Occasional Paper Number 15
September 2008
Improving the detection of correctable low
vision in older people
This publication summarises findings from research funded
by Thomas Pocklington Trust and carried out at the
Institute of Optometry by Zahra Jessa and Prof Bruce
Evans in collaboration with Prof David Thomson, Prof
Gillian Rowlands, Mitesh Amin, Hannah Sawyerr and John
Cooper.
Summary
The research sought to investigate new vision screening
instruments as methods of improving the take-up of primary
eyecare services by older people in South London.
In Screening Study 1, a computerised vision screener (CVS1)
was used to test 180 older people (aged 65+) in South London.
All participants also received a ‘gold standard’ eye examination,
which found that 32% of participants had significant cataract and
39% needed new spectacles.
Overall, 58% of participants had at least one of these problems
and the computerised vision screener detected about 80% of
these cases. This first study determined the usefulness of each
subtest in the screener and two tests were subsequently
dropped from the screener.
In Screening Study 2 the revised computerised vision
screener (CVS2) and a rapid flipchart vision screener (FVS)
were used to test a new sample of 200 older people. The gold
1
standard eye examination found that 31% had cataracts and
30% correctable refractive errors; 51% had at least one of
these conditions.
Both screening tools detected about 80% of cases of visual loss
due to these problems or to age-related macular degeneration
(AMD). The tools also correctly classified about 70% of those
with normal visual function. Further analyses revealed the best
combination of tests in the screeners and showed, as expected,
that simple vision screening is not good at detecting glaucoma,
which is known to be difficult to diagnose. Participants reported
a significant improvement in quality of life, most marked in those
who were prescribed new spectacles.
Vision screening does not replace the need for professional
eyecare, but can help to identify older people with correctable
visual problems. All people who are screened should be
reminded of the need for regular eyecare.
Introduction
A recent systematic review reveals that 20-50% of older people
1
have undetected reduced vision. The majority of these people
have correctable visual problems (refractive errors or cataract). It
is particularly startling that, in a ‘developed’ country, between 7%
and 34% of older people have visual impairments that could be
cured simply by appropriate spectacles. This has been attributed,
at least in part, to inadequate levels of attendance at the
community optometrist.
This undetected, yet correctable, reduced vision is associated
with impaired quality of life and ability to carry out activities of
daily living, depression, and falls and other accidents. Those
with low vision are about twice as likely to have falls than fully
sighted people. This correctable reduced vision is likely to be
particularly prevalent amongst people who suffer from the
effects of poverty and/or are from ethnic minorities.
Two different (but not mutually exclusive) approaches to
improving the detection of visual problems in older people are
better to publicise the need for regular optometric eye
2
examinations and to screen for visual problems. If an older
person attended a vision screening programme and was told
personally that their visual problem had a high likelihood of
being treatable, or at the least might benefit from low vision
services, then the research team believes that they would be
very likely to follow up on the referral that would result from the
screening. It is believed that the likelihood of their seeking care
is much greater than a person who has only seen publicity
advertising NHS sight tests.
In view of this, it is surprising that there has been relatively little
research on vision screening in older people. As part of this
project, the research team carried out a detailed and systematic
literature review of research on vision screening in older people.
This literature review was published in the peer-reviewed journal
of the College of Optometrists, Ophthalmic & Physiological
2
Optics. Only the main findings will be summarised here.
There is a lack of rigorous research investigating whether vision
screening is effective at detecting correctable low vision in older
people. Visual function in older people is not fully described by
high contrast visual acuity (e.g., the conventional letter chart
test), or by self-reports of visual difficulties. Other tests that may
be relevant include visual field testing, low contrast visual acuity,
contrast sensitivity, and stereoacuity.
1
Evans BJW, Rowlands G (2004) Review article. Correctable
visual impairment in older people: a major unmet need.
Ophthal.Physiol.Opt. 2004;24:161-80.
2
Jessa Z, Evans B, Thomson D, Rowlands G (2007) Vision
screening of older people. Ophthal. Physiol. Opt. 2007;27:52746.
3
The review paper noted that there is still uncertainty over the
battery of vision tests that are most appropriate. This, and
optimum venues for screening, requires further research before it
can be determined conclusively whether vision screening of older
people is worthwhile. The review noted that if a vision screening
programme using a battery of vision tests, perhaps
computerised, can be established then this should be tested to
determine how well the screening can detect the target
conditions.
The literature suggests that quite basic tests (described below)
will be able to detect uncorrected refractive errors and cataract.
These are the main target conditions in this research because:
(a) they have a very high prevalence, (b) they can readily be
cured, and (c) their treatment is of direct and immediate benefit
to the public through correcting visual loss and improving quality
of life.
The computerised vision screener and flipchart screener that
were developed for this research also include a test of visual
acuity, which will detect visual impairment from another common
cause in older people: age-related macular degeneration (AMD).
Although this condition is not readily correctable in most cases, it
is helpful to detect cases so that they can be referred when
appropriate for ophthalmological investigation and for further
support and low vision aids (e.g., magnifiers). There have also
been recent advances in the treatment of some cases of AMD
and it is likely that further technological developments will lead to
a higher proportion of cases being treated. In view of these
developments, it was decided to evaluate the performance of the
screening tools at detecting significant AMD and the cases which
were most at risk of deteriorating to the sight-threatening wet
AMD.
The only common visual anomaly that it was anticipated would
be difficult to detect with vision screening is glaucoma. Although
visual loss from glaucoma cannot be treated, it can be prevented
through early detection. It is difficult to screen for glaucoma,
since all three commonly used glaucoma tests have a poor ability
to diagnose glaucoma when taken in isolation and using all three
tests in screening by non-healthcare professionals is impractical.
4
A visual field test, which is likely to be of some use for
detecting glaucoma, was included in the computerised vision
screener. Nonetheless, it was accepted from the outset that
such a test is unlikely to match the accuracy of a full eye
examination for detecting glaucoma.
This research followed the tenets of the Helsinki declaration for
research involving human subjects and conformed to the
Department of Health’s Research Governance Framework. The
research received approval from appropriate ethical and NHS
committees. All participants were given full information about the
research, both verbally and in writing, and it was explained that
participation was optional and that refusal to participate would not
in any way influence their continued medical, optometric or social
care. Particular care was taken not to alarm or confuse older
people.
Preliminary study on the provision of NHS eyecare &
eyewear in South London
Introduction
All people over the age of 60 are entitled to eye examinations
in the community funded by the NHS, and people on low
incomes or with unusually high optical prescriptions are
entitled to an NHS Optical Voucher. This is a voucher that can
be used to pay for or reduce the cost of spectacles. This
preliminary study was carried out to determine which optical
practices in the South London area have a reasonable range
of spectacles whose cost is fully covered by the NHS Optical
Voucher (referred to below as Voucher Value Spectacles:
VVS).
Methods
A questionnaire was developed for sending to optical
practices. This was designed to determine the availability of
NHS-funded eyecare and eyewear.
5
Results
In South London, 65 questionnaires were sent out and there
were 53 responses (response rate 82%). Nearly a third of the
practices that responded to the survey do not provide VVS.
It has been suggested that optometric practices are deterred
from providing VVS because the values of the vouchers are
uneconomic. Compelling practices to provide VVS could be
counter-productive if the values of the vouchers remain
uneconomic, because it could force practices to withdraw from
providing NHS services altogether. It seems likely that the
limited availability of spectacles fully funded by the NHS is one
of the reasons why so many older people in the UK have poor
vision simply through lack of appropriate spectacles.
The list of practices where VVS spectacles are available was
printed and issued in Screening Study 1 and Screening Study 2
to participants who were eligible for VVS.
Screening Study 1
Introduction
The main goal of Screening Study 1 was to determine the most
appropriate screening tests for inclusion in the final version
computerised vision screener and flipchart screener. Some
basic epidemiological data were also obtained. Most
participants were seen at the Institute of Optometry but some
community based venues were also used. The Institute of
Optometry is situated in Lambeth, which has the eighth highest
ethnic minority representation nationally. Over half of the local
population is part of an ethnic minority group.
The required number of participants was calculated using
sample size calculations. The target sample size in Screening
Study 1 was 180.
6
Methods
Participants were people aged 65 or older who consented to
participate in the study. People of all ethnic backgrounds and
with or without physical or mental disabilities were welcomed.
Computerised vision screener (CVS1)
The CVS1 was a software program that ran on a laptop
computer, the display of which had been calibrated. The
following seven tests were included:







symptoms & history
near visual acuity (binocular)
visual field test
fixation disparity (a test of eye coordination)
stereoacuity (depth perception)
high contrast visual acuity
low contrast visual acuity.
In addition to the CVS1, all participants underwent a full ‘gold
standard’ eye examination by an optometrist. The optometrist
and the lay person carrying out the screening were unaware
of each other’s results. The gold standard eye examination
included the following tests:
 detailed symptoms & history
 checking the prescription in the current glasses
 determination of refractive error by both objective and
subjective tests
 six tests of binocular coordination
 high and low contrast distance visual acuity and near
visual acuity
 visual fields
 four tests of ocular health (tonometry, pupil reactions,
anterior segment biomicroscopy, dilated fundoscopy).
7
Based on the results of the gold standard eye examination,
standardised methods were used to diagnose undercorrected refractive error (an improvement of two lines of a
letter chart with new spectacles), cataracts (the Lens
Opacities Classification System III), AMD (Clinical Age
Related Maculopathy Staging System). Participants with or at
risk of glaucoma were identified according to conventional
clinical criteria.
The performance of the screening test was assessed by
determining the sensitivity (the ability of a test to identify
correctly people who have the target conditions) and
specificity (the ability of a test to identify correctly people who
do not have the target conditions). The optimum test cut-off
values (pass/fail criteria) were determined using a standard
method, involving plotting graphs that show the trade-off
between sensitivity and specificity (receiver-operator
characteristic (ROC) curves).
Results
The average age of the 180 participants was 77 years (range
67-99 years), 46% were male and 12% were seen in the
community. Overall, 58.3% had correctable visual loss (31.7%
cataract, 39.4% correctable refractive error; some both) and
28.9% had significant AMD. All participants were able to carry
out the CVS1 and none complained that it was difficult to do.
Extensive analyses were carried out to determine the value of
each component subtest of the CVS1 for detecting undercorrected refractive error, cataract, AMD, glaucoma, and a
history of falls. Two of the tests were found to be of little
value: the fixation disparity and the stereoacuity tests. These
were dropped from the screener for the second study.
The most valuable test was high contrast visual acuity, which
detected nearly 80% of cases of under-corrected refractive
error or cataract and correctly classified nearly 60% of
participants who were visually normal.
8
A supplementary study was included in Screening Study 1 to
evaluate whether cataracts could be reliably graded using a
portable version of the table top slit lamp biomicroscope that
conventionally is used to grade cataracts. This study showed
that cataracts can be reliably graded in this way, which
allowed Screening Study 2 to be based in the community to a
greater extent.
Screening Study 2
Introduction
Screening Study 2 evaluated the revised computerised vision
screener (CVS2) and a flipchart vision screener (FVS) on a
new group of 200 people aged 65+. Many of the participants
were seen in the community, either at a community centre or
a GP practice.
Methods
CVS2 was similar to CVS1, except that the fixation disparity
and stereoacuity tests were not included. The FVS included
three tests, presenting binocular near visual acuity, and
presenting monocular distance high contrast and low contrast
visual acuities. The gold standard eye examination was the
same as in Screening Study 1.
9
Since Screening Study 2 investigated the ‘final versions’ of
the screening tools, greater emphasis was placed on follow3
up. The Quality of Life (QoL) questionnaire, a brief
4
standardised test (one side of A4 paper, taking
approximately 5 minutes) was applied at the time of the eye
examination and up to three months after any intervention.
Results
As in Screening Study 1, ROC curves were used
extensively to determine the best compromise between
sensitivity and specificity. An additional variable was
calculated: the positive predictive value (PPV). This is the
probability that the condition is present when the test is
positive (failed).
The average age of the 200 participants in Screening Study
2 was 77 years (range 65-94 years); 31% were male and
32% were seen in the community. Overall, 51% had
correctable visual loss (30.7% cataract, 30% correctable
refractive error; some both) and 22.5% had significant
macular degeneration. All participants were able to carry
out the CVS2 and none complained that it was difficult to
do. This screening tool was found to be appropriate for use
in community settings. Some of the staff at a community
venue were trained in the use of the CVS2 and they found it
easy to use.
3
Wolffsohn JS, Cochrane AL (2000) Design of the low
vision quality of life questionnaire (LVQOL) and measuring
the outcome of low vision rehabilitation. Am. J. Ophthalmol.
2000;130:793-802.
4
de Boer MR, Moll AC, de Vet HC, Terwee CB, VolkerDieben HJ, van Rens GH (2004) Psychometric properties of
vision-related quality of life questionnaires: a systematic
review. Ophthal. Physiol. Opt. 2004;24:257-73.
10
Revised Computerised Vision Screener (CVS2)
Monocular data were used to determine the best cut-off
(pass/fail point) for each test for detecting the target
conditions. These results agreed with those of Study 1.
To investigate the overall performance of the CVS2,
significant eye disorder (excluding glaucoma) was defined
as the presence, in one or both eyes, of significant
uncorrected refractive error, cataract, or AMD. High contrast
visual acuity gives a sensitivity, specificity, and PPV of 75%,
73%, and 83%. The equivalent figures for low contrast
visual acuity are 71%, 80%, and 86%.
The next stage in the statistical analysis was to combine tests
from the screener. The challenge when combining tests is as
follows. If a person is said to ‘fail’ the screening if they fail any
one of a number of subtests in the screener, then a great
many people will fail. The sensitivity will be high (most people
with a visual disorder will fail) but the specificity will be low
(many people without a visual disorder will also fail). To
achieve good sensitivity without also having poor specificity
requires the judicious selection of the tests that should be
used, and the results from 37 different test combinations were
analysed to determine this.
For example, if people are said to fail the CVS2 if they fail at
least one of high contrast acuity, low contrast acuity,
symptoms, or near acuity then the test fails 82% of people
with significant eye disorders (defined above), but only
passes 60% of people who do not have these disorders. If
people are failed solely on the basis of high contrast or near
visual acuity, then CVS2 correctly identifies 79.5% of
people with the disorders and correctly passes 68% of
those who are normal.
11
The last stage of the analysis of the test results from
Screening Study 2 involved the inclusion of glaucoma in the
diseases to be detected. The visual field test was included
specifically to provide some ability to detect glaucoma, and
this test did detect 15 of the 19 participants with or at risk of
glaucoma. If glaucoma was added to the ‘significant eye
diseases’ defined above, then the combination of high
contrast acuity and visual field test would detect 88% of
participants with these target conditions. However, the
inclusion of this criterion reduces the overall test specificity
to about 25%. This means that 75% of visually normal
people would fail the screener.
Flipchart Vision Screener (FVS)
All participants in Screening Study 2 could be tested with the
FVS and none complained that it was difficult to do. This
screening tool was found to be appropriate for use in
community settings. Some of the staff at a community venue
were trained in the use of the FVS and they found it easy to
use.
The FVS results were analysed in the same way as for the
CVS2 and the data were comparable to those for the CVS2.
The results show that if one test alone had to be chosen
from the rapid flipchart tool, it ought to be low contrast VA.
Quality of Life (QoL)
A response rate of 97% was obtained for the QoL follow-up. In
no case did the QoL decrease following an eye examination
and, across all participants, there was a significant
improvement in QoL (Wilcoxon signed ranks test, Z=10.5,
p<0.001). In participants who did not receive an intervention,
the improvement in QoL appeared to be attributable to an
improvement in the response to the question ‘How well has
your eye condition been explained to you?’
12
The largest QoL gain was in participants who were prescribed
new spectacles. In this group, the degree of gain in QoL was
proportional to the degree of improvement in visual acuity with
new spectacles.
Discussion
Screening Study 2 was more community based than Screening
Study 1 and found a similar high prevalence of correctable
visual problems. The simple distance visual acuity test in CVS2
detected 75% of cases of uncorrected refractive error or
cataract or AMD. By combining tests in the screener a
sensitivity of over 80% can be achieved, although the specificity
drops. As anticipated, the detection of glaucoma is more
problematic. The screener was able to detect 15 out of 19
patients with or at risk of glaucoma but this criterion reduced the
overall specificity of the CVS2 to about 25%, meaning that 75%
of visually normal people would have failed the test.
The FVS performed similarly to the CVS2. An interesting
exception relates to high and low contrast distance visual acuity
testing. If it was asked which subtest by itself would be most
useful, then with the CVS2 this would be high contrast visual
acuity but with FVS this would be low contrast visual acuity. It is
tempting to attribute this to properties of the computer monitor,
but this had been carefully calibrated. The research team feel
that this is most likely to be a chance finding.
Screening Study 2 demonstrated that QoL can be improved by
refractive correction, and this is in agreement with the literature.
It is believed that this study is the first to demonstrate a
correlation between the degree of acuity gain and the
improvement in QoL. Although it was possible to evaluate the
effect of spectacle intervention on QoL, this was not possible for
cataract surgery. This is because of hospital waiting times and
because very few ophthalmologists provide feedback to the
referring optometrist.
13
The results also indicate that there was an increase in the QoL
even in those patients who did not require intervention. It is
thought that the reason for this may simply be that the
practitioner took the time to answer questions and reassure
patients about their ocular health. Although this improvement in
QoL was smaller than in those who had a spectacle
intervention, this important benefit should not be
underestimated. Older people are often concerned about their
eyesight and even when it cannot be improved then information
from a caring eyecare practitioner is still helpful.
Summary of results
The preliminary study revealed that nearly a third of optical
practices in South London do not provide any spectacles
whose cost is fully covered by the NHS Optical Voucher.
This indicates that older people with low incomes may find it
difficult to obtain spectacles that they can afford. This finding
is most likely explained by the fact that the NHS sight test
fee is uneconomic, covering less than half the cost of
providing a modern eye examination. This low fee is
subsidised by spectacles, and yet the NHS Optical Voucher
value is also uneconomic. In other words, the current system
of funding community eyecare in England requires spectacle
wearers to subsidise the uneconomic cost of the NHS sight
test. People with low incomes are unable to make this
subsidy comfortably, and it seems likely that many therefore
avoid seeking eyecare. The solution to this problem is not to
force practices to provide a range of VVS, because if they
are compelled to participate in uneconomic activities
practices are likely to withdraw from NHS services. A better
option would be to fund NHS eyecare in England properly,
mirroring recent developments in Scotland and Wales.
Screening Study 1 demonstrated that the CVS1 has reasonable
sensitivity and specificity for detecting the target conditions
14
(cataract and under-corrected refractive error) and is also
effective at detecting AMD. This study showed that the fixation
disparity and stereoacuity tests in CVS1 did not provide very
useful data and could be dropped in CVS2.
The supplementary study on cataract grading showed that a
portable slit lamp biomicroscope can be used to grade cataracts
using the LOCSIII system. This allowed Screening Study 2 to
be based in the community to a greater extent.
Considering the results from both screening studies, the gold
standard eye examinations revealed a high prevalence (over
50%) of the target conditions in a South London population of
people over the age of 65 years. About 30% have significant
cataract, 30-40% under-corrected refractive error, and 20-30%
significant AMD. These findings are particularly noteworthy
since the research was carried out in an area of London where
poverty is prevalent and where over half of the population
belongs to an ethnic minority group.
Most of these cases of correctable visual problems were
detected by the screening instruments. In Screening Study 1,
high contrast visual acuity alone detected about 80% of cases
of correctable visual loss. This sensitivity was good, but the
specificity of just 60% meant that the test would have ‘failed’
about 40% of people who were in fact visually normal.
The sensitivity and specificity were explored further in
Screening Study 2 where, using the final version of the
computerised vision screener (CVS2), a sensitivity of about
80% could be achieved for detecting cataract, correctable
refractive error, and significant AMD. A specificity of about 70%
was possible and the best test combination was obtained by
selecting participants who failed the high contrast visual acuity
or near visual acuity tests.
15
The FVS was found to be very simple to use and performed
similarly to CVS2. For detecting cataract, correctable refractive
error, and significant AMD a sensitivity of about 80% could be
achieved with a specificity approaching 70%. These values
were obtained by selecting people who failed either the high
contrast or low contrast distance visual acuity tests, and 79% of
people who failed one of these tests had one of these
conditions.
Even in a gold standard eye examination where three or more
glaucoma tests are carried out, the detection of glaucoma is
challenging. It was anticipated from the outset that the
screening tools would not have a high sensitivity or specificity
for detecting glaucoma and this was found to be the case. The
visual field test on CVS2 detected 15 of 19 cases who had or
were at risk of glaucoma, but this greatly reduced the specificity
of the screener – causing it to ‘fail’ about three-quarters of those
who were visually normal.
The data from both screening instruments partly support the
hypothesis raised in the introduction that vision screening
should include more tests of visual function in addition to high
contrast visual acuity. However, high contrast visual acuity was
found to be one of the best predictors of the presence of the
target conditions, although it was also found to be useful to
include other tests
(e.g. near visual acuity, low contrast acuity, visual fields).
The QoL data show that a consultation with a caring eyecare
practitioner brings about an improvement in QoL even when no
intervention is required, simply because the older person has
received an explanation of their visual status. When a new
refractive correction is required this is associated with a marked
improvement in QoL. The greater the improvement in vision
from the refractive correction the more substantial is the
improvement in the QoL.
16
This research supports previous findings that there is a high
prevalence of correctable visual loss in older people. The notion
that older people with visual problems will fully engage in
eyecare services is clearly nothing more than an ideal and this
underlines the need for methods that will encourage older
people to seek regular eyecare. The screening instruments that
have been investigated here are reasonably efficient at
detecting people with visual problems and it was found that
when participants were told in person that they would be likely
to benefit from an intervention then most were keen to follow
this advice.
One important caveat needs to be stressed. Any type of
screening can be dangerous if it has less than 100% sensitivity
and if participants are so reassured by the screening that they
fail to participate in healthcare services. It is very important that
people who undergo vision screening are given verbal and
written information stressing that a ‘pass’ in the vision screening
test does not diminish the need for regular professional
eyecare.
Both the computerised and flipchart screening instruments were
found to be easy to use and appropriate for use by lay people in
community settings. Participants did not find the testing difficult
or unpleasant. The time taken to test a participant was about 810 minutes for CVS2 and 5 minutes for FVS.
The research team’s experience is that, although GPs were
generally supportive of the research and pleased to publicise
the studies, most GP practices are not likely to be suitable as
venues for vision screening as set up in this study. Surgeries
are very busy and generally do not have unused areas suitable
for vision testing. The two community venues where the
screening instruments were found to be most appropriate were
an intermediary care centre and a community centre.
The FVS is easy to use, highly portable, and inexpensive to
produce. One possibility might be for a community nurse to
carry it so that older people could be tested at home, for
17
example if they were seen by a community nurse when
recovering from a fall. The time taken to test a participant was
about 8-10 minutes for CVS2 and 5 minutes for FVS.
Authors
Professor Bruce Evans and Miss Zahra Jessa Institute of
Optometry 56-62 Newington Causeway London SE1 6DS
References
de Boer MR, Moll AC, de Vet HC, Terwee CB, Volker-Dieben
HJ, van Rens GH (2004) Psychometric properties of visionrelated quality of life questionnaires: a systematic review.
Ophthal. Physiol. Opt. 2004;24:257-73.
Evans BJW, Rowlands G (2004) Review article. Correctable
visual impairment in older people: a major unmet need.
Ophthal.Physiol.Opt. 2004;24:161-80.
Jessa Z, Evans B, Thomson D, Rowlands G (2007) Vision
screening of older people. Ophthal. Physiol. Opt. 2007;27:52746.
Wolffsohn JS, Cochrane AL (2000) Design of the low vision
quality of life questionnaire (LVQOL) and measuring the
outcome of low vision rehabilitation. Am.J.Ophthalmol.
2000;130:793-802.
18
How to obtain further information
A summary report, in the form of a ‘Research Findings’, entitled
Improving the detection of correctable low vision in older
people, by Professor Bruce Evans and Zahra Jessa, is available
from:
Thomas Pocklington Trust
5 Castle Row, Horticultural Place
London W4 4JQ
Telephone: 020 8995 0880
Email: info@pocklington-trust.org.uk
Web: www.pocklington-trust.org.uk
Copies of this report in large print, audio tape or CD, Braille and
electronic format are available from Thomas Pocklington Trust.
Background on Pocklington
Thomas Pocklington Trust is the leading provider of housing,
care and support services for people with sight loss in the UK.
Each year we also commit around £700,000 to fund social and
public health research and development projects.
Pocklington’s operations offer a range of sheltered and
supported housing, residential care, respite care, day services,
home care services, resource centres and community based
support services.
A Positive about Disability and an Investor in People
organisation, we are adopting quality assurance systems for all
our services to ensure we not only maintain our quality
standards, but also seek continuous improvement in line with
the changing needs and expectations of our current and future
service users.
We are working in partnership with local authorities, registered
social landlords and other voluntary organisations to expand our
range of services.
19
Our research and development programme aims to identify
practical ways to improve the lives of people with sight loss, by
improving social inclusion, independence and quality of life,
improving and developing service outcomes as well as focusing
on public health issues. We are also applying our research
findings by way of pilot service developments to test new
service models and develop best practice.
In this publication, the terms ‘visually impaired people’, ‘blind
and partially sighted people’ and ‘people with sight loss’ all refer
to people who are blind or who have partial sight.
Published by Thomas Pocklington Trust
5 Castle Row, Horticultural Place
Chiswick
London W4 4JQ
Tel: 020 8995 0880
Email: info@pocklington-trust.org.uk
Website: www.pocklington-trust.org.uk
Registered Charity No. 1113729
Company Registered No. 5359336
ISBN 978-1-906464-08-0
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