Attachment 4a

CHAIR’S ACTION : BOOTS LETTER TO THE TIMES (launch of Boots Opticians Green Paper)

Original Letter

From: Parul Desai
Sent: 31 October 2016 11:42
To: Mercy Jeyasingham; Jenny Cook; ''
Cc: ''
Subject: Fw: Letter to the Times to Coincide with launch of Boots Opticians Green Paper

Dear Mercy

This is primarily about increasing the number of GOS sight tests in children and young people for the management of uncorrected refractive error- whilst important, it is not about preventing severe sight loss.

I have the following comments –

  1. The term “children” should be defined and not used loosely given the audience of this letter. In health care and population health distinction is made between “children” and “young people” .
  1. Severe visual impairment or blindness in the UK in children and young people is uncommon[i]:
  • UK prevalence of SVI/BL is about 0.5 per 1000 under 16 year olds.
  • The risk to a child born in the UK today of becoming SVI/BL by her 16th birthday is 6 per 10,000 children <=16yrs of age
  1. Milder causes of vision impairment are more common and include [ii] -
  • Prevalence of amblyopia (depending on definition ) is 1%
  • Prevalence of strabismus is 3-5% (depending on type and age)
  • Prevalence of uncorrected refractive error in children in the UK is estimated to be 20% (it varies depending on the definition of myopia).
  1. Myopia in the UK is increasing but probably not at the same rate as in other populations. Also evidence on the associations with risk of myopia in UK populations include [ii]:
  • parental/family history; higher social class; greater educational attainment; greater ‘educational exposure’ (using time spent in formal education as the proxy); and early life influences ( maternal/pregnancy health, birth weight, and general growth in childhood).
  • Studies from other populations – which have notably different genetic predisposition - point to time spent outdoors (ie distance rather than near viewing) as being ‘protective’.

References -

[i] Rahi J, Cable N, BCVISG. Severe visual impairment and blindness in children in the UK. Lancet 2003; 362: 1359-65.

[ii] Briefing document to Clinical Council for Eye Health Commissioning– Children. CCEHC Meeting October 2016.Rahi J.

As presented in the letter, the epidemiological data are misleading and open to misinterpretation with respect to the public health implications on child eye health.

Given this, the OPHC cannot support the letter in its current format.

I would suggest that Boots should consider revising to include the following :

  • placing their figure of “1 in 5 children facing undiagnosed health risk” in context with the epidemiology of mild visual impairment (largely uncorrected refractive error)
  • emphasising the need for commissioning of the National Screening Committee’s recommended vision screening of 4-5 year old children - which would pick up many of the mild to moderate issues and lead to a care plan for the child most likely in collaboration with the local hospital eye and community optometric services
  • whilst also highlighting the fact that NHS funded sight tests are available for children up to age 16yrs and those in full-time education between 16-18yrs – which would raise awareness of this amongst parents and the general population.

b/w

Parul

From: Mercy Jeyasingham [mailto:
Sent: 31 October 2016 08:01
To: Desai, Parul; Jenny Cook; ''
Cc: ''
Subject: Fw: Letter to the Times to Coincide with launch of Boots Opticians Green Paper

Dear Parul, Jenny and Rowena

I have told Boots I need to consult my committees so am asking you as Chairs (and President of BIOS) for your opinion on the below. Presumably they are asking me to get a VISION 2020 UK endorsement of some kind. It would be good to get publicity on eye health but the message needs to be clear. I know Jugnoo would be concerned of too many referrals to her clinic for example (she is abroad I think but copied in). I think the problem with the eyes spoken about means increasing myopia? Your opinions would be good.

Thanks

Mercy

From: Samantha Watson <
Sent: 29 October 2016 09:10
To: Mercy Jeyasingham
Subject: Letter to the Times to Coincide with launch of Boots Opticians Green Paper

Dear Mercy

I do hope you are well.

I am just getting in touch ahead of the launch of our Green Paper next week. We are intending to send a letter to the Times the text of which is below. I would be grateful if you could let me know whether you felt this was something VISION 2020 could support?

I am also just checking whether you are able to attend? Apologies if you have already responded to MHP.

Best regards

Sam

The undiagnosed health risk faced by 1 in 5 of our children

It is estimated that over 1.5 million school children in England have an undiagnosed issue with their vision and this figure is rising. Good eye health is key to supporting children's wider life chances. Research has shown that vision problems can negatively impact on a child's literacy, educational attainment and well-being. This can lead to higher likelihood of unemployment or lower paid employment in later life. School entry screening should be provided by local authorities and eye examinations are funded by the NHS, though worryingly many parents do not know whether their child has been screened and one in four parents say their child has never had an eye test.

Vision is not only about how we see the world, but also how we understand it. 80% of what our children learn is through sight. We must ensure that all children have access to school entry vision screening and eye tests. We are calling for better information and education for parents, teachers and health professionals on eye health as well as commissioning of a fully funded screening programme for all children aged four to five, regardless of where they live.

We should not allow a single child's potential to go to waste simply because they haven't had an eye test - let's make sure we give them all an equal chance.

Samantha Watson BSc(Hons)

Policy and Professional Affairs

Boots Opticians

07725 427213

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