National strategy for eye health ‘urgently needed,’ say experts

A set of practical recommendations for a National Strategy for Eye Health has been published by the Industry Vision Group.

The group, made up of representatives from seven pharmaceutical and medical devices companies, has advised that a coordinated strategy should focus on prevention, data and digital technologies, and treatment and innovation. 

The group is working to create a national strategy for eye health and is “committed to increasing the prioritisation of eye health among Government, NHS leaders, policymakers and commissioners at both a national and local level,” its report said.

Pharmaceuticals and the medical device industry has a strong role “in tackling avoidable and inherited causes of sight loss, and the role that existing treatments and emerging technologies can play in these efforts,” it added.

Membership of the Industry Vision Group currently includes representation from AbbVie, Apellis, Bayer, Janssen, Glaukos, Roche and Santen.

The Royal National Institiute of Blind People (RNIB), Macular Society, Retina UK, Glaucoma UK, Fight for Sight, the Royal College of Ophthalmologists and various NHS trusts also assisted in creation of the report.

Introducing the report, Tori Griffiths, the group chair and a public affairs partner at Roche, and Paul Cox, the group’s vice chair and a general manager at Apellis, said: “a new national strategy for eye health is now urgently needed, setting out the steps that can enable the NHS to be the best place for the care and treatment of people living with these conditions.”

The report was developed alongside clinical experts and patients, “with the ultimate goal of better outcomes for people at risk of or living with sight loss,” Griffiths and Cox added.

The report noted that the economic burden of sight loss is expected to increase to £29.9 billion by 2030, and £33.5 billion a year by 2050.

Better preventative action, timely diagnosis, effective condition management and faster adoption of innovations in care and treatment are required to adequately manage the predicted increase, the report suggested, adding that adopting these solutions is a “necessity if we are to reduce the burden of avoidable sight loss on patients, the NHS and wider society.”

The report notes that ophthalmology has not been a focus of national health strategy documents such as the NHS Long Term Plan or August 2023’s Major Conditions Strategy Framework, despite being the busiest outpatient specialty in the NHS.

“There are significant opportunities to address the growing burden of eye health conditions on individuals, the health system and wider society,” the report said.

It highlighted innovation within ophthalmology, including that retinopathy was an early adopter of artificial intelligence (AI) and that between 10,000 and 15,000 patients are recruited to ophthalmology trials every year.

There are challenges with data not always being joined up, the report said, meaning patients might present at an optometry or GP practice or in hospital, and lack of information sharing can hinder innovation, which “then affects the quality of decision-making for both individual treatment options and wider commissioning strategies.”

The ophthalmology workforce was also identified as an issue that needs attention.

There is a need for a government strategy to improve ophthalmology research, because there are “wider pressures on ophthalmology services which mean that many clinicians in other areas simply don’t have the capacity to meaningfully engage in research activity,” the report said.

There is an “urgent need for increased training among the ophthalmology workforce to treat retinal conditions and broaden the role to encompass new conditions and improve access to meet growing demand on services,” the report continued.

The NHS Long Term Workforce Plan needs to consider ophthalmology, it added, noting that “specific consideration is needed around how implementation of workforce plans will seek to address eye health inequalities.”

The Industry Vision Group hopes the report’s recommendations will highlight opportunities that exist, help to inform a national eye care strategy, and have wide applications across the UK.

What a national eye health strategy could accomplish

A national eye health strategy would offer an opportunity to highlight “emerging best practice taking place across the country – including how different ways of working can support in enhancing patient choice, reducing demand of primary and secondary care services, and improve data collection,” the report said.

It would also “provide a platform for action” in response to challenges in ophthalmology, it emphasised, adding that “a long-term, strategic approach to NHS eye care delivery is therefore vital to ensure NHS preparedness for future demand, within which novel treatment and technologies are likely to play a crucial role.”

A strategy would present “an opportunity to bring together existing initiatives into one strategic approach to transforming ophthalmology services,” the report said. 

The report also noted that a national strategy would allow for consistency in approach whichever political party is in government, highlighting that a 20-year improvement in cancer survival was seen in Denmark after a cross-party approach was agreed upon.

“Any national strategy for eye care would likely set out clear and helpful targets for improving outcomes, [and] recommendations around the uptake of best practice and would ultimately provide a powerful vision for how stakeholders can best work together to transcend traditional care boundaries and the short-term recurrent crises facing the health service,” the report said.

It continued: “This would be particularly beneficial in the context of the recent transition to Integrated Care Systems (ICSs), by providing systems with a clear framework for local action to improve eye care service delivery and helping to eliminate unwarranted variation.”

Phil Ambler, England country director at the Royal National Institute of Blind People, was quoted in the report.

“There is a clear need for a national eye health plan to address avoidable sight loss coherently, across all ages and sections of society, and to address the existing inequalities,” Ambler said.

Joanne Creighton, chief executive of Glaucoma UK, added that “to genuinely tackle avoidable sight loss, a national eye health strategy must address the challenge of underserved audiences wherein the greatest risk of sight loss often lies.”

She added: “Innovation focused on community-based mobile screening has particular potential for glaucoma, for example, but we need to know much more about the health seeking attitudes and behaviours of our target audiences in order to make a meaningful difference to equality and access.”

Primary care optometry

The report notes that optometrists play an integral role as first-contact NHS care providers for the assessment and management of minor eye conditions and eye disease, as well the management of some post-operative care, and that “there is therefore an opportunity to intervene at the earliest stage with advice, support and signposting to services.”

If optometrists are fully utilised the burden on secondary care can be reduced, the report suggested, adding that the Industry Vision Group supports independent prescribing for optometrists, alongside greater access to clinical placements in hospitals.

“Demand for eye care services is at an all-time high and is set to increase in the years ahead, so we need to look at how these services are provided to address this,” Ambler said. “Delays to treatment for certain eye conditions can have life changing and irreversible consequences. Wet age-related macular degeneration is one such condition, where patients can experience rapid and sometimes complete central vision loss within a few weeks if left untreated.”

Six recommendations

The overarching recommendations offered by the report are themed around prevention, data and digital technologies, and treatment and innovation.

1 Prevention strategies set by the Government should include a specific testing programme for eye health conditions

Targeted testing for eye conditions would be particularly useful among at-risk groups, the report said. Men and ethnic groups are the most likely to skip an eye test, so a prevention policy should focus on the value of sight tests too.

“Promoting and supporting greater uptake of routine eye tests – particularly for at-risk groups such as those with diabetes, history of eye disease and in the advanced age population – offers the opportunity to increase early detection of eye disease, support timely referral to treatment and improve both outcomes and experience for patients,” the report said.

2 National data registries for eye health conditions

These should be set up across the UK in order “to better understand service performance, patient outcomes and clinical risk across the system,” the report advised.

Improved recording of data should be a requirement of ICSs, and cover all sight-threatening conditions as well as mental health conditions and treatment, it continued, adding that “development of national level registries should enable improvements in the quality, depth and accuracy of data collected at a national level.”

3 Electronic records and referral systems in ophthalmology should be better integrated into community and primary care

The report emphasised that IT connectivity is needed because patients often present to different parts of the system.

“Electronic record and referral systems will encourage seamless and efficient transfer of information and diagnostic imaging between providers, ensuring information travels with the patient throughout their journey, as well as reducing bureaucracy involved in repeat information or tests, thereby ultimately reducing delays to diagnosis,” the report said.

4 Consultation with patients and patient groups is needed

Further consultation with patients and their representative groups is needed in order to “better understand health status and quality of life of people with eye health conditions and sight loss,” the report said, noting that health services should be designed around the individual.

It added that ICSs in England should be “encouraged to engage with the populations that they serve to ensure measurement of the outcomes that matter most to patients.”

5 A strategy should feature training on innovative treatments and technologies

Advanced therapies, emerging cell and gene therapies, medical devices and diagnostic technologies including AI will “shape the future ophthalmology environment and provide the UK with the opportunity to become a world-leader in advancing standards of care,” the Industry Vision Group believes.

6 A focus on rare eye diseases

  
NHS and national health technology appraisal agencies should develop guidance for the management and treatment of rare eye diseases, “including clear care pathways, access to genetic counselling and testing, criteria for referral to specialist care and treatment, and data collection requirements,” the report said. “To support this, NHS organisations should consider development of a rare eye disease database.”