People ‘needlessly going blind’ due to glaucoma waiting lists, say politicians

Patients are ‘needlessly going blind’ because of the length of ophthalmology waiting lists in the UK, two politicians have warned.

Marsha De Cordova, MP for Battersea, and Lord Low of Dalston, chair and co-chair of the All Party Parliamentary Group on Eye Health and Visual Impairment, have made the warning as part of the Specsavers State of the UK’s Eye Health report.

The report singles out the glaucoma ‘emergency,’ where waiting lists for tests run into multiple months.

The case of patient Michael Bayley, who is now registered blind after waiting 10 months rather than the previous three for tests, is highlighted in the report.

Patients like Bayley ‘find themselves at the mercy of a broken system,’ De Cordova and Lord Low said.

We must all work together to design integrated care systems that make use of the entire primary and secondary care workforce to ensure people receive timely treatment

The report also points out that new patients are waiting 18 months for an appointment in some areas. Whilst glaucoma accounts for 20% of NHS outpatient appointments, as many as half of all cases are undiagnosed.

De Cordova and Lord Low warn in the report that ‘senior ophthalmologists say waiting lists for key treatments are the longest they have ever been’ and speak of ‘a tidal wave of avoidable blindness.’

They note that regular monitoring is crucial for those diagnosed with glaucoma.
“Patients who were assessed as low risk a year ago need to be seen now,” the politicians said. “We must all work together to design integrated care systems that make use of the entire primary and secondary care workforce to ensure people receive timely treatment.”

They added: “Expert clinicians are concerned people are needlessly going blind.”

The economic cost of sight loss and blindness, which was estimated to be £36bn in 2019 and is expected to rise by £2.5bn by 2024, is also emphasised in the report.

It notes that 633,000 people remained on NHS ophthalmology waiting lists as of May 2022, and that of these more than 24,000 had been waiting for more than a year.

More than two million people living with ocular hypertension or glaucoma are at risk of vision loss, and the Royal College of Ophthalmologists anticipates a 44% increase in demand for glaucoma services by 2035, the report said.

The report calls for a co-ordinated approach to tackle the issue of glaucoma care in communities, “because patients are at risk of irreversible vision loss.”

A solution-based approach

Professor Anthony King, a consultant ophthalmologist and the chair of Glaucoma UK, said that improving pathways for glaucoma patients and raising awareness so undiagnosed people can be identified and access care is vital.

“Ophthalmology services throughout England and the devolved nations are still under immense pressure from the increase in demand,” King said.

He added: “Many patients are still experiencing long waiting times and delayed follow-ups, and I am concerned that these delays could have an impact on their sight.”

Doug Perkins, founder of Specsavers, said: “It is shocking that patients are losing sight from this treatable condition while on waiting lists. Prevention must be a priority for us all, and together we need to reach millions of people with important messages about looking after their eyes.”

He added: “For those with confirmed glaucoma, regular monitoring is crucial, yet challenges to capacity mean that appointments are often rescheduled.

“We need to reduce the numbers of patients who need to be seen in secondary care, for example by using referral filtering models consistently. We also need to increase capacity for those patients through the wider adoption of shared services.”

The report calls for a standardised approach to glaucoma patient referrals throughout the UK. Research highlighted reveals that inconsistent funding models drive regional differences in the roles optometrists play in glaucoma care.

We are completely focused on being part of that solution, going the extra mile to care for the nation’s eye health, so reducing avoidable sight loss

It also emphasises an enhanced role for optometrists in tackling the problem, pointing out that “Scotland, Northern Ireland and Wales have well established protocols for the use of primary care optometrists in the glaucoma care pathway, supported by coordinated funding.”

The report added that “with investment in shared care approaches and training there is potential to expand the role of optometrists everywhere and notably in the glaucoma care pathway in England.”

Giles Edmonds, clinical services director at Specsavers, believes optometry is well-placed to be part of the solution. He pointed out that many optometrists have already developed their knowledge using higher qualifications.

“Continued exposure to patients in ophthalmology and shared clinics will only improve their skills,” Edmonds said.

Perkins added that Specsavers’ “founding vision has always been to make the best eye care available to everyone. We are completely focused on being part of that solution, going the extra mile to care for the nation’s eye health, so reducing avoidable sight loss.”

The full State of the UK's Eye Health report can be viewed online.