An AOP explainer on... working towards low vision service commissioning

One of the recommendations we made related to the availability of low vision services in the UK, as anecdotal evidence suggests that these services are vital for many patients at a crucial point in their sight loss journey.

It was disturbing to see that there was still a massive disparity in provision. There was no mandatory commissioning. Even in the areas with a good low vision service, this was often achieved in a slightly ad hoc way by dedicated individuals and so the chances of services remaining commissioned without them are quite high. It is a very fragile service.

We know that in Wales there is a national low vision service and it appears to be working well. Northern Ireland has many high-quality services based in hospital optometry. In Scotland, there is progress towards a national model, but negotiations are underway, while in England there remains a disparity in commissioning structures and pathways.

As part of the Transforming eye care for older people for better health project, we wanted to gather the sector together to understand better how low vision services could be commissioned.

We have worked very closely with the Royal National Institute of Blind People (RNIB), who have produced the adult low vision service quality framework, which we signed up to.

In late 2025, the AOP hosted a Low Vision Services Consensus Workshop in collaboration with RNIB to bring together eye care professionals and representatives from government.

Through the workshop, we sought to reach a consensus on next steps for how we best persuade commissioners that the gold standard of low vision, as mapped out by RNIB, should be embedded into every integrated care board (ICB) service in England.

The consensus meeting told us that the evidence base is not strong enough. There are currently no financial, persuasive numbers to encourage commissioners to realise that a national low vision service in England will improve services or save money.

From the roundtable we also gained a useful strengths, weaknesses, opportunities and threats analysis of the different types of models that we know are well established. We hope these add to the narrative to encourage commissioners to see that these services are achievable and effective.

The main issue is the lack of evidence, and so as a next step, the AOP wants to act as a facilitator to bring together all the elements of research currently underway.

This may look like bringing together researchers to gather and synthesise the research into a cohesive and compelling single goal.

Ultimately, the idea would be that there is a ready-made service that is universally available to all patients in the UK, no matter where they live. In England, ICBs can use the material that has already been developed by the RNIB and others, perhaps following the model in Wales.

We know that the costs of a low vision service will not be that great and it should have a lot of benefit.

This is linked to the Certificate of Visual Impairment (CVI) because this triggers an automatic referral that could provide impetus to commissioners to provide a low vision service.

We know that currently a lot of people don’t receive the support and benefits they might otherwise because the current system means only ophthalmology can sign off CVIs. If optometrists were enabled to do this then more patients will be reached.

The problem is that the CVI process is enshrined in law in England. In Wales, there was room in the legislation to support optometrists being able to sign CVIs.

The legislation will not be easy to change and so I expect this will be a slow process. However, this gives us time to gather the evidence we need to prove why it is important and the effect it may have on the take up of low vision services.

We will continue to collaborate with the optometry bodies in Wales and Scotland, and maintain a close dialogue with the RNIB which has worked on the quality framework for adults and have recently launched another for children. We think a unified voice that persuades commissioners is useful because ultimately, we want every patient to be able to access the benefits of the low vision service.

The AOP policy team is actively working towards seeing the implementation of the recommendations set out in the Transforming eye care for older people for better health project. It is all part of the bigger picture of joining up services and joining the dots for older people.

We know that older people form the biggest demographic for most optometry practices and we want members to know we are actively trying to support optometrists to be more embedded in the wider care of older people, and that low vision services will be there for them to refer into.

There has been a push recently in the neighbourhood health framework from government in England around frailty. Optometrists are well placed to be able to recognise frailty, and so everything we are working on would help to realise those ambitions.

Read more about the AOP’s initiative to transform healthcare for older people.