Royal College of Ophthalmologists warns of 'overstretched, under-resourced' NHS

AOP says optometrists are ready to provide community care to address the ageing population’s eye health and reduce patient harm


Hundreds of patients each year permanently lose their sight because eye specialists are overstretched and under-resourced, the Royal College of Ophthalmologists president, Professor Carrie MacEwen, estimated.

She supports the expansion of eye health services provided by optometrists, orthoptists and ophthalmic nurses to address this issue.

Professor MacEwen, making her comments to the BBC, said a “perfect storm” had hit, where an ageing population meant sight-threatening eye disease rates are rising just as new long-term treatments, like anti-vascular endothelial growth factor injections for age-related macular degeneration, are being discovered.

Ophthalmic hospital appointments had grown by 30% in the last five years, she said. Most of these are for patients with chronic diseases, from glaucoma to diabetic retinopathy.

Wait times for ophthalmologist appointments are a particular problem, with close to 500 reports in the National Reporting and Learning System of patients suffering loss or deterioration of their sight from appointment delays between 2011 and 2013, she said.

The College is also undertaking research to find patients whose eye health has been harmed by follow-up appointment delays, Professor MacEwen said.

“Preliminary results indicate that across the UK at least 20 patients per month suffer severe visual sight loss from such delays.”

Professor MacEwen warned: “Follow-up patients are the most vulnerable and at the greatest risk of irreversible sight loss. These conditions require long-term repeat appointments for close monitoring and care.

“And it’s these follow-up appointments that are more likely to be postponed or lost in the system for months – and sometimes years – to accommodate new referrals in already over-subscribed clinics.”

Among Professor MacEwen’s recommendations on how to solve this growing eye health crisis is the expanded use of optometrists, orthoptists and ophthalmic nurses for disease treatment.

AOP clinical and regulatory officer, Henry Leonard, said optometrists are keen to play their part in addressing the problem.

He added: “Optometrists are ideally placed to provide high levels of eye care to patients in the community, and have a vital role to play in reducing preventable vision loss.

“We are working with the NHS and other optical bodies to ensure that these challenges can be met, through better commissioning of community services and improvements in IT connectivity for optometrists,” he explained.

Professor MacEwen also recommends optimising efficient care, strengthening ties between primary and secondary care and informing patients of the importance of follow-up appointments. NHS targets should prioritise follow-up care as highly as initial appointments, she added.