Glaucoma in the spotlight on the 100% Optical stage

The increasing prevalence of glaucoma within the current political and healthcare context was the focus when Glaucoma UK and Specsavers teamed up for their joint session at 100% Optical (24–26 February).

Taking to the Main Stage on the Sunday (25 February), Specsavers’ clinical services director, Giles Edmonds, and director of professional advancement, Paul Morris, and Glaucoma UK’s Professor Anthony King, discussed the challenge of early diagnosis, the importance of collaboration, and how to increase public awareness of the condition.

Opening the session, entitled Are we doing everything we can for every glaucoma patient?, Edmonds identified politics and technology as key factors that could impact glaucoma care in the near future.

There is expected to be a 44% increase in the need for glaucoma services by 2035, he shared.

“We shouldn't forget that glaucoma already accounts for about 20% of NHS outpatient ophthalmology appointments. So, it is a real challenge,” Edmonds said.

He encouraged practitioners to retain their General Ophthalmic Service contracts, but noted that the fee must evolve in order to allow every demographic of patient to be seen in practice.

“We must continue to develop, ourselves, [the] services and pathways to be more patient-centric and more efficient,” he added.

Edmonds emphasised that the National Eye Health Strategy bill for England, championed by Marsha de Cordova, would have given the profession “a really brilliant platform to drive change, as we have seen in the devolved nations.”

Although the bill did not receive its second reading in 2023 due to the timing of parliamentary sessions, Edmonds believes that there are still strong opportunities to influence policymakers into prioritising eye care.

“As a group of eye care professionals, we must collaborate, and lobby for change with key decision makers, to make sure we get better services for our patients and opportunities,” he said, adding that the value of time and money is critical in the run up to a general election.

He added that, on a more basic level, “for those patients with glaucoma, their friends and their family, we must do a better job of signposting services – services that will give them better outcomes and will lessen the impact of the disease on their lives.”

Speaking about technology, Edmonds noted that “artificial intelligence (AI)-assisted clinical decision making, within our sector, is already here – but a tangible benefit, in terms of wait times and clinic management, seems some way off.”

“These changes will eventually innovate the way that we manage conditions and prevent harm, but at the moment, they remain costly and complex,” he said.

Improvements in the accuracy of auto-refraction mean that competition from new entrants to the optometry sector will increase, Edmonds said.

He continued: “We have to make sure that we’re utilising every tool, as a group of eye care practitioners, that we have. We have to make a real difference to every patient we see. We have to educate the public on the importance of the role we as primary care optometrists play, to make sure we remain trusted experts within our communities.

“Working together, we can lobby and influence for change, for the benefit of our communities and our patients.”

For those patients with glaucoma, their friends and their family, we must do a better job of signposting services

A ‘bulge’ in glaucoma cases

Professor Anthony King, consultant ophthalmologist at Nottingham University Hospital and chairman of Glaucoma UK, spoke about glaucoma in the current context and explained that the charity is supporting patients to integrate with community optometry.

He noted that, because glaucoma can be asymptomatic, half of those living with the condition do not know that they have it.

Without intervention “people will become blind,” King said. “This is what we are trying to prevent.”

An ageing population means a significant increase in the number of people in their 60s, 70s and 80s in the next 10–15 years, he added.

Prevalence of glaucoma in those in their 70s and 80s is 10%, meaning “there is a massive increase in the number of potential people who are going to be suffering for glaucoma over the next 10 to 15 years.”

He also noted that there was already a glaucoma backlog before the pandemic, and that adding an ageing population to this will only compound existing issues such as waiting lists – and in turn, lead to increased prevalence of deteriorating vision in patients.

Added to this are challenges including a lack of knowledge and awareness of glaucoma, a reluctance for patients to attend eye tests if they do not have symptoms, a lack of engagement in health services from high-risk groups, delays in diagnosis and treatment, and insufficient investment in research.

This combination could mean a “perfect storm going forward,” King believes.

The reality is that the eye health sector will need to manage this increase in patients, King said, adding: “Most of us are not naive – we realise that there isn’t going to be an increased resource to help us manage patients of that proportion over that period of time.

“So, we have to look, not only at the challenges, but think laterally about how we manage these patients.”

Optometry is the first point of contact for most glaucoma patients, King said, although finding patients with glaucoma “is very opportunistic at the moment.”

He added that patients with low visual acuity and those who have eye tests less frequently than advised are at higher risk of glaucoma, as are those from ethnic backgrounds. Social deprivation also plays a role.

Adherence to medication can often also be a struggle for these patients, King said.

He added: “We do not have a systemic strategy for diagnosing these people. But the good news is that, once we identify these people and treat them, either with medicine or with surgery, they stop progressing.”

Optometrists can find those who might not know they have the condition by testing all patients who are over 60 or have a family history of glaucoma, handing out leaflets in practice, improving glaucoma expertise amongst practitioners, referring in a timely manner, directing patients to Glaucoma UK, and emphasising the importance of glaucoma care to their Integrated Care Board, he added.

“Do not miss the opportunities, when they come into your practice, to screen for glaucoma,” King advised.

He emphasised that there are training opportunities available for optometrists who want to upskill in glaucoma, and for practices that want to support their staff members in doing so.

Glaucoma UK’s vision is to end sight loss by raising awareness, providing support to patients, supporting research and development, and influencing policy and professional practice, he said.

Once we identify these people and treat them, either with medicine or with surgery, they stop progressing

“Silent thief of sight”

Paul Morris called glaucoma the “silent thief of sight.”

“We, as an optometric community, are really good at picking up glaucoma when it’s in front of us,” he said.

One tangible use of AI, Morris believes, could be to find the patients who aren’t presenting in practice – those who might already have late-stage glaucoma, and now need treatment.

This could be done through the use of genetic markers, Morris said.

Because there is currently no funding for this, he emphasised that “being connected better within the NHS and within our own frameworks is going to be absolutely key.”

Lack of connection with the NHS is a problem the optometry sector can work together to solve, Morris believes.

In Wales, glaucoma specialists are being added to some health boards in order to increase capacity, Morris shared.

Like King, Morris also emphasised that poor adherence can be a problem, and that patients with co-morbidities might find it hard to take their eye drops.

He demonstrated this by encouraging attendees to use eye drops that had been handed out at the start of the session.

He also emphasised that “public health is just advertising,” and that optometrists can act as public health campaigners for eye care.

“If they don’t trust you, then who?” he asked.

Morris encouraged optometrists to increase public awareness of glaucoma by speaking to local press and radio about the condition, and by engaging with local places of worship, charities, and sight loss and community groups.

“You could be part of the solution,” he said.

Edmonds, closing the session, reiterated Morris’ argument, and encouraged attendees to highlight the importance of eye care with their elected representatives.

“As a sector, our time is now,” he said. “It’s time for us to engage at a local and a national level. It’s time for us all to write to our MPs, to invite them into our practices, to showcase the brilliant work we do, and to let them know that we are here to help.”

He added: “Together, as a group of eye care professionals, we can make a fundamental difference to the eye care of everyone in the UK. Our communities, and their eyesight, are counting on us.”