str_mv e83b45ec71428bd748ce201048f43d6a
2fd4b7c3f82c6d3bd546eff61ff944e9
author_id_fullname_str_mv e83b45ec71428bd748ce201048f43d6a_***_Becky Thomas
2fd4b7c3f82c6d3bd546eff61ff944e9_***_David Owens
author Becky Thomas
David Owens
author2 Becky Thomas
Rebecca John
Catey Bunce
Wen Xing
Antra Zekite
Declan Flanagan
Gwyn Samuel Williams
Rhianon Reynolds
David Owens
format Journal article
container_title BMJ Open
container_volume 15
container_issue 1
container_start_page e090597
publishDate 2025
institution Swansea University
issn 2044-6055
2044-6055
doi_str_mv 10.1136/bmjopen-2024-090597
publisher BMJ Publishing Group Ltd
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
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description Objectives: This study aims to report the trends in the certification of both sight impairment (SI) and severe sight impairment (SSI) in England and Wales during the period of 2010 to 2020, prior to the COVID-19 pandemic. The focus is on diabetic retinopathy/maculopathy as the key causative factor. Design: Retrospective database analysis. Setting: England and Wales. Participants: Individuals certified as SI or SSI. Outcome measures: Trends in certification of vision impairment in England and Wales due to any cause, with specific attention to diabetic retinopathy. Methods: Certifications of vision impairment made by ophthalmologists in England and Wales were recorded and copies were sent to Moorfields Eye Hospital for epidemiological analysis. All certificates completed in England and Wales over an 11-year period, from April 2009 to March 2020, were queried and analysed on an annual basis. This analysis included all causes, and where both the main cause was diabetic eye disease or where diabetic eye disease was a contributory cause among multiple pathologies. Poisson regression was employed to analyse changes in trends over time for certifications of vision impairment. Results: In England, from 2010 to 2020, there was a small but significant reduction (p<0.001) in the overall rate of certifications for SI and SSI due to any cause, from 43.4 certifications per 100 000 people to 41.7 per 100 000 people. Conversely, in Wales, an initial decline was observed, with a decrease from 50.6 to 40.1 per 100 000 people from 2009/2010 to 2014/2015, respectively. This rate subsequently increased to 51.8 per 100 000 by 2019/2020; however, this was not statistically significant (p=0.087). Individuals in Wales had a 9% higher certification rate compared with those in England (1.09 (95% CI 1.07, 1.10)). For diabetic retinopathy, certifications in England significantly decreased from 72.8 to 41.3 per 100 000 people over the study period; in Wales, the certification rate initially declined from 82.3 to 47.1 per 100 000 by 2016/2017 before increasing to 55.5 per 100 000 in 2019/2020. Despite this fluctuation, there was a significant decrease in certifications due to diabetic retinopathy in Wales during the study period. Conclusions: The findings underscore the importance of understanding regional variations in certification rates, particularly in the context of diabetic retinopathy. Despite fluctuations in Wales, the overall reduction in certifications due to diabetic retinopathy in both regions suggests a critical need for ongoing public health initiatives aimed at preventing vision impairment linked to diabetes. However, to provide a true reflection of the burden of vision impairment and its various causes, ensuring that all eligible people are certified is a prerequisite. Continuing attempts to limit the incidence of vision impairment due to diabetic retinopathy remain a priority.
published_date 2025-01-21T05:26:02Z
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