Certification of visual impairment is used to register persons as visually impaired or severely visually impaired according to set criteria. This data is reported nationally and allows comparisons between regions and ages, and is essential in planning health, social, and educational services.1

Given the size of the population of Bradford district, it would be expected that 1% of national visual impairment would be accounted for by the region. However, reported data suggests that Bradford district accounts for 13% of the national registered visual impairment and 16% of registered severe visual impairment in 0–4 year olds. This figure drops to 3.5% and 3% of visual impairment and severe visual impairment, respectively, in 5–17 year olds.

The age-specific rates of registered severe visual impairment and visual impairment in Bradford district are compared with the national average in Tables 1 and 2. These rates are significantly higher in Bradford district compared with the national average (Z-test, P<0.001).

Table 1 Rates of registered severe visual impairment per 1000 population in England and Bradford district
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Table 2 Rates of visual impairment per 1000 population in England and Bradford district
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There are a number of possible explanations for these differences. Bradford district has a higher prevalence than the national average of children born with some forms of disability that may be associated with visual impairment,2 thought to be particularly prevalent in Black and minority ethnic (BME) groups. This may be due, in part, to a high prevalence of autosomal recessive and inherited disorders.3 Areas with similar BME populations, such as Calderdale, Walsall, and Oldham, have none or very few cases of registered visual impairment. Therefore, this suggests that other causes may be contributing to the higher rate.

Another explanation may be differences in registering visual impairment between regions such as differing levels of access to an ophthalmologist. As Bradford district has a high prevalence of visual impairment, clinicians may be more confident in registering children at an early age than areas with lower prevalences.

Registration rates of visual impairment in children is higher in Bradford district than the rest of England. The cause of this is unclear and is likely to because of the combination of a genuinely higher prevalence of visual impairment locally and underreporting of visual impairment nationally.