Health and wellbeing – Page 215 – The NEN

Scottish researchers investigate new treatment for diabetes to combat sight loss

Researchers in Scotland are investigating a new treatment for diabetes which they hope could reduce one of the most common complications of the condition – sight loss.

The team of scientists, funded by the British Heart Foundation (BHF), are aiming to find new ways of preventing diabetic retinopathy (DR) and have been given a grant of £286,000 for the study, which is being led by Professor Mirela Delibegovic in collaboration with clinical colleagues Professor John Forrester and Dr Lucia Kuffova at the University of Aberdeen.

People living with cardiovascular disease and high blood pressure can develop a condition called retinal microvascular disease and this is increased in the presence of diabetes.

Diabetic retinopathy is one of the most common complications of diabetes. Those with DR develop damage, often permanent, to the retina – the light-sensing layer inside the eyeball – and as a result, are at risk of losing their sight.

People in the UK known to have diabetes are offered retinal screening once a year to detect signs of changes in the retina caused by DR. This new project aims to identify physical signs of DR when they occur, but before they lead to loss of vision, and to help find treatments to prevent it from developing.

Professor Delibegovic (above), who is the Director of the Aberdeen Cardiovascular Disease Centre at the University of Aberdeen, explains: “Given its nature, DR is a significant and worrying complication of diabetes and so it is important that we understand more about it and find ways to reduce and prevent it.

“In addition, as Type 2 diabetes – the most common type of diabetes – can often go undetected and undiagnosed for many years, up to 40% of people with Type 2 diabetes already have signs of DR when they are first diagnosed with the condition. Being able to intervene sooner could make a real difference for people living with diabetes.”

Over the next 3 years, the team will investigate if inhibition of an enzyme, called PTP1B, will lead to protection against retinal microvascular disease and diabetic retinopathy.

The BHF is the largest independent funder of research into heart and circulatory diseases in Scotland and this project is one of more than 100 research projects currently underway in ten universities across Scotland.

James Jopling, Head of BHF Scotland, said: “This is an important project which could benefit patients living with heart and circulatory disease and diabetes. As such, it is vital we understand more about diabetic retinopathy.

“Research projects like this one in Aberdeen help inform how we treat patients, identify those at particular risk and ultimately find new ways to save and improve lives.”

For more information on the BHF’s life saving research and the work of the BHF visit www.bhf.org.uk

Dentist say seize the moment, as CMOs back water fluoridation

The British Dental Association has welcomed the new joint statement from all four UK Chief Medical Officers highlighting the benefits of water fluoridation in reducing tooth decay.

The BDA fully supports community water fluoridation as a safe and effective public health intervention, as part of a package of measures to improve dental health, where technically feasible and appropriate for local needs. The Health and Care Bill, currently before Parliament, is set to simplify the rollout of the policy in England. Dentist leaders are now urging all 4 UK administrations to restate their positions on water fluoridation in light of the statement.

Public Health England modelling shows water fluoridation more than pays for itself in medium term, owing to reduction in treatment need. £1 spent equates to £12.71 savings in five years, rising to £21.98 in ten. The BDA has stressed that upfront investment by Government is vital to unlock these benefits.

In their statement, the four UK CMOs recognise water fluoridation should be seen as a complementary strategy, and not a substitute for regular dental check-ups and other effective methods of increasing fluoride use.

The BDA backs a joined-up approach in which tried and tested policies like water fluoridation and supervised tooth brushing in early years settings are expanded, with parallel effort applied to rebuilding high street dental services.

Oral health inequality is anticipated to widen, given combination of unprecedented access problems, the suspension and ongoing disruption to public health programmes and changes to dietary habits since the start of the pandemic. Over 30 million appointments have been lost in NHS dentistry since lockdown, in England alone.

Around 5.8 million people in England receive fluoridated water, the lion’s share artificially added, but in some locations the appropriate level exists naturally within local water supplies.

British Dental Association Chair Eddie Crouch said: “Every dentist will thank the CMOs for recognising the lasting benefits water fluoridation could bring to the nation’s oral health.

“However, these gains are purely theoretical without upfront investment. Spending here will pay for itself, and Ministers need to show they are willing to seize the moment.

“We need a joined-up approach. COVID has left millions unable to access care, and deep inequalities are now set to widen. The four Governments must double down on tried and tested policies while rebuilding the services millions depend on.”

Review of Autism Strategy criticises lack of progress

An independent review of the Scottish Government and COSLAs 10-year Autism Strategy has been published today.

The strategy, which comes to an end this year, set out with the vision that by 2021 autistic people would be “respected, accepted and valued by their communities and have confidence in services to treat them fairly so that they are able to have meaningful and satisfying lives’.

The review concludes: “After ten years, valuable resources have been created and new and additional services delivered. However, real change for many autistic people, both in how they engage with services and in how they are supported to live productive lives, is not as evident. To have a greater impact, the services and support need to have greater reach, become embedded and be sustained.”

This echoes the findings from the Cross-Party Group on Autism’s own 2020 review the ‘Accountability Gap’ which found (from a survey of 900) that 72% of autistic people and families did not have enough support to meet their needs across a number of areas including education, care and employment.

In the lead up to the May Holyrood Election National Autistic Society Scotland together with partners Scottish Autism and ENABLE Scotland campaigned under the banner of ‘Our Voice Our Rights’ for a Commissioner to promote and protect the rights of individuals and their families.

This resulted in a commitment in the SNP Manifesto to introduce a Commissioner as part of a Learning Disability, Autism and Neurodiversity Bill. Scoping work on this is due to begin shortly.

Nick Ward, Director of National Autistic Society Scotland, (above) said: “What is clear from today’s review of the Scottish Strategy for Autism is that autistic people and their families are still, after ten years, not getting the vital support that they need to live meaningful and fulfilled lives.

“The review echoes findings from last year’s ‘Accountability Gap’ report produced by the Cross-Party Group on Autism which found that while progress had been made, 72% of individuals and their families did not get enough support to meet their needs.

“Today’s review sets out some positive ways forward and we are delighted that Scottish Government has committed to establishing a Commissioner. We believe a Commissioner with robust powers to uphold rights, challenge bad practice and promote good will lever real change.”

Suzanne from Dunfermline was part of the ‘Our Voice Our Rights’ campaign and has an autistic son called Callum. She said: “Callum has a lot of challenges, he is constantly having to deal with sensory issues and sounds and he needs someone supporting him most of the time.

“It’s difficult for people to understand what he is saying and so we need to be with him when he is out to help as well as explain his compulsion to touch people.

“When Covid hit a lot of the services withdrew leaving us to deal with health education and social work issues. Over time that has got better but we’re still not receiving the level of support we had before the pandemic.

Suzanne (with Callum, above) added: “I think there needs to be a lot more joined up thinking, sometimes we end up going from service to service – there needs to be someone holding the system together, someone at a national level I can go to if there is an issue.

“My hope is that when Callum leaves school he doesn’t end up sitting in a day centre all the time and that there are opportunities for him. He loves buses and would love to be a bus driver. That may not be possible but working or volunteering in and around buses would be amazing for him.”

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Urban greenspace benefits deprived and ethnic minority communities, research finds

While urban greenspace is often associated with improved mental health, new research has found the benefits are dependent on the characteristics of the population using the space – and their proximity to it.

Researchers at the James Hutton Institute and Scotland’s Rural College (SRUC) looked at the link between greenspace and prescription rates to treat mental health disorders across all Scottish towns with more than 10,000 residents.

They found a significant relationship between mental health and the amount of urban greenspace in areas with high proportions of people from black and minority ethnic and/or in areas of high deprivation.

However, the link between lower prescription rates and greenspace in these communities was only evident when looking at those spaces in the immediate neighbourhood. When considering greenspace within a 30-minute walk, no significant relationship was found between greenspace and mental health disorders.

This suggests that the mental health benefits of greenspace for these groups occur where it is closest to home – with previous research finding they are often the least likely to use their nearest greenspace.

Researchers found no significant relationship between mental health and green space in all other population groups.

The research, which has been published by the Urban Forestry & Urban Greening journal, will provide valuable information for urban and land-use planning, where decisions are taken at the population level.

The lead author Dr Michaela Roberts, Environmental Economist at the James Hutton Institute, said: “Our work supports the broad supposition that greenspace and mental health are positively related, and adds further support for the need to understand a populations’ relationship with greenspaces, to ensure urban greening achieves the highest gains for communities.”

Co-author Alistair McVittie, Ecosystem Services Economist at SRUC, said: “Our results highlight that the relationship between greenspace and mental health relies not only on the presence of greenspace itself, but also on the characteristics of the population using the greenspace.”

The research was funded by the Scottish Government’s Rural & Environment Science & Analytical Services Division.

Army called in to help tackle Scotland’s ambulance crisis

Health Secretary Humza Yousaf has confirmed that more than 100 military personnel will be drafted in to help tackle the ambulance crisis. He also told MSPs that additional funding of £20 million will be invested in the Scottish Ambulance Service (SAS) to help improve response times, alleviate pressures and improve staff wellbeing.

In a statement to Parliament, Mr Yousaf announced:

assistance from more than 100 military personnel – 88 drivers and 15 support staff – following final approval by the Ministry of Defence. Personnel are expected to begin deployment from this weekend onwards.
around 100 2^nd year paramedic students to help in ambulance control rooms
more Hospital Ambulance Liaison Officers at the busiest A&Es, increasing from 11 to 20 – helping ensure timely admission of patients at A&E and reduce ambulance waiting times
additional help from the Scottish Fire and Rescue Service in the form of volunteer drivers, as well as the British Red Cross and private transport companies where clinically appropriate
immediate work to create temporary admission wards in hospitals, meaning patients can be admitted quicker
additional senior clinical input in ambulance control rooms and to assist and speed up decision-making on mental health, addictions, falls, breathing difficulties, high intensity users and trauma
£500,000 to fund staff wellbeing measures
14 additional staff members in Highland to reduce the on-call requirement in Campeltown, and remove it completely in Fort William, Kirkwall and Broadford.

Tuesday’s funding announcement comes in addition to £20 million already announced as part of the NHS Recovery Plan. That investment will deliver a net increase of almost 300 ambulance service staff by April 2022.

Mr Yousaf said: “The global pandemic has created the most challenging crisis in the history of the NHS. Ambulance services around the UK, as well as the wider NHS, are experiencing unprecedented demand – largely because of COVID-19, but also due to a combination of increasingly complex cases, and exceptionally busy emergency departments.

“The Scottish Ambulance Service is the heartbeat of our NHS. It has a unique role in engaging with all parts of the health and social care system across the whole of Scotland – 24 hours of every day. It is vital that we ensure it has the support it needs to perform this crucial role.

“The additional investment I have set out today means that the Scottish Ambulance service’s frontline budget for this year is more than 16% higher than it was last year. The measures we have announced today will begin to address some of these issues, both improving the level of service for the public, and also helping to reduce the pressure on the workforce, who are doing so much to serve the public during these incredibly demanding times.”

Time to Play!

BPS survey reveals high level of parents’ fears about effect of pandemic on primary school playtime

A survey for the British Psychological Society (BPS) has revealed that more than three-quarters of parents of primary-aged children believe play is now more than or just as important as academic catch-up, amid fears the pandemic has reduced opportunities for their children to engage in playtime at school.

Almost all parents who responded to the BPS survey said access to playtime in the primary school day was important for their children (96 per cent).

Yet research shows that since 1995, children’s break times in the school day have been reduced by 45 minutes a week, resulting in eight out of ten children now having less than one hour of physical activity per day.*

As a result of the findings, the BPS is launching a Time to Play campaign to put more play back in the school day, restore the playtime eroded and reverse the negative impact on children’s wellbeing and development.

The YouGov survey, commissioned by the BPS, had more than 1,500 respondents from across the UK. Key findings include:

96 per cent of parents surveyed said access to playtime in the school day was either very important (79 per cent) or important (17 per cent) for their children
79 per cent of parents said play was more important or equally as important as academic catch up for their children post-pandemic.
69 per cent were very or fairly concerned that the pandemic has impacted on the opportunities their children have for unstructured playtime at school.
61 per cent ranked social development as the most important benefit of play to their child.

Dr Dan O’Hare, co-chair of the BPS Division of Educational and Child Psychology, said: “It’s clear from the survey findings that play is valued highly by parents. We now need the government to take bold action and prioritise school playtime for our children’s development.

“This isn’t an ‘ask’ for more playtime, it’s about reclaiming what has been lost. There needs to be adequate support, funding and resources for teachers who are already under increasing pressure to deliver the curriculum.”

The campaign will urge the government to put back 10 minutes each day onto school playtime, effectively reversing the years of decline by restoring 50 minutes spread over a week.

In June this year, in a Statement to Parliament on the education recovery programme, the previous Education Secretary Gavin Williamson said the next stage of the government’s recovery plan would include a review of time spent in school and college. The findings of the review are scheduled to be set out this year.

Against this backdrop, the BPS is calling for a focus on unstructured, child-led play in school, highlighting its benefits including aiding social development, problem solving and physical development as vital priorities alongside academic catch-up.

Dr O’Hare added: “We know that pre-pandemic children’s playtime has been eroded and now, against the landscape of ‘academic catch up’ after lockdowns, closures and pressure on children and schools, this issue is even more urgent.

“Reduced opportunities to play will likely have a negative impact on the wellbeing and development of children, and it is vital that we don’t forget that children have also missed out on play with their friends, physical activity and fun.

“It’s important to understand the role play has in children’s development to really understand why we are campaigning to get more play in the school day. Play is fundamental to children’s health and wellbeing. It can develop children’s skills in coping with challenge, facing uncertainty and how to be flexible and adaptable to different circumstances.

“The intrinsic value of play is that it brings entertainment, enjoyment and freedom to children. It is important that there are opportunities for all children to have high quality play throughout the school day, regardless of their needs, skills and abilities.”

For further campaign information: https://www.bps.org.uk/time-to-play

Hospital visiting guidance

We know visits from loved ones can help with recovery. Please help us keep everyone safe by following this guidance:

To ensure that there are not high numbers of people in multi-bedded rooms we need to work with you to plan visits.
Please do not visit if you have COVID symptoms or have been identified as a contact of someone who is.
On arrival please check-in with a member of the ward team who will make sure that it is safe to visit.
Each patient may have two designated visitors (this can be changed throughout the stay if required).
If both visitors are from the same household, they may visit together. If they are not, they must visit separately.
Visitors must have had both doses of the Covid vaccine, the second dose more than 14 days before any visit.
Unfortunately, children and young people under 16 will not usually be able to visit.
These arrangements may vary. In certain circumstances more than two people may visit, e.g. when patients are nearing the end of life, or for patients with dementia whose distress may be eased by the presence of a relative or carer.
You must wear a face covering during your visit and follow infection control guidance.
We want to ensure that our patients have close contact with you during the visit, therefore holding hands is permitted but you must adhere to hand hygiene requirements. You do not need to wear gloves.
During outbreaks we may need to amend our guidance to maintain safety.
Please maintain physical distancing in communal areas of the hospital.
The name and contact details of those visiting will be kept should we need to inform NHS SCotland Test and Protect.

Thank you for following our guidance and helping keep everyone safe.

We encourage all visitors to take a voluntary Lateral Flow Test prior to visiting. Information on how to order Lateral Flow Tests is available on the Scottish Government’s website. Tests can also be collected from COVID testing centres in the afternoon or early evenings. If you do not wish to have a test or are not able to, you will still be permitted to visit.

It is essential you do not visit if you have any of the symptoms of coronavirus (COVID-19)

a persistent cough
flu-like symptoms
fever
new loss of taste or smell

It is also essential that you should not visit if you have been identified as a close contact of someone who has tested positive for coronavirus (COVID-19); you should remain at home for the required isolation period, which is currently 14 days.

In order to keep our patients as safe as possible, the guidance may need to be amended at short notice. If this is the case, we will tell you why and keep it under review where possible.

Men’s Sheds receive life-saving kit through charity partnership

The Scottish Men’s Sheds Association (SMSA) has partnered up with Scotland’s only dedicated first aid charity and leading first aid training provider, St Andrew’s First Aid, to provide free Automated External Defibrillators (AEDs) to ten Scottish Men’s Sheds.

The SMSA put a call out to the 190+ Men’s Sheds across Scotland inviting them to apply for the Automated External Defibrillators (AEDs) and received 44 applications showing a huge demand for this vital equipment (retailed at just over £1,500) to be located at Shed premises across Scotland.

The ten recipients will use the equipment to not only protect their members but – with the addition of an outdoor cabinet purchased by the Shed – will also make them accessible to the public 24 hours a day, seven days a week.

Sudden cardiac arrest strikes 7 million people a year worldwide with no warning and no pattern. There’s little time to react and even less time to think, this means an AED must be close at hand, easy-to-use and ready to shock.

Chris Jowsey, Treasurer of Glenkens Men’s Shed, said: “One of our members had a cardiac arrest whilst at the Shed and sadly passed away despite the prompt actions of his fellow Shedders to get medical assistance. We can’t help but wonder if we’d had a defibrillator that day, if the outcome might have been different.

“We are delighted to have received this defibrillator through the SMSA and St Andrews First Aid and to be able to make it accessible to our entire community.”

Tom Bennett of Springburn Park Men’s Shed (above) said: “We have been trying to raise funds for a defibrillator for over two years for our Shed located within a public park in our village.

“We are thrilled to accept and maintain this defibrillator and make it accessible to our members, other community groups, park users and the general public.”

Jim Dorman, Director of Campaigns and Public Engagement at St Andrew’s First Aid, said: “Knowing that these vital pieces of equipment will be available to both members of the ten Sheds and to the wider communities will hopefully bring considerable peace of mind.

“With every minute that passes following a cardiac arrest, the chance of survival drops by 10%. Swift use of a defibrillator is all the difference needed to significantly increase a person’s chance of survival. We are delighted to donate these defibrillators to help more communities save lives.”

The successful Men’s Sheds across Scotland are: Aberchirder & District Men’s Shed; Forfar and District Men’s Shed; Glenkens Men’s Shed; Inverurie & District Men’s Shed; Macmerry Men’s Shed; Mens Shed Dumfries; Pentlands Men’s Shed; Peterhead & District Men’s Shed; Springburn Park Men’s Shed; and Whale Firth Men’s Shed.

There is still time to apply for the prestigious ‘Scottish Men’s Shed of the Year’ Awards 2021 from the Scottish Men’s Sheds Association (SMSA).

2021 Timeline:

Deadline for applications:
Midnight on Sunday 26th September 2021

Shortlist announced and open to public vote:
Monday 4th October 2021

Closed to public vote:
Midnight on Sunday 17th October 2021

Winner announced at SMSA AGM/Awards event:
Thursday 4th November 2021

More than a quarter of Scottish families are concerned about substance use

More than a quarter of residents living in Scotland are concerned about a loved one’s drug and alcohol use during the pandemic, a new survey has uncovered

Drug and alcohol use has impacted the lives of millions of people living in the UK. In England and Wales, it’s estimated that 3.2 million people had taken drugs in the last year alone.

The new Drug and Alcohol Survey from Delamere, has uncovered the regions and cities that are most concerned about a loved one’s drug or alcohol use.

The UK Drug and Alcohol Use Survey 2021

According to the survey data, Scotland was the location with the sixth-highest concern for drug and substance abuse. 26% of the region reported being concerned about a friend or family member’s drinking or drug use during the pandemic – that’s more than 1 in 4 people!

The biggest worry was alcohol, with one in seven Brits saying that in the last year they have been concerned with a loved one’s drinking. Men are almost three times (32%) more likely to be worried about how drinking or substance abuse is affecting their lives, compared to women where 24% reported feeling concerned.

Over a third of people in the UK (36%) consumed drugs over the last 12 months
22% of adults in Britain increased their alcohol consumption during the pandemic
Prescription drug misuse is on the rise, with 1 in 10 overusing prescribed medication
Cannabis is the most commonly used drug in the UK, with a 7% usage in the last year
Brighton was the drug hotspot of the UK, with the highest rate for three drugs

England and Wales have seen a record number of drug-related deaths during the pandemic in 2020, a total number of 4,561 deaths related to drug poisoning were registered. The new Drug and Alcohol Survey from Delamere, the private rehab clinic, has uncovered the prevalence of drug and alcohol misuse in the UK in a post-pandemic world.

The addiction experts surveyed 2,000 adults living in the UK on their alcohol and drug consumption over the last 12 months to determine the impact of the pandemic on usage.

Despite pubs, bars being closed for around 31 weeks in 2020, the pandemic brought an increase to the nation’s drinking habits. The survey found that one in four (22%) of adults had increased their alcohol consumption in the last year.

Despite the nation living under lockdown restrictions, the findings uncovered that 49% of UK residents had consumed alcohol in the last twelve months alone and 36% had taken drugs.

It’s no secret that the coronavirus pandemic and resulting shutdown of social interaction last year caused upheaval in the mental wellbeing of people across the UK. Cannabis has become a feature in many people’s lives during the lockdown, with 7% of the country using it in the last year, making it the most commonly used drug in the UK.

Although most people take prescription medications responsibly, misuse is becoming a health concern for specialists in the United Kingdom. The survey discovered that one in ten UK residents have overused prescription medication outside of prescriptions.

A fifth of UK respondents had purchased prescription drugs rather than obtaining them via a GP, with 7% saying they had ordered the medication through the dark web. The biggest prescription problem was found in Wales, London, West Midlands and Edinburgh.

Experts have warned the use of illegal drugs is rising at an alarming rate across the UK, with some of the boroughs most populated areas among the worst affected areas. Brighton was the drug use hotspot in the South, with the highest rate of use for Cocaine, Ketamine and MDMA use. One in five Brighton residents reported having used cocaine, while one in ten reported using MDMA.

The use of painkillers such as Codeine and Tramadol outside of a prescription was more prevalent in Belfast and Cardiff had the biggest rate of people taking these drugs outside of a prescription.

Which cities are using drugs the most?

City	Cities that use each drug the most	Residents who have used the drug
Belfast	Painkillers	3 in 10
Liverpool	Cannabis	Over 3 in 10
Liverpool	Ecstasy	1 in 6
Liverpool	“Legal” Highs	1 in 10
Cardiff	Prescription Drugs	1 in 6
Brighton	Ketamine	1 in 14
Brighton	MDMA	1 in 10
Brighton	Cocaine	1 in 5
Sheffield	Over the Counter Medication	Over 1 in 6
Sheffield	Heroin	1 in 20

The use of painkillers such as Codeine and Tramadol outside of a prescription was more prevalent in Belfast and Cardiff had the biggest rate of people taking these drugs outside of a prescription.

Sight loss charity urges people to go for regular eye check-ups

Two Edinburgh women are backing a national campaign by charity RNIB Scotland, which has expressed concern that the covid crisis may lead to a rise in preventable sight loss if people neglect eye-treatment or regular check-ups.

During National Eye Health Week this week [September 20-26th], it will remind people that going for regular eye examinations remains as important as ever.

The Edinburgh-based charity’s director James Adams said: “A lot has happened over the past 18 months with the covid pandemic. But we must not neglect other health matters such as our vision because of this.

“Eye examinations are free in Scotland and can not only detect early signs of sight problems, possibly in time to arrest or reverse damage, but also sometimes pick up the symptoms of other conditions, such as high blood pressure and diabetes. It is entirely safe to visit your local optometrist.”

Julie Mosgrove, vice-chair of Optometry Scotland, said: “We have been communicating regularly with our members to share the latest Scottish Government guidance throughout the pandemic in relation to personal protective equipment (PPE) and social distancing measures.

“We would stress the importance of attending regular eye examinations as this is a vital health check that can detect a number of conditions and prevent avoidable sight loss.”

[LINK to short video of Hazel – https://vimeo.com/606607762/abc91c907b]

Edinburgh resident Hazel Kelly from Corstorphine has described how an eye examination prevented her own sight condition getting worse.

“In my case, after a routine check-up by my optician, they picked up on something and referred me to my local eye hospital, where I was diagnosed with the beginning of two rare corneal conditions,” Hazel said. “This referral from my optician ensured I got early treatment which prevented me from actually going blind. And while I still have issues, if these conditions hadn’t been picked up earlier then the outcomes for me could have been far, far worse.”

Kirin Saeed also from Edinburgh, backed Hazel’s message from her own experience of sight loss. “I believe eye tests are incredibly important,” she emphasised, “because they’re free and you can make sure that the precious gift that we all have, which is eye-sight, is kept safe and secure.”

LINK to short video of Kirin – https://vimeo.com/606608270/790e09c9c6

According to the recent ‘State of the UK’s Eye Health 2021‘ report there were 4.3 million fewer eye tests across the UK in 2020, a 23 per cent drop compared to the last 12 months.

RNIB provides high quality information about all aspects of eye health, and a wide range of support to people experiencing problems with their sight, from emotional reassurance and counselling, to practical help with new technology and welfare benefits.

* Contact RNIB’s Sight Loss Advice Service on 0303 123 9999 or visit rnib.org.uk/eyehealth.