Report describes the cost of the pandemic on eye health

New research has illustrated the negative impacts the pandemic has had on eye health in the UK, with 2986 people estimated to have lost vision due to delays in the identification and treatment of eye disease. 

With services restricted to urgent and emergency cases in optometry and ophthalmology at the height of the first lockdown due to COVID-19, and patients more reluctant to attend appointments, research by Deloitte Access Economics, commissioned by Specsavers, sought to examine the scale of the resulting issues for the eye care sector.

The report found a 4.3 million drop in the number of eye tests delivered in the UK during 2020 – a decrease of 23% compared to 2019.

Referrals to ophthalmology also fell by 316,000 between March and December 2020, a 28% drop compared to 2019. 

Considering specific issues, the research found that the number of people referred with suspected glaucoma fell by an estimated 43,000 – 2600 of whom would have been for urgent treatment.

Referrals for wet age-related macular degeneration (AMD) dropped by more than 10,820, and referrals for diabetic retinopathy dropped by 6133 during the year.

Presenting the data in a webinar launch of the report, Giles Edmonds, clinical services director for Specsavers, said: “This is particularly worrying when we know that glaucoma is typically symptomless in its early stages.

“Those patients displaying symptoms of wet AMD or retinal tears probably would have had obvious symptoms that something was wrong and would have been more likely to seek help. But the vast majority of people with suspected glaucoma would not have known anything was wrong.”

The impact on ophthalmology

The report highlighted that ophthalmology outpatient attendance and day case procedures declined by 36% and 45% respectively between March and December 2020 compared to 2019.

An estimated 235,000 necessary eye surgeries were missed or delayed in 2020, the report suggested.

While it was advised during the pandemic that anti-VEGF injections for AMD should continue, the report highlights that not all patients attended, estimating an average of 10% of injections were delayed. The report suggested 6313 fewer patients received injections for wet AMD.

An estimated 8680 less patients received injections for diabetic retinopathy, while NHS glaucoma follow-up treatments dropped by 11,062.

The cost of sight loss

Before COVID-19, the annual cost of sight loss and blindness in the UK was estimated at £36 billion. Looking at the impact of the pandemic, researchers suggested the estimated additional economic cost of sight loss and blindness between 2021 and 2024 would be £2.5 billion.

This makes the net additional impact of the pandemic on the cost of sight loss and blindness in the UK £1.7 billion between 2020 and 2024.

Though the cost to the country’s healthcare system was seen to decline in 2020 (by £778.3million), the researchers suggested this was a result of reduced use of services, adding: “This reduction may have serious and ongoing implications in the coming years, not least for those who have lost vision.” 

As restrictions have eased, community optometrists have been seeing more patients presenting with new sight loss, researchers suggested.

For those people who did not seek care during the lockdown, perhaps due to shielding or a reluctance to leave home, the report warned: “In some cases, their disease is more advanced and their sight loss is irreversible. Some will need support for the rest of their lives. This presents an additional personal and societal cost, far greater than the health cost the research has revealed.”

The backlog of services is likely to impose significant costs for people with sight-threatening conditions, the report continued, living at greater risk of falls, fear of further vision loss, productivity losses and experiencing reduced quality of life.

Doug Perkins, chairman and founder of Specsavers said the report “paints a stark picture of the challenging context we have been living and working in,” adding that community eye care “has shown great resilience… we continue to provide frontline healthcare that, for many, can be life-changing and sight-saving.”

He added that optometry has an “unprecedented opportunity” to integrate with GPs and ophthalmology “to reduce preventable sight loss and its impact and so help reduce the pressure on an already over-burdened NHS.”

Also commenting in the report, Professor Philip Bloom, consultant ophthalmic surgeon and chair of Glaucoma UK, expressed his concern about the patient backlog, and that when patients do return, “we will uncover a large amount of disease.”

“We have long needed more patients to be seen in community optometry practices,” Bloom said. Arguing that hospital eye services are overwhelmed, he said: “We must accelerate the pace of change by scaling up the innovation and collaboration established during the COVID-19 crisis.”

In discussion: the state of the nation’s eye health

Launching the report, Specsavers held a virtual presentation and roundtable discussion with experts from across the optical profession on the key findings and implications.

Providing an insight on the impact the pandemic has had for hospital eye services, Professor Bernie Chang, president of The Royal College of Ophthalmologists, said: “The biggest concern for us eye care professionals is the episodes of avoidable sight loss that may have occurred.”

Through the pandemic, hospitals have been risk-stratifying and triaging patients to ensure those at the highest risk of sight loss could be prioritised and still receive necessary care. He explained: “Now we’re trying to recover and restore services, we have a significantly bigger demand, not just to meet the backlog because even before COVID-19, the need for eye care has been steadily increasing due to people living longer.”

“We have to build an improved capacity in order to avoid sight loss,” he urged, which would ensure “every patient with eye conditions can be managed in a timely manner.”

Emphasising the need for more “collaborative and integrated pathways” across sectors, he shared that the organisation is working with NHS England and Improvement to develop interim recommendations on managing the backlog.

The challenge now is to develop a commissioning framework to support the delivery of the new care models that really allows providers in all branches in eye care to work more collaboratively together

Zoe Richmond, clinical director at Local Optical Committee Support Unit, discussed the role of clinical commissioning in tackling the backlog, sharing: “Even before COVID-19, we knew that working harder and faster and delivering care in the same way wasn’t going to meet the future demand and COVID-19 has accelerated the challenges.”

The National Eye Care Recovery and Transformation programme has been working to develop clinical care pathways, making use of the whole workforce.

“The challenge now is to develop a commissioning framework to support the delivery of the new care models that really allows providers in all branches in eye care to work more collaboratively together,” she said.

Commenting on the role of community optometry in addressing the challenges highlighted in the report, Paul Morris, director of professional advancement for Specsavers said: “Patients should be able to access services locally, stable conditions especially, so there is less need to travel to hospitals with that technological and communicative enablement. If they really need to see a consultant in person because they have greater needs then of course they can.”

Scaling to meet the challenges will be key, and Morris suggested there will be a need to embrace technologies as well as increase communication with patients, emphasising the importance of regular sight tests.

Yes delivering eye care costs money, but as this report and others have shown, saving sight saves money

“I think it’s really important that we, as community optometrists, tell people who come to visit us exactly how we help them so they can go and tell friends and family to access those key services too,” he said. “Prevention will save a lot of sight loss in the future, if we can just make sure everyone is accessing that regular care.”

Asked how community optometry can position itself for the future, Richmond agreed that promoting the services of the profession is important: “I think we need to recognise what it is we do in primary care optometry and work with the rest of primary care to ensure that they also understand what it is that primary care optometry can deliver to the eye care pathway.”

“There’s very many patients out there who really don’t understand the importance of a sight test and what it is we can do,” she suggested, encouraging optometrists to engage with campaigns such as National Eye Health Week and connect with Local Optical Committees.

For those patients who might be reluctant to come into practices and require at-home care, Richmond highlighted the important service that domiciliary optometry provides, as well as the potential for remote services that would mean patients don’t necessarily need to come into practice.

“We need to be continuing to embrace that and allow patients to seek advice and guidance in a remote way where it’s safe to do so,” she said.