Need for a national glaucoma pathway emphasised during Westminster Hall debate

The state of glaucoma care in the UK and the need for a national framework for detection, monitoring and treatment were discussed during a Westminster Hall debate on Wednesday 9 July.

The debate was raised by Shockat Adam, an optometrist and the MP for Leicester South.

Referencing the AOP’s 2024 co-commissioned Key Interventions to Transform Eye Care & Eye Health report, Adam emphasised that: “We are now facing a growing crisis.”

“Work done by the Association of Optometrists, Primary Eyecare Services and Fight for Sight has shown that glaucoma cases are expected to rise by 22% in the next 10 years and 44% in the next 20 years,” he said.

“That is hundreds of thousands more people needing care, follow-up and support, yet we already have the tools to stop this.”

The debate came shortly after Glaucoma Awareness Week (30 June–6 July), which Adam said exists “because many people are not aware of the condition.”

“As an optometrist for many years, I have had the privilege — sometimes the heartbreak — of looking into the eyes of people whose lives are changing without their even knowing about it,” he said, adding: “Fundamentally, that is what glaucoma does: it changes lives quietly, and often without warning.”

Adam praised the work of Glaucoma UK, and outlined to MPs the pathology of glaucoma as a clinical condition.

“Because vision loss begins at the edges, people do not often realise that anything is wrong until it is too late,” he explained.

Adam used two examples from his own optometry practice to highlight the reality of the condition: a woman who was involved in a car crash after losing her peripheral vision, and a man who was brought in by his wife after repeatedly knocking condiments off the table.

He noted that glaucoma “is the leading cause of preventable blindness in this country,” and that over 700,000 people are affected, more than half of whom are undiagnosed.

“They are walking and driving around not knowing that they have the condition,” Adam said.

He also referenced former Liberal Democrat MP, Paul Tyler, who was diagnosed with glaucoma at a routine sight test and as a result of early detection still has his sight 25 years on.

Tyler’s story is highlighted as part of the AOP’s You won’t see it coming glaucoma awareness campaign.

Adam also noted that glaucoma is often free of symptoms in its early stages.

The condition behaves “as if the fire has gutted the house before anybody has even smelled the smoke,” he said.

He added: “That loss has far-reaching consequences. People lose not only their sight but, more importantly, their independence — their ability to drive, read, cook or even leave the house.

“Falls increase, isolation grows, and then come the emotional and mental health impacts: fear, depression and loss of identity.”

“The answer lies in the community”

Adam framed the issue of glaucoma in the context of the Government’s ‘three shifts’ for healthcare, the first of which is the shift from hospital to community.

“Patients are losing their sight not because care does not exist, but because the pathway is broken and follow-up is delayed,” he said

He used the example of one of his patients, who after an initial glaucoma diagnosis had two follow-up appointments delayed.

The patient had lost two lines on her visual acuity chart when she was seen in practice a year later, Adam said.

“That is the difference between being able to read letters or not; between seeing a grandchild smile or only hearing them,” he said.

Current waiting lists only measure initial appointments rather than follow-up care, he added.

He emphasised that “we need published data on follow-up waiting times, because that is where sight is being lost. That data would allow patients to make an informed choice about where they would like to receive treatment.”

He noted that hospital ophthalmology is the largest outpatient specialty in the NHS, with 8.9 million appointments in England in 2023–2024.

“It [ophthalmology] cannot carry that load alone,” Adam said.

“The answer lies in the community. There are over 14,000 qualified optometrists in England, providing more than 13 million eye tests. They are trained, regulated and ready to help.”

A nationally regulated programme could free up 300,000 hospital appointments a year, Adam said – and this would not be a one-off saving, because glaucoma is a chronic condition.

“Shared care would allow faster appointments, earlier diagnosis, less vision loss, and critically, more time for hospital ophthalmologists to treat complex cases. It could also save the NHS an estimated £12 million annually,” he said.

Wales has already adopted a shared care model for glaucoma but fewer than one in five areas in England offer the service, Adam added.

He noted that “it is a postcode lottery — one that punishes the most vulnerable, especially given that people from black and Asian communities are up to four times more likely to develop glaucoma and often have the least access to care.”

A national roll-out of an integrated glaucoma pathway is required, Adam believes.

He also noted that lack of digital connectivity is a major obstacle, with many optometrists unable to send digital referrals to local hospitals or access shared patient records, meaning information on medication, medical history and images can get lost, or be delayed or duplicated.

“This is 2025. It should not be easier to get a takeaway delivered than to refer a patient with a sight-threatening disease,” he said.

Access to NHS email for all primary eye care providers, shared patient records between optometrists, GPs and hospital services, and an efficient two-way electronic referral system are required, Adam emphasised.

He added: “That kind of interoperability is basic infrastructure and would transform the speed, safety and continuity of glaucoma care.”

He also urged the primary care minister, Stephen Kinnock MP, to consider the commissioning of minimally invasive glaucoma surgery (MIGS).

“It is critical that patients with glaucoma who need cataract surgery are able to discuss options with their glaucoma consultant, because if MIGS is not performed during cataract surgery, it may be eliminated as a future option,” Adam said.

Patients are losing their sight not because care does not exist, but because the pathway is broken and follow-up is delayed

Best practice in the west of Scotland

During the debate, MPs shared insight on eye care services in their own local areas.

Jim Shannon, MP for Strangford, noted that there are 18,000 confirmed glaucoma cases in Northern Ireland currently, with 50,000 people waiting for ophthalmology outpatient appointments.

Irene Campbell, MP for North Ayrshire and Arran, said that there are 1000 more people living with glaucoma in her local NHS area than the national average.

She explained that a “redirection strategy” to ensure that people are accessing the services most appropriate to their symptoms has promoted the message that a local optometrist is the best person to see for minor eye conditions, rather than a GP or A&E department.

The service, Eyecare Ayrshire, “has been very successful and continues to operate,” Campbell said.

Directing people to visit an optometrist “can be vital if there are any other underlying or undiagnosed eye conditions,” she added.

“As we have heard today, early intervention can be crucial.”

Helen Morgan, MP for North Shropshire and the Liberal Democrat health spokesperson, agreed that early intervention is key, and shared the story of one of her own constituents.

“One elderly patient in my constituency was sent for an urgent referral following a routine eye test. He was warned that if he was not seen in the next few weeks, he was at risk of losing sight in the affected eye,” she said.

“The appointment came through in time, only for it to be cancelled, along with the replacement appointment. By the time he was able to see a specialist, it was too late and he lost sight in that eye.

“This entirely avoidable incident demonstrates how it is crucial that we address the chronic shortage of ophthalmologists to deliver the care that people deserve.”

Speaking about the 10-Year Health Plan, Morgan added: “Optometry is a critical part of primary care and needs to be delivered locally.

“For glaucoma specifically, that means investing in eye services in the community and empowering the training of trusted, qualified optometrists to manage the condition.”

She added: “Optometrists are already in place to manage glaucoma across Wales and Scotland, so we have a strong base of evidence to inform that work.

“Research suggests that the additional training required is rewarding for optometrists, for the ophthalmologists training them and, more importantly, for the patients they are treating.”

In England, glaucoma services “vary drastically” depending on the integrated care board (ICB) area, Morgan said.

The reorganisation of ICBs could be an opportunity to “standardise a better, more consistent, community-focused approach,” she added.

She also asked how the Government plans to encourage further partnership between optometrists and ophthalmologists, with care being delivered in communities where possible.

Dr Luke Evans, MP for Hinckley and Bosworth, also questioned whether the Government would consider the creation of a nationally-commissioned glaucoma pathway.

Single point of access in action

Responding to MPs’ questions, Kinnock said that the Government’s three shifts – from analogue to digital, from treatment to prevention, and from hospital to community – are relevant in preventing and managing conditions including glaucoma across the country.

“More tests and scans delivered in the community, and better joint working between services, will support the management of conditions, including glaucoma, closer to home,” Kinnock said.

The Government takes glaucoma seriously as one of the main causes of sight loss, he noted.

Kinnock added: “I acknowledge the vital role played by community optometry in protecting people’s eye health across the country.”

He also acknowledged the importance of glaucoma referral refinement services that are being commissioned by ICBs and embedded in optical practices.

The eye care waiting list has fallen by 24,000 since July 2024, Kinnock said.

He explained that NHS England has been working with 11 ICBs on a single point of access approach, which allows patient data and images to be assessed by clinicians in order to determine whether a secondary care appointment is needed and to reduce hospital visits.

The trial has “consistently demonstrated a reduction in unnecessary secondary care appointments and a significant reduction in waiting times, both in time to treatment and to follow-up care” and the results will be shared with ICBs more widely, Kinnock said.

He added: “I want to see more ICBs adopting that approach for the benefit of patients, including those with suspected or diagnosed glaucoma.”

The single point of access approach “has tremendous unharnessed potential and is a great example of how, by harnessing technology, we can improve the way the overall system works and facilitate the interface between primary and secondary care that we know is at the heart of so many of the challenges that we face across our health and care system,” Kinnock told MPs.

He continued: “Community optometry continues to play a vital role in preventing glaucoma. We are committed to improving eyecare services and patient outcomes, to reducing avoidable sight loss and, in particular, to harnessing the power of technology to drive those improvements forward.”

Adam noted that the debate had achieved its primary objective, which was to raise awareness of glaucoma and “keep the conversation going.”

He added: “We need a statutory framework to regulate the whole process of detection, monitoring and treating glaucoma.

“Working collectively with the optical and ophthalmic bodies and the Government, we can surely do our best to keep people from suffering preventable sight loss and the devasting impact that that has on their lives.”