Hospital-only glaucoma care ‘no longer viable’ says College of Optometrists

The College of Optometrists has published a report that calls for a shift in the delivery of glaucoma care, using the capacity of primary care to tackle rising patient demand and reduce pressure on hospital services.

The College of Optometrists is calling for the commissioning and expansion of optometry-led glaucoma referral filtering services in England, the roll out of shared care pathways for patients with ocular hypertension across England, and the roll out of community shared care pathways for patients with low-risk and stable glaucoma across England and Northern Ireland. It would also like to see the continuation of support for existing glaucoma repeat measures services in the UK.

Glaucoma is the second leading cause of irreversible sight loss in the UK, affecting more than one million people, with prevalence expected to rise to 1.145 million by 2030. At the same time, ophthalmology outpatient waiting lists remain one of the largest contributors to NHS backlogs, with glaucoma accounting for around 20–25% of hospital eye services activity.

The College of Optometrists’ The safety and effectiveness of glaucoma filtering services and shared care pathways in the UK review highlights evidence supporting optometry-led glaucoma services in the community, and highlights that referral filtering services and shared care-based pathways for low-risk and stable glaucoma patients are a safe and effective solution to reduce hospital glaucoma waiting lists.

The organisation states that “universal commissioning of targeted enhanced glaucoma services in primary care across the UK would help prevent avoidable sight loss and create sustainable models of shared patient care that meet the needs of an ageing population.”

The College of Optometrists’ review also highlights that glaucoma referral filtering services (GRFS), alongside shared care pathways for low-risk and stable patients, delivered by optometrists, reduce the number of false-positive referrals into hospital eye services while maintaining clinical safety. The review adds that evidence shows that between 40% and 75% of new glaucoma referrals could be avoided through effective filtering.

Access to referral filtering services remains inconsistent across England, leading to variation in referral quality, waiting times and patient outcomes. In contrast, GRFS are commissioned across Scotland, Wales and Northern Ireland.

The review concludes that community glaucoma shared care pathways, which allow trained optometrists to assess, monitor and manage low-risk patients outside hospital settings, should be universally adopted across the UK, adding that these models are being rolled out nationally in Scotland and Wales, and services for ocular hypertension are already available in Northern Ireland.

Expanding such pathways would allow hospital specialists to focus on more complex and high-risk cases, improving safety and overall system efficiency, The College of Optometrists emphasised.

Dr Paramdeep Bilkhu, clinical advisor at The College of Optometrists, said maintaining hospital-only glaucoma pathways is no longer viable, and “rising numbers of patients and constrained hospital capacity are creating increasing risks to patient outcomes and system sustainability.”

He explained “Optometry-led glaucoma referral filtering services and shared community-based pathways for low-risk and stable glaucoma patients provide a proven, scalable solution that protects patients from avoidable sight loss and supports a more resilient eye care system fit for an ageing population. While Wales and Scotland are leading the way in rolling out such services, we need to ensure they are available across the whole UK, so that all patients can benefit, no matter where they live.”

The AOP has welcomed the review, emphasising that it “aligns with our vision for the future of glaucoma care.”

Dr Peter Hampson, AOP clinical and policy director, said: “Expanding optometry-led glaucoma referral filtering and community-based shared care pathways is essential to delivering timely, patient-centred eye care across the UK.

“By supporting optometrists to provide enhanced services to manage ocular hypertension, low-risk, and stable glaucoma closer to home, we can significantly reduce pressure on hospital services, improve access to care, and deliver consistently high standards of care nationwide.”

Specsavers has also welcomed the findings, with Paul Morris, director of professional advancement at Specsavers, stating that it provides “clear, evidence-based reassurance around the safety and effectiveness of delivering appropriately commissioned glaucoma services in community settings.”

Morris added: “Its findings chime with what we set out in Specsavers’ Access to Care report – that bringing care closer to home, through community optometry, improves access for patients. This matters more than ever. Recent research has warned that the number of people living with glaucoma in the UK is already higher than previously estimated and is set to rise significantly as the population ages. If we are to prevent avoidable sight loss at scale, we need care models that are accessible, joined-up and focused on early detection and ongoing monitoring.”

Morris emphasised: “Community optometrists have the skills, technology and local reach to play a crucial role in this. The College’s report adds further weight to the case for consistent commissioning of glaucoma services that allow care to be delivered safely and effectively, closer to where patients live.”

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Glaucoma is a leading cause of sight loss worldwide. Yet half of people with the condition go undiagnosed