100% Optical

Five practitioners on the top tools they would like to see to improve glaucoma care

From MIGS to better management in the community, five eye care practitioners on what they would change for their glaucoma patients

3 min read

Middle aged woman with grey hair applying eye drops whilst suffering from cataract and glaucoma

Getty/IsiMS

Lucy Miller

05 June 2025

What development in services or technology would make the most difference in the management of glaucoma across both primary and secondary care?

That was the question OT posted to practitioners at 100% Optical 2025.

From minimally invasive glaucoma surgery (MIGS) to management in the community, here is what they said...

James Bontoft, independent practice owner and optometrist at James Bontoft Optometrist: management in the community

“I feel the biggest difference that can be made in glaucoma management across primary and secondary care is the discharge of stable glaucoma patients into the community from secondary care.

“Having recently completed my hospital experience for my higher certificate in glaucoma, the referrals into secondary care, I felt, were of quite a reasonable standard, as we have had glaucoma referral refinements in my area for some time now.

“Discharge of stable glaucoma patients is the next glaucoma enhanced service we’re looking to launch locally and if successful, [it] would make significant gains in hospital appointment availability. It seems to be an ‘easy win.’”

Nishani Amerasinghe, ophthalmologist and glaucoma and cataract specialist: identifying patients early

“Picking up these patients is the most important thing. It would be brilliant if we could use services like artificial Intelligence to screen for glaucoma and pick up these patients, and then bring them into the right service for their ongoing care.”

Paul Morris, director of professional advancement at Specsavers: an end to the postcode lottery for treatment

“It’s really important that we get the infrastructure right. We have to set a clear standard for that national pathway, that everyone can lean into.

“It has to be really clear, irrespective of the postcode in which you live. We have seen the challenges in this. In Wales, we’ve got fantastic services. But we still lack the infrastructure to underpin it, so that we can manage with ophthalmology and in the community. It comes down, again, to IT.”

Moemen Elnawawy, ophthalmic surgeon at CHEC: minimally invasive glaucoma surgery

“MIGS is a very big topic. It represents a change in the surgical management. It can be combined with cataract surgery. The glaucoma patient is usually an older patient, so they often also have a cataract. So, why not combine the surgeries, and improve their quality of life?

“Some people may be against surgical management of glaucoma because a lot of research has been done on the side effects, but MIGS is a fairly recent development, with very minimal side effects.

“It would be nice to let patients know about the existence of such a thing: that you can combine your cataract with a stent, that can decrease your dependence on drops. I wouldn’t say it stops the drops altogether, but it can lessen your dependence on them.

“As most glaucoma patients are elderly and might have cataracts, they might also have arthritis. They may find it difficult to insert drops. They might live alone. If we can help them with that, and improve their quality of life, that would be really nice.”

Giles Edmonds, clinical services director at Specsavers: improved connectivity between primary and secondary care

“Better connectivity is critical. Connectivity between primary care optometry and secondary care ophthalmology is absolutely vital. There is still a lack of investment and a lack of a clear plan nationally, even in the devolved nations, to address that.”