Eye care everywhere: taking pressure off Emergency Departments in England

Executive summary

Emergency Departments (EDs) in England remain under sustained and growing pressure.

Eye‑related conditions alone account for around 3% of all A&E attendances; 780,000 patient visits each year. These attendances are predictable, recurrent, and often driven by conditions that are low risk, non‑sight‑threatening and are routinely managed by optometrists in community settings.

Our analysis of the NHS Emergency Care Data Set shows that the majority of eye‑related ED attendances relate to symptoms including eye pain, flashes and floaters, visual disturbance, dry eye disease, conjunctivitis, foreign bodies and corneal abrasions. These presentations require specialist assessment but do not usually require hospital‑based emergency care. In the absence of visible alternatives, many patients default to EDs as their only recognisable option.

Our conservative analysis indicates that between 62% and 78% of eye‑related ED attendances associated with the most common conditions could be safely diverted through timely assessment and management in community optometry. When applied across all eye‑related attendances, this equates to approximately 320,000–400,000 deflected ED visits each year, rising to around 390,000–490,000 when accounting for coding gaps in the data.

Community optometry is already widely accessible via High Street opticians, has a clinically skilled workforce, and is equipped to manage urgent eye conditions safely. Where commissioned urgent eye care services exist in some parts of England, evidence shows reduced pressure on both ED and general practice. However, provision remains fragmented, with significant geographic variation and without a requirement for ICBs to commission these services.

The case for action is clear. Expanding and standardising access to community‑based urgent eye care in England would deflect pressure away from EDs, improve patient experience, and deliver care closer to home in line with wider government priorities. The data available demonstrates the scale of the pressure on EDs; optometry has shown the positive impact of delivering primary eye care services; and with direction and leadership from the Government, these services could be available and accessible everywhere in England.

Key findings

Our conclusions

1. A large proportion of eye-related ED attendances could be better managed elsewhere
2. Up to two thirds – and potentially more – of these cases could be directed to more appropriate locations than ED’s if assessment and management in community optometry was readily available
3. Direction and leadership from the Government is needed to address existing inconsistencies in commissioning – the postcode lottery – to ensure everyone in England can access an urgent and primary eye care service via community optometry
4. National campaigning will be necessary to alert patients to the service provided by community optometry in order to deflect pressure away from EDs.