Embed Size (px)
Citation preview
1
T H EE Y E W AY C O D EKeep Your Eyes^on the Road
After 40 years old
and life
RISKAHEAD
GLAUCOMA
1
T H E I G A‘Eyeway code:
Keep Your Eyes^on the Road
After 40 years old’
and life
As part of its 2011 ‘CAN U C 2 Drive’ campaign, the International Glaucoma Association (IGA), a UK-based charity, presents the ‘EyeWay Code: keep your eyes ^ on the road after 40 years old’.
The EyeWay Code addresses the risks of glaucoma – one of the leading causes of preventable blindness in the UK– which primarily, but not solely, affects people aged 40 and over.
Glaucoma affects more than 600,000 people in the UK1, yet it is estimated that over half the people concerned are undiagnosed and untreated. The condition affects peripheral vision and without regular testing, people will miss the early onset of the disease, as there is no automatic ‘warning light’ for glaucoma. Early diagnosis and compliance with recommended treatments can add on average, 12 years good sight1 – a period within which most drivers with glaucoma can normally continue to drive safely and with confidence.
The prevalence of glaucoma – which is increasing in line with the ageing population - and in particular its current level of under diagnosis and treatment, creates a
glaring risk on our roads. For the safety of drivers, passengers, other road users and pedestrians, it is time to ‘get into gear’ with glaucoma.
and life
2
The EyeWay Code is both simple and short, with four parts:
1. Glaucoma – the disease and driving: We explain what the condition is, how it affects the vision and who is at risk.
2. ‘Road test your eyes’: We show how and why most adults over 40 should ‘road test’ their eyes. Taking a pit-stop at a local optician where an optometrist can carry out the first line of testing for the disease is a key step in avoiding unnecessary sight loss.
3. ‘Road map to treatment’: If you are diagnosed with glaucoma, we take you through the ‘road map to treatment’. This is the best way to ‘slow down’ the progression of the disease. In addition, we explain the responsible steps you need to take regarding the DVLA. Glaucoma does not necessarily mean the ‘end of the road’ for drivers.
4. Call to action: ‘Get into gear with glaucoma’: We share the results of research carried out by the IGA this summer, which show that despite most adult drivers fearing the life changing consequences of losing the ability to drive, many are blind to the risk of developing glaucoma. We also include the stories of two patients and expert comments on the disease and Code.
1. Glaucoma – the disease and driving
Glaucoma is the name given to a group of eye conditions in which the optic nerve is damaged where it leaves the eye. This nerve carries information about what is being seen from the eye to the brain and as it becomes damaged the vision deteriorates.
The damage to the optic nerve is usually associated with excessive pressure within the eye. If the pressure gets too high, it squeezes the optic nerve and kills some of the nerve fibres, which leads to sight loss.
Glaucoma affects the off-centre parts of the field of vision first and does not affect the central detailed vision until the late stages of the condition. This off-centre damage can go unnoticed for some time, partly because we use our central vision most of the time and partly because, if the damage is in different areas of the visual field in each eye, one eye will ‘fill-in’ for the other.
The danger comes, especially in driving, when the damaged areas in each eye overlap: instead of an accurate combined visual picture, the brain will reconstruct the missing parts of the picture based on the information it has from the parts of the field of vision that are working. The driver will have no idea that this is happening. This may give a dangerously inaccurate picture and unexpected events may be missed, such as a child crossing the road.
If glaucoma is left untreated, the damage can progress to ‘tunnel vision’ and eventual loss of central vision, though blindness is rare.
Simulation of the impact glaucoma could have on the vision of a driver3
4
There are four main types of glaucoma:
• Primary Open Angle Glaucoma (POAG), also known as chronic glaucoma, is by far the most common form of glaucoma
• Primary Angle Closure Glaucoma (PACG), also known as acute glaucoma
• Secondary Glaucoma, where glaucoma is the consequence of another condition
• and Developmental Glaucoma, despite being very rare, glaucoma can also affect babies, children and teenagers
You can find out more about all types of glaucoma on the IGA website www.glaucoma-association.com
Risk Factors for glaucoma:
Other risk factors are:
• Race: People of African-Caribbean or Asian origin are at higher risk of developing glaucoma
• Family history: If blood relatives had or have the disease, your risks are higher
• Short sight or long sight: Both short and long-sighted people are at higher risk
• Diabetes: The link between the two diseases isn’t fully understood, but people with diabetes appear to have a higher risk of having glaucoma
Prevalence:
• It is estimated that 2% of the people aged over 40 have glaucoma, which represents over 610,000 people in the UK1
• It is also estimated that over half of all people with glaucoma in the UK remain undiagnosed1
Age: Anybody can develop glaucoma but it becomes much more common with age, especially after 40
5
Glaucoma could take away your driving licence.
Regular eye health checks can protect your vision.
CAN U C 2 DRIVE
The Problem:Too many over 40s don’t take regular eye tests
• 18% of people aged 40-49 have not been for a sight test for five years or more. A further 6% cannot remember the last time they had a sight test.2
• 10% of people aged 50-59 haven’t been for a sight test for five years or more. A further 2% cannot remember the last time they had a sight test.2
5
6
2. ‘Road Test Your Eyes for Glaucoma’ – Book an eye health check
However perfect you think your eyesight is the IGA recommends that everyone over the age of 40 should have an eye test at least every two years.
Contact your local opticians to book an eye health check. The tests will be carried out and then assessed by an optometrist, who is trained to examine the eyes to detect defects in vision, signs of injury, ocular diseases or abnormality and problems with general health.
Eye tests can also be carried out by ophthalmic medical practitioners (OMP) who are doctors who have chosen to specialise in examining eyes and usually practice in ‘Medical Eye Centres’. Domiciliary eye tests services are also available, please contact your local optometrist for more information.
When booking an appointment, ensure that you will not only have a basic eye test, but also a full ‘eye health check’ which includes all three glaucoma tests. They are all painless and together can identify glaucoma long before damage and therefore significant sight loss has occurred:
1. Ophthalmoscopy: Viewing the appearance of the optic nerve with a special torch brought close to the eye. This can also be done with a slit-lamp used by many optometrists.
2. Tonometry: A test to measure the pressure within the eye. Most commonly known as the air puff test, non-contact tonometry is used as a screening test in many optometric practices. Alternatively contact tonometry may also be used because it is more accurate and is recognised because a drop of anaesthetic will be put into the eye before the test. Both systems are of value in the initial detection of glaucoma.
3. Perimetry: A test to map any areas of reduced or defective vision in the periphery of the visual field. There are many different instruments that may be used to check the field of vision, but in most cases the patient will be asked to fix their eye on a central dot of light and press a button when they see flashes of light or wavy lines in any direction.
Illustration of the tonometry test: Courtesy of Stephen McPherson, Optometrist, Aberdeen
7
All three tests together increase the detection rate of glaucoma by four times when compared with ophthalmoscopy3 alone, so by taking all three tests, you will be more certain of whether you have glaucoma or not and if a referral to a glaucoma specialist at a hospital is required to confirm diagnosis and treatment.
If the optometrist notices any anomalies regarding your eye pressure or a change in your visual field, he/she will refer you to the hospital where you will be seen by a medical specialist (ophthalmologist) who will carry out extra tests and will determine whether or not treatment should be prescribed (see Road Map to Treatment on page 8).
Cost of eye tests:
The cost of an eye test can vary from one place to another but be aware many people are entitled to free NHS eye tests.
People who qualify for a free NHS eye test are those who:
• Are aged 60 or over
• Are under 16 (or 19 and in full-time education)
• Live in Scotland
• Receive (or their partners receive) income support, family credit, income based job seekers allowance, pension credit guarantee, and are entitled to a named or a valid NHS tax credit exemption certificate, or are named on valid HC2 certificate
• have diabetes or glaucoma
• are 40 or over and have a close relative with glaucoma
• are registered blind or are entitled to vouchers for complex lenses
Some optometrists may charge extra to carry out the tonometry and perimetry tests even if the rest of the test is paid for by the NHS. Consequently, it is worth checking this when booking your eye test and shop around if appropriate.
Remember: Even if you don’t have glaucoma
when tested, carry on booking eye tests every
two years, as the disease may develop later.
8
3. ‘Road Map to Treatment’:
Treatment for Primary Open Angle Glaucoma (POAG) - Chronic Glaucoma
The most common type of glaucoma – Primary Open Angle Glaucoma or Chronic Glaucoma – is usually treated by means of eye drops, prescribed by the medical specialist (ophthalmologist) and dispensed at the pharmacy. The eye drops aim to reduce the pressure within the eye to a level at which no further damage occurs to the optic nerve.
There are several different types of eye drops for glaucoma and your ophthalmologist may need to change your treatment until the right drop or combination of drops is found. Once eye drops have been started, they usually need to be taken for life. There is no such thing as a short course of eye drop treatment for glaucoma and on-going compliance is vital.
Getting into a regular daily routine of treatment is important and effective. Drops can be applied in front of the mirror, sitting down with your head tilted back, standing or lying down. The IGA provide tips to encourage compliance and how to apply the drops – see more at:http://www.glaucoma-association.com/i-have-glaucoma/glaucoma-treatments.htmlor contact the IGA Sightline (helpline) for a free information leaflet (contact details can be found on page 13).
If eye drops do not provide a sufficient pressure lowering effect, laser or surgical treatments are available.
Treatment compliance helps retain sight:
• Research suggests that through early diagnosis and compliance with treatment, a glaucoma patient could expect to retain good sight for 12 years more than a patient who is not treated:
How to use your eye drops: instill the eye drop into your eye, then close the tear duct
Photos by Rachel Ganszczyk
9
‘A treated glaucoma patient would progress from mild to at least unilateral blindness in approximately 35 years, while for untreated patients, the time of progression is estimated to be 23 years’1
• Treatment reduces the developing or worsening of glaucoma by approximately 60%4
How to check if it is still safe for you to drive
If you are diagnosed with glaucoma it is a responsible step to check if you are still safe to drive. Most people are still able to drive for many years, if not for the rest of their lives, provided that they comply with prescribed treatment and their visual field loss is not severe.
If you have been diagnosed with glaucoma in one eye, and the other eye has good vision, you do not need to inform the DVLA. However if you have glaucoma in both eyes, you must by law, inform the DVLA about your condition and undergo a visual field test with both eyes open in order to check the extent of damage to your functional sight.
Driver and Vehicle Licensing Agency (DVLA)
Drivers Customer Services (DCS)
Correspondence Team DVLA, Swansea SA6 7JL
Car Licence Group One call: 0300 790 6806
LGV and PVC Group Two call: 0300 790 6807
Email: [email protected]
www.dvla.gov.uk
Once you have informed the DVLA they will send you a medical questionnaire (V1) to help assess your medical fitness to drive.
For more information, please visit:http://www.direct.gov.uk/en/Motoring/DriverLicensing/MedicalRulesForDrivers/MedicalA-Z/DG_185444
Remember: Glaucoma doesn’t necessarily
mean the ‘end of the road’ for drivers.
10
4. Call to Action: ‘Get into Gear with Glaucoma’
Drivers Blind Spot about glaucomaICM Research carried out an on-line survey for the IGA on 13-14th July 2011 (respondents from England, Scotland and Wales). The following pages show the results of 1037 of the respondents all of whom were driving licence holders aged 40 years old or over.
Whilst awareness of glaucoma is high….
• 96% of respondents described glaucoma as an eye disease
Most people don’t know about glaucoma’s impact on vision….
• Over half (52%) did not know that glaucoma mainly effects peripheral vision
Or how it is diagnosed
• 30% of people did not know how the disease is diagnosed
• 14% inaccurately felt that the condition is easily diagnosed ‘as people recognise their sight is declining’
In line with other recent research our survey also showed many drivers don’t test their eyes regularly enough….(and could miss the onset of the condition, when beginning treatment can delay the disease progression and keep them driving longer)
• 30% of respondents in the 40 to 54 age group – when vulnerability to glaucoma starts to increase – are failing to take an eye test every two years or more frequently
• 9% of this group of respondents reported they take an eye test about every three years
• 17% reported taking an eye test less frequently than every three years
• 4% said they had never had an eye test
11
Meaning their risk of the life changing impact of losing the ability to drive is higher….
• Over eight out of ten people (83%) said it would dramatically or considerably change their life if they could no longer drive
• 73% feared the impact on their social life (meeting up with family and friends) of not being able to drive
• 21% would no longer be able to do their job if they had to stop driving
• 47% were concerned that their access to health care e.g. getting to the doctors – would be impacted by not being able to drive
Remember:
• In most cases, glaucoma has no symptoms in the early stage
• Anybody can develop glaucoma but if you are over 40 you are at increased risk
• Book an eye test every two years
• Make sure you have a full ‘eye health check’
• If diagnosed take your eye drops as prescribed
• Don’t hesitate to ask questions
If things are still unclear or you would like more information, visit www.glaucoma-association.com or contact our helpline on 01233 64 81 70
12
I was diagnosed with glaucoma: the story of two patients
Peter, aged 55, from Pirbright:
Peter was diagnosed with glaucoma in 1988. He discovered he had glaucoma through one of his regular eye tests at the opticians. He complies with a prescribed eye drop regime, his sight is good and he can continue to drive and much more. Peter said: “I play cricket, drive my sports car and have also been able to maintain my flying licence. If you develop glaucoma keep positive: it does not have to affect your life”.
Julia, aged 61, from Colchester:
By the time Julia was diagnosed aged 42, she had advanced glaucoma: “My diagnosis in that year halted my career as an adult education teacher which had involved me driving everywhere around the country. It also hits home when I can’t just jump in the car to see family and it was upsetting when I missed out on the birth of my daughter’s first baby.”
You can watch a video and listen to Julia and Peter’s stories
on the IGA website:
www.glaucoma-association.com
13
Comments from the experts
David Wright, Chief Executive of the IGA said: “When people turn 40, and to be sure even younger, it’s time to ‘get into gear’ with glaucoma, starting with regular pit stops at a local optician to see the optometrist. Nobody wants to lose their eyesight unnecessarily or prematurely, especially when treatment has proven to be so effective. This disease can impact on anyone, so don’t be blind to the risk.”
Professor David Crabb, Department of Optometry and Visual Science, City University, London, said “Glaucoma affects the off-centre parts of the field of vision first and does not affect the central detailed vision until the late stages of the condition. Regular professional testing by an optometrist at the opticians is essential to pick up the disease early on. This greatly increases the probability of successful disease management and a continued ability to drive safely and with confidence.”
Andrew Howard, AA Head of Road Safety, said: “As we get older having our eyes tested regularly becomes more and more important. From a driving angle we need to make sure that we can meet the basic eyesight test, but we also have to ensure we don’t have the conditions, like glaucoma, that can eventually preclude driving if untreated. And a check isn’t everything, drivers need to discuss driving with their opticians, so that anything that will affect them in the future can be identified and acted on before they start to affect ability to drive”.
For more information....
• Call the IGA Sightline: 01233 64 81 70 to talk to one of our advisors direct about any aspect of glaucoma and/or request our free information leaflets
• IGA website: www.glaucoma-association.com, where you can find more details about glaucoma and a video simulating what a driver with advanced glaucoma would see
• Email: [email protected]
• By Post: International Glaucoma Association, Woodcote House, 15 Highpoint Business Village, Henwood, Ashford, Kent TN24 8DH
14
Sources
1. Burr JM, Mowatt G, et al. The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technol Assess. 2007 Oct; 11(41):1-190. Number of people affected by glaucoma calculated based on the UK population figures estimated for 2009
http://www.statistics.gov.uk/statbase/Product.asp?vlnk=15106
2. Freshminds research (College of Optometrists): 4,004 adults aged 18 to 60, UK, Online survey, May 2010
3. Tuck MJ, Crick RP. Relative effectiveness of different modes of glaucoma screening in optometric practice. Ophthal. Physiol. Opt. 1993; 13: 227-232
4. Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open angle glaucoma. Arch Ophthalmol 2002;120:701-713
The Charity for People with GlaucomaEstablished 1974
THE IGA
‘Eyeway code:
Keep Your Eyes^on the Road After 40 years old’
Charity registered in England & Wales No. 274681 and in Scotland No. SC041550
© International Glaucoma Association 2011
and life
