In discussion: glaucoma and community optometry

MPs discussed the role of optometrists in glaucoma care during a Westminster debate

Westminster on a sunny day – the sky is blue, the buildings are a warm brown, and the Thames looks fast flowing

Eye care and the contribution of community optometry was the focus of two debates in Westminster at the end of April.

On 30 April, Jim Shannon, MP for Strangford, Northern Ireland, brought a debate on the topic of Glaucoma and community optometry, while Margaret Greenwood, MP for Wirral West, brought up the issue of Preventable sight loss.

In the first of a two-part series, OT reports on the discussions.

Glaucoma and community optometry

Shannon secured the debate after a number of people, including local optometrists, and professional bodies, had contacted him around issues of sight and sight loss.

He emphasised that, though health is devolved across regions, “the approach to making the system more fit-for-purpose must be UK-wide,” adding that: “It is clear that we need joined-up thinking to a joint problem.”

Shannon referenced the levels of preventable sight loss in the UK, as well as the impact of vision impairment and sight loss on the economy – of approximately £36 billion a year.

“We can work alongside optometrists and opticians, and have a partnership whereby people can have their eyesight tests done more often,” Shannon said. He continued: “Optometrists in my area have told me that they are happy to work with the NHS or the health and personal social services in Northern Ireland to make that happen.”

Highlighting the impact of sight loss on independence and confidence, and the need for prevention and early diagnosis, Shannon quoted data from Specsavers, with practices within the multiple making 30,000 referrals for glaucoma in people aged 40 to 60 in 2023.  

Glaucoma: spotting the signs, referral routes, and waiting lists

Reflecting on the role of eye care professionals in addressing glaucoma, he said: “Optometrists have a key role to play because they can spot the early signs of glaucoma during routine tests. For patients with stable glaucoma, optometrists have a role in monitoring eye health and helping them to manage their condition.”

For those patients with glaucoma who are referred into the hospital eye care service, long NHS waiting lists remain a problem.

Shannon outlined two glaucoma referral and refinement pathways in Northern Ireland, available at community practices where eye care professionals have the appropriate accreditations in glaucoma care.

The services enable patients to receive glaucoma testing in the community, with results shared securely with ophthalmologists.

“This joined-up approach helps to streamline the experience for the patient and ensures that optometry practices and ophthalmologists work together for the benefit of the patient,” he said.

An ocular hypertension monitoring service is also in place in Northern Ireland, allowing optometrists to manage patients in the community, who would previously have been seen in the hospital eye service. Some 2000 patients have been discharged to the scheme to date, Shannon said.

“Those successful services show that community optometry, alongside other primary care providers, is responsible for delivering the shift from secondary to community care and is able to do so at almost no cost to the taxpayer, given that it uses existing capacity,” he commented, suggesting that this is an example of how services could be delivered across the UK.

Shannon emphasised that professional bodies, such as the AOP, are ready to assist.

“Northern Ireland has shown how a model focusing on glaucoma care in the community can be effective,” he said. A key challenge is that, in Northern Ireland, the services exist outside of the General Ophthalmic Services (GOS) contract, and so are reliant on non-recurrent funding.

Given the success of the services, Shannon highlighted, there is a drive for the funding to be established on a stable, recurring basis and subject to the same process for fee uplifts as GOS, asking whether fees could be reviewed.

Shannon also highlighted challenges in cataract surgery, the most common NHS elective surgical procedure and accounting for the majority of the ophthalmic backlog.

Between 10% and 15% of those with cataracts have concomitant glaucoma.

“I am bringing the issue into the debate because cataracts are often treated separately. I suggest that we consider how we could do the two together – the glaucoma and the cataract surgery,” he said.

Shannon asked whether micro-scale injectable therapies, produced by Glaukos, could be a cost-effective solution to help in the treatment of cataracts and glaucoma, without the need for secondary surgery.

A commitment to working with optometrists

Andrew Gwynne, MP for Denton and Reddish, referred to the high numbers of patients on waiting lists adding that: “Given the risk that glaucoma poses if left untreated, such extensive waiting lists are a serious threat to patient outcomes.”

Labour has committed to reforming the system, he said, utilising existing capacity on the High Streets: “That is why the next Labour Government has committed to seeking negotiations with High Street opticians to strike a deal to deliver more NHS outpatient appointments.”

“With 6000 High Street opticians serving communities across the country, we cannot afford to sit back and waste their incredible potential. We will work with High Street opticians to beat the backlog and to get the system moving again,” he said.  

The Minister for Health and Secondary Care, Andrew Stephenson, MP for Pendle, attended the debate, responding on behalf of Dame Andrea Leadsom, the minister responsible for primary and secondary eye care services who was in the Tobacco and Vapes Bill Committee at the time. [Leadsom has since stepped down as MP for South Northamptonshire and will not stand in the General Election.]

“Up and down the country, community optometry plays an essential role in protecting people’s eye health. It also plays a key role in the early detection of glaucoma, as most glaucoma patients are identified through routine sight tests,” Stephenson said. 

“Up and down the country, community optometry plays an essential role in protecting people’s eye health”

Andrew Stephenson, Minister for Health and Secondary Care

He explained the Government’s commitment to making greater use of community optometry to help alleviate pressures in secondary care: “Many integrated care boards (ICBs) are already commissioning a greater range of services on the High Street, including minor and urgent eye care services, pre- and post-cataract checks, and glaucoma referral filtering and glaucoma monitoring.”

Stephenson acknowledged the results of glaucoma referral filtering schemes, such as a case study in Devon where a former Nightingale ward was been repurposed to screen glaucoma and medical retina patients – reducing the hospital backlog from under 4000 in April 2022 to below 500 in October 2023.

Stephenson highlighted the “ambitious targets” outlined in the elective recovery plan.

Waiting times are falling, he said, adding: “The number of patients waiting 78 weeks or longer for ophthalmology has been reduced by 96% since its peak, but we know that we have to go further.”

NHS England’s transformation programme is seeing seven projects run across each integrated care system area, such as testing how improving IT links between primary and secondary care could allow patients to be assessed and triaged virtually.

He commented: “Today, many glaucoma patients often have their condition managed in hospital, but in some cases, where clinically appropriate, there is no reason why they cannot be seen somewhere else in their community that is more convenient for them. In England, it is up to ICBs to commission services based on local need, and some ICBs are already trying new ways of working to do just that.

Stephenson explained that the current strategy pursued by the NHS is to evaluate different programmes across England on what delivers the best outcomes for patients.

“Community optometry is helping us manage the flow of glaucoma patients and it is already deployed effectively in many areas across the country to support patients,” he said.

Stephenson ended his comments with an appeal to the public to remember to have an eye examination and check the NHS website to see if they are eligible for help.

A report from the second debate, Preventable sight loss, will be published on OT in the coming days.