UK research finds lower rate of GOS sight test activity in areas of deprivation

UK research has uncovered “striking” inequalities in General Ophthalmic Service (GOS) sight test activity in deprived areas compared with areas of affluence.

Following on from an Eye study last year that explored the relationship between deprivation and the location of GOS contractors, researchers have moved on to examine the link between socioeconomic hardship and sight test activity.

In an exclusive interview with OT about the Ophthalmic and Physiological Optics research, study co-author and optometrist, Robert Harper, highlighted that those in the most affluent areas were over five times more likely to access GOS sight tests than those in the most deprived areas.

“I believe passionately that we can’t sit still and leave this as it is,” he emphasised to OT.

He highlighted that Professor Darren Shickle et al questioned the GOS model a decade ago, calling for different approaches to address eye health inequalities and to reduce preventable sight loss.

The most recent research by Harper and colleagues examined data from 5622 GOS contractors in England between 2022 and 2023. A total of 12.94 million GOS sight tests were performed over the period.

Harper highlighted that while there are known issues around deprivation and the risk of pathology, these findings point to a broader, as-yet-undefined problem.

“There’s a whole raft of issues associated with undetected eye disease that we don’t know about yet,” he said.

“These are the people who will go on to become late presenters,” Harper shared.

He added that the fact that people from more deprived areas access GOS services less is a narrative that fits with findings around late presentations.

“If we look at glaucoma, as one example, there’s quite a bit of research showing people with advanced glaucoma are much more likely to come from a socio economically deprived background,” Harper said.

Co-author, Dr David Parkins, highlighted that there were “stark differences” in terms of GOS sight test activity across the Index of Multiple Deprivation dataset.

“The variation was so consistent – it actually forms a very straight line,” he said.

He added that while there are some uncertainties in the research – for example, where patients live is not captured – he is confident in the overall findings.

“What’s really powerful with this particular piece of work is the size of the data. This is big data, and it is the first time I've seen these issues explored using the England GOS dataset,” Parkins shared.

The previous Eye study, published in September 2023, found that in the most deprived areas of England there were 6.93 optometry practices per 100,000 people.

In contrast, in the most affluent areas of the country, there were 18.33 optometry practices per 100,000 people.

“That shows quite a stark difference in provision from the least to the most deprived,” Harper shared.

Addressing inequalities

Turning to the reasons why there is less GOS activity in areas of socioeconomic deprivation, Harper highlighted that the commercial aspect of optometry can deter people from attending for their sight test.

“There is a potential barrier for some to do with the perception of cost,” he said.

“This issue of healthcare versus commerce is something that needs clarity. We have some work to do around debunking any myths that may exist and reducing the reticence that some people may hold,” Harper emphasised.

Harper’s view is supported by the latest General Optical Council (GOC) Public Perceptions Survey – which found that the perceived cost of a visit to an optometry practice was a common source of unease among members of the public. 

Of the 2035 survey respondents, 51% had felt uncomfortable visiting an optometry practice in the past.

Among this group, the cost of glasses or contact lenses was mentioned by around one in four (24%) respondents as the source of their unease, while close to one in five respondents (18%) said they had been uncomfortable because of the cost of the eye examination.

Additionally, pressure to buy contact lenses or glasses was mentioned by 14% of respondents as the reason they felt uncomfortable visiting an optometry practice.

Dr Louise Gow, RNIB’s clinical lead for eye health, optometry and low vision services, shared that there are a range of reasons that people do not attend eye examinations.

Alongside the perceived cost of having a sight test, Gow shared that there is the cost of taking time out from work and paying for transport.

“I do think finances are a big issue. I also think that the public health messaging around why you should go for a sight test is lacking,” she shared.

“I think that many members of the public don’t realise that when you go for a sight test it is a health check. They are not aware that there are some eye conditions which don’t have symptoms in the early stages,” Gow highlighted.

There’s nothing better than catching an eye condition early and knowing that you’ve changed the trajectory of someone’s vision

She shared that some groups are less likely than the general population to attend a sight test – including Black, Asian and minority ethnic patients, patients with disabilities and those who are homeless.

“Unfortunately, these are the groups that are at highest risk,” Gow shared.

“We need to find a way of getting the public health messaging out there so that they do attend for their eye tests and that we provide eye tests that are in an appropriate format,” she said.

The GOC public perceptions research found that patients with disabilities and those from an ethnic minority background were less likely to be satisfied with their experience at an optometry practice. 

In terms of her tips for how practices can make their services more accessible, Gow recommended conducting an ‘audit’ of a practice’s patient base in relation to the demographics of the area.

“Look at who is attending and then look at the gaps – who isn’t attending? Why might this be the case?” she said.

She shared that once a practice has identified the groups that are not attending, becoming engaged with local community groups – for example, by delivering a presentation – can help to raise awareness and make people feel more comfortable attending an optometry practice.

“Once you know who is missing, think about who might influence that group in your community so that they know they are welcome,” she said.

Gow recommends that practices have a standard question when someone is booking an appointment to establish if they have any additional needs.

Practice staff can consider if they have suitable equipment and technology to meet a range of needs – such hearing loops for those with hearing loss, providing information in accessible formats and enabling access to translation services.

“I think one of the top tips that I would give is to invite a couple of patients with disabilities to tell you where the pinch points are,” Gow advised.

She shared that addressing gaps in who accesses eye care makes sense for many reasons.

“It’s something that we really should be prioritising, not just for the individuals concerned, but in terms of the economic impact avoidable sight loss has on our country,” Gow emphasised.

On a personal level, Gow enjoys being able to see patients from every walk of life when working as an optometrist.

“It makes the day so much more fulfilling. There’s nothing better than catching an eye condition early and knowing that you’ve changed the trajectory of someone’s vision,” she said.

The AOP view

AOP clinical and policy director, Dr Peter Hampson, shared with OT that the research on sight test activity and deprivation raises important points.

Hampson highlighted that, for many years, the AOP has been making the case that the current level of GOS funding is “unsustainable” as part of the Optometric Fees Negotiating Committee.

“We know that in areas of socioeconomic deprivation it is hard to open and maintain a practice and that lowGOSfees have the greatest impact on these practices,” he said.

“As this research appears to show, if those practices are lost, already vulnerable communities will suffer, and we will see further health inequality. That is one of the reasons why we will continue to make the case for increasedGOSfees to the new government,” Hampson emphasised.