This was an exploratory study of the relationship between substance use – alcohol and other drugs – and sight loss. Its origins lay in practice-based concerns about the extent to which service provision met the needs of people with sight loss who were experiencing problematic substance use. A preliminary review of the international literature found limited evidence relating to medical or clinical associations between sight loss and substance use but almost no literature that explored the experiences of those living, or working with, sight loss and substance use. Therefore, this study sought to answer three key research questions:
• What does current evidence reveal about the nature and extent of the relationship between substance use and sight loss?
• What is the role substance use plays in the lives of people with sight loss?
• What are the experiences of professionals working with people who have sight loss and substance problems?

Key findings:
• People with sight loss are more likely than their sighted peers to abstain from drinking alcohol. Analysis of two UK datasets showed that they are also more likely to drink fewer units of alcohol per week.
• An international review of the literature found very little evidence for substance use leading directly to sight loss.
• There was evidence that substance use may be a risk for sight loss conditions such as ‘tobacco-alcohol amblyopia’ or ‘toxic amblyopia’ where heavy substance use is combined with other risk factors including smoking or poor nutrition.
• Among the people we spoke to who were living with sight loss and current or past substance use, some had been told by sight loss professionals that their alcohol or other drug use caused their sight loss.
• For some people their substance use was a way of coping with the negative experiences of sight loss.
• Among the professionals we spoke to, the number of people they worked with who had sight loss and substance problems was small but those who did posed considerable professional challenges.
• In general, professionals in sight loss and substance use services felt they were not adequately equipped with the knowledge, professional guidance or organisational policy frameworks, to help them to identify and respond confidently when working with someone with both sight loss and substance problems.
• Professionals identified partnership working as key to providing support and to stopping people falling through the gap in services. Joint training and resources for staff and individuals are recommended.