The importance of minimally invasive glaucoma surgery (MIGS), how Glaucoma UK can help patients on their treatment journey, and why the condition needs to be prioritised in any potential national eye care plan were the key topics of conversation when OT caught up with Specsavers’ Giles Edmonds and Paul Morris at 100% Optical 2025 (1– 3 March).
Joining Edmonds and Morris on the Main Stage, and in conversation with OT afterwards, was Nishani Amerasinghe, a glaucoma and cataract specialist at Southampton University Hospitals NHS Trust and a past president of the UK and Eire Glaucoma Society.
Edmonds, clinical services director at Specsavers, had begun the session by outlining the wider political and economic context that advances in glaucoma care sit within.
Amerasinghe highlighted the vital role that optometrists play in MIGS, before Morris, the director of professional advancement at Specsavers, advised on what optometrists can do practically to ensure that advances in glaucoma care are seen on the ground.
Could you tell OT about your 100% Optical session?
Giles Edmonds (GE): I started by giving an update on PEST – the political, economic, social, and technological factors and forces influencing our profession – calling upon government, who we believe are being quiet at the moment on their plans around chronic care, especially glaucoma, and [highlighting] the need for us to have a national eye care strategy.
Paul Morris (PM): After Nishani’s great session on cataract and glaucoma, I picked up what optometrists and the sector should be doing to make a big difference. This is not a problem in isolation. We all need to work together to make this count, and the biggest thing we can do is proactively call for change.
What is the key message that you want people to take away from the session?
Nishani Amerasinghe (NA): We have two big key messages. One, we wanted optometrists to think about cataract surgery in glaucoma patients, because it’s not as straightforward as normal cataract surgery, and for them to think about where they would refer the patients.
And then, our real key message was the importance of Glaucoma UK as a pastoral partner to healthcare professionals in helping the wellbeing of patients.
What do you think are the key challenges for optometrists in providing glaucoma care?
GE: I think optometry and ophthalmology have to work together, with defined pathways, to make sure that we can do good for patients with glaucoma and reduce avoidable sight loss.
PM: No matter where you are as an optometrist, whether you’re in Northern Ireland, Scotland, Wales or England, upskill yourself, and become the best clinician you could be.
But also, don’t forget that, for the vast majority of people you see, there’s a health care message that you can give, that will make people able to go out and talk more eloquently to others in their network about accessing care. One in four people still don’t access regular eye care. We all have a responsibility, no matter what our role is, to help people to understand that they should be accessing services.
GE: We have a really defined model. When we look at Wales or Scotland, we can see what the future needs to look like. We just need to convince policymakers and stakeholders that this is the future for eye care in England.
Optometry and ophthalmology have to work together, with defined pathways, to make sure that we can do good for patients with glaucoma
Why did Specsavers decided to focus on patients with both cataracts and glaucoma at 100% Optical this year?
PM: It’s one of the Glaucoma UK priorities, and it’s something that I’ve learned a lot about this year. We don’t always think about the secondary and tertiary issues of people’s eye health, and it’s a massive issue.
With the technology that we have now, with SLT and now MIGs, there is a way to give people far better outcomes in the long-term. Some people are even able to go without drops. Drops are a huge ball around the ankle for certain people, because they might have peripheral neuropathies, and difficulty putting them in. Most people will have some ocular surface disease as a result of repeatedly using drops on a daily basis. If we can give them a drop-free life, they’ll be more concordant, but ultimately they’ll have better outcomes.
Why do patients with both cataracts and glaucoma need particular care and attention?
NA: Cataracts in glaucoma patients is not like a straightforward cataract. Doing the operation does have more risks, especially with intraocular pressure spikes, which can cause permanent visual damage. So, we have to manage those patients in a very different manner, and therefore it requires a glaucoma specialist to look after the patient.
What role does the optometrist play in that process?
NA: The optometrist is our gatekeeper. They help pick up these patients so that they can be diagnosed. Because 50% of glaucoma is undiagnosed, we need the optometrist to ask the right questions and refer to the right places, because they are the people who pick up these patients with glaucoma and cataracts. It’s for them to signpost the patients to the right place, and then to help with the wellbeing and the understanding of the patient, and enabling patients to live well with glaucoma, signposting them to Glaucoma UK, so that their overall management is done well.
For patients with glaucoma, referring them on to the right service is really important. Glaucoma UK has all the resources and the time to help the patient’s wellbeing.
The optometrist is our gatekeeper. They help pick up these patients so that they can be diagnosed
What opportunity does MIGS provide in terms of meeting patients’ needs?
PM: It’s vital that people offering cataract surgery have MIGS in their mind. It’s also vital for optometrists to know what services are available to them locally. If you are referring somewhere that doesn’t also have a glaucoma service for people at risk of glaucoma, then it might be time to engage in a choice conversation with them, to think about their longer-term eye journey.
Are there any changes that you feel are needed in the broader eye care sector in order to support patient outcomes?
GE: We need a national eye care strategy in England, specifically around chronic care. We know that the waiting lists in cataracts, so elective care, are coming down, which is great. But ultimately, we need to address that for chronic care, especially glaucoma.
Also, we need to upskill ourselves as optometrists. We need to continue to develop ourselves, and pathways and services, to be more patient-centric and more efficient at the same time.
What change would you like to see more broadly in glaucoma care?
NA: What we really need in glaucoma care is a timely diagnosis and appropriate follow-up. We need policymakers to realise how important glaucoma is. It affects 2% of the population over the age of 40 and 10% of the population over the age of 75. These patients need to be picked up and also have timely management, and we need the healthcare and policymakers able to provide the resources so that we can do this.
What would you say to policymakers about the importance of having a joined-up plan for eye care?
NA: Eye care problems, especially glaucoma, are a huge part of the healthcare budget and [patient] population. What politicians need to know is that it’s not just about cataracts – glaucoma and chronic eye diseases are part of long-term care. If these patients aren’t looked after, the morbidity that’s associated with them affects social care, and affects all the other parts of their funding stream.
If we pick up these patients early, we’ll help them live well with their chronic diseases, and they won’t be such a burden to the whole overall healthcare and social economy.
What would you say to policymakers about the importance of including glaucoma as part of a potential national eye care strategy?
GE: My message to key stakeholders and politicians is, we need a national eye health strategy for England, now, that includes glaucoma and other chronic conditions. But the answer is now. It needs to happen now. Every day, more and more patients are losing their sight needlessly, which is an absolute travesty. Time is of the essence.
How to achieve better outcomes in glaucoma patients with cataracts
The current state of glaucoma care and tools that can be utilised to improve it was the basis of a Main Stage presentation from Specsavers and Glaucoma UK at 100% Optical
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