Digital eye tests detect early warning of illness

A digital retinal examination
A digital retinal camera being used to conduct an examination. Photo: Specsavers

The majority of the working-age population is entitled to some form of eye care through their employers. Specsavers’ Jim Lythgow looks at the benefits of offering preventive, instead of reactive, eye care.

Preventive care marks a significant shift in the focus of employee benefits. While healthcare aims to ensure that employees are well looked after if they become ill, preventive care goes one step further or, more to the point, one step earlier.

Employee wellbeing has an effect in both directions: provision of care is positive for the employee, but it is not altruistic, as the employer also benefits from healthier, happier employees. Employers are now looking to the next level of provision and, as a result, both they and their employees are seeing the further advantages.

Preventive care covers a wide spectrum of options, from awareness initiatives such as healthy eating campaigns, to wellbeing events and health screening. While the more simple activities to raise awareness can be made available to most or all employees at a relatively low cost to the employer, the more advanced options – for example, health screening – carry a significant investment of time and money. It is therefore often the case that only senior-level employees receive the best preventive care options and the employer faces a careful balancing act between cost and return.

Employer’s responsibility

Preventive care changes the onus on benefits, with employers able to offer far more than just incentive or reward. Employee benefits can fulfil a much wider and more significant role. This, however, also changes the level of responsibility placed on the employer.

Indeed, with the Government’s welfare reforms, this is the way in which society is being channeled. Taking responsibility for oneself is one approach, but forward-thinking employers understand how cost-effective prevention can be – not just in terms of the cost of treatment, but also in terms of the cost of sick leave and temporary cover.

Regulatory eye care

Employers have many obligations regarding employee eye care. Under health and safety regulations surrounding display screen equipment, all screen users are entitled to eye care. The Health and Safety Executive (HSE) also makes it clear that the responsibility for the eyesight of those who drive in the course of their work is shared between the employee and their employer. Once those requiring safety eyewear for “at risk” roles are added, this does not leave a great deal of the working population who are not entitled to some form of employer-funded eye care.

Eye care can be a significant influence on preventive care. Coupled with the fact that it is obligatory for it to be provided for the vast majority of employees, this makes eye care a very attractive option in terms of both ease of administration and cost effectiveness.

Eye care as preventive care

A full eye examination by a qualified optometrist can detect a huge range of conditions, including:

  • cataract
  • glaucoma;
  • wet and dry age-related macular degeneration;
  • retinal detachment;
  • uveitis;
  • strabismus;
  • amblyopia, or “lazy eye”;
  • conjunctivitis;
  • keratitis;
  • corneal thinning, for example keratoconus;
  • optic neuritis;
  • eyelid skin cancers;
  • ocular tumours;
  • dry eye; and
  • macular hole.

There is far more to an eye examination than simply assessing the patient’s vision. In fact, the process enables the optometrist to monitor the whole body and detect systemic conditions that would not seem, to most people, to have any connection with the eyes.

Examples of these systemic conditions include:

  • diabetes;
  • raised blood pressure;
  • raised cholesterol;
  • cardiovascular disease;
  • brain tumours;
  • pituitary tumour;
  • cranial nerve palsies;
  • cerebrovascular accidents;
  • brain aneurysms;
  • temporal arteritis;
  • arthritis;
  • thyroid problems;
  • migraine; and
  • multiple sclerosis.

Eye care goes digital

The digital retinal camera is an additional tool to help the optometrist look at the health of the fundus – the central retina. The camera gives a 45-degree field of view and is generally positioned to image the macula and optic disc. It can directly help in spotting haemorrhages, which might indicate diabetes, high blood pressure, artery/vein occlusions or wet age-related macular degeneration.

Digital retinal technology helps in assessing the optic disc for glaucoma. It can show a swollen disc, which might indicate papilloedema from a brain tumour, or inflammation of the optic nerve, which might be optic neuritis and can sometimes be related to multiple sclerosis. The camera can also help in diagnosing any abnormalities of the macula – such as a macular hole or age-related macular degeneration.

The digital camera is used in addition to direct ophthalmoscopy or volk examination. Perhaps the biggest advantage of digital retinal technology is that it enables quite sensitive monitoring of the fundus over time. While an optometrist can give an extremely detailed description of a patient’s condition, this cannot replicate the value of looking back at fundus photos from the previous year to make a direct comparison and monitor any changes. It is unusual for optometrists to make a formal diagnosis themselves, but their role is to refer the patient to a specialist for further investigation.

Forty-seven lives saved in 2012

The success of eye care in terms of preventive care is simple to prove: at least 47 lives were saved in 2012 through routine visits to Specsavers’ opticians alone.

Last year, these 47 individuals were simply visiting their optician to have their eyesight checked. In each case, the routine process led to the detection of a life-threatening condition, which was subsequently successfully treated.

Vision screening for Royal Mail

Royal Mail staff in Southampton recently participated in a vision-screening programme provided by Specsavers Corporate Eyecare. Some 500 members of staff benefitted from a vision-screening day, held on site at the Southampton Mail Centre.

The aim of the event was to encourage non-desk-based staff – some of whom do not qualify for company-funded eye care under Health and Safety (Display Screen Equipment) Regulations 1992 – to get their eyesight checked and visit a qualified optician for a full eye examination. Staff were also offered advice and money-off vouchers for eye care at local stores.

Ashleigh Fairhurst, world-class mail people development manager, said: “Royal Mail takes the health and wellbeing of all our colleagues very seriously. Many of our colleagues work in active, non-desk-based roles, and we wanted to ensure they have access to and are aware of the importance of regular sight check-ups.”

As well as explaining how a full eye examination can help with the detection and monitoring of serious illnesses such as diabetes, cancers and heart conditions, Specsavers Corporate Eyecare also concentrated on driver eyesight and the requirements for safe and legal driving. All Royal Mail employees who drive in the course of their work are entitled to company-funded eye care, but the vital aspect is communicating this fact and encouraging take-up of the opportunity.

The Southampton Mail Centre plans to make this a regular event and similar events have also been held for Royal Mail in London and Edinburgh.

Preventing absenteeism

The number of lives saved at Specsavers alone show how crucial this element of care really is to an employee’s overall health and wellbeing. The benefits are felt by the employer too, however, with the Office for National Statistics stating that 400,000 working days are lost each year through diabetes and 4.5 million days are lost through heart and blood-pressure-related conditions – all conditions that could be picked up during a routine eye examination.

Using diabetes as an example, Diabetes UK says that there are 3.8 million people with the condition in the UK and it is estimated that by 2025 this will reach five million. In the UK, diabetes is the leading cause of blindness in working-age people and a main contributor to kidney failure, amputations and cardiovascular disease, including heart attack and stroke. Preventive care programmes, including eye care, offered by employers could have a significant effect on the time employees are off work dealing with the disease and its symptoms.

Even much less serious ailments can have a considerable effect on working time. It is estimated, for example, that 1.6 million working days are lost each year to headaches and eyestrain alone.

A benefit worth offering

Preventive care has obvious advantages in terms of cost effectiveness and, more to the point, patient wellbeing. It has perhaps seemed, however, an unobtainable goal for employers.

It is a statutory requirement for employers to provide eye care for the vast majority of employees. With the wide range of both common and unusual conditions that can be detected and monitored through eye care, this makes preventive care in the workplace a very worthy option.


About Jim Lythgow

Jim Lythgow is director of strategic alliances at Specsavers.
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