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Optometry's response to Covid-19

Patient having an eye test

In each UK nation ophthalmology is either the first or second most common reason for attending an outpatient appointment. As the table below shows, a large number of these appointments are repeat attendances for treatment or follow-up.

Number of ophthalmology outpatient appointments in the UK nations 2019-20 (NB Wales is 2018-19)

   Number of new attendances  Number of repeat attendances  Total number of attendances
 England10  1,942,513  5,983,911  7,934,291
Northern Ireland11      
 Scotland12  134,965  291,064  426,029
 Wales13  85,765  236,143  321,908
 Total  2,483,402  7,289,411  9,772,818

When the COVID-19 pandemic began hospitals had to divert resources to patients with COVID-19, and make careful decisions about the priority to give to other patients, not least in order to support the aim for people to stay at home to avoid the risk of infection.

Actions taken by hospital ophthalmology departments included:

  • Many hospitals reviewed their patient lists to ensure that they were seeing people whose sight was in imminent danger, and to develop alternative ways of supporting other patients
  • They developed systems to review patients online instead of in person
  • They changed responsibilities within the departments, with optometrists stepping up to lead clinics that had previously been run by doctors

Meanwhile, in March 2020 primary care optical practices were designated as essential services and many remained available for patient care. In many cases they achieved this by advertising telephone numbers that patients could use to seek advice and information. They could then provide emergency support such as replacement of broken spectacles for key workers or treatment of minor emergencies, and see patients physically, if necessary, in carefully controlled ways.

Because of their existing national schemes, the Scottish and Welsh governments could build upon these as part of their response to the pandemic. They both provided detailed guidance for optical practices to ensure the continuation of essential services and safeguard the health of patients and staff at the various phases of the pandemic14,15. In Northern Ireland optometrists were able to carry out appointments remotely or face to face and claim a fee via an online reporting system.

In many parts of England at the start of the pandemic there was no provision for optometrists to offer NHS treatment of minor eye conditions, and patients with such problems would need to go to their GP or their hospital emergency department. The Local Optical Committee Support Unit (LOCSU) and other optical bodies including the AOP, worked extensively with NHS England, and the Clinical Council for Eye Health Commissioning to develop the COVID-19 Urgent Eyecare Service (CUES) pathway. This was endorsed by the Royal College of Ophthalmologists and College of Optometrists.

The service was designed to “allow patients to gain prompt access to a remote consultation leading to a care plan for the patient to:

  • Self-manage their ocular condition (with access to appropriate topical medications where appropriate); or
  • Be managed by an optical professional with advice, guidance and remote prescribing as necessary; or
  • Be appropriately referred to hospital ophthalmology services”16

CCGs that had not previously commissioned Minor Eye Conditions Services (MECS) were encouraged to commission CUES. By March 2021 78% of English CCGs had commissioned CUES and 78% of the population was covered17. LOCSU is now seeing this as the basis of a comprehensive urgent eye care service across England and many innovators are using the term “Optometry First” to describe a new approach that encourages members of the public and the NHS to treat the optometry practice as the first place to go to for treatment or advice.

10Source: www.dgital.nhs.uk/data-and-information/publications/statistical/hospital-outpatient-activity/2019-20
Note: for the 7867 appointments missing from first/follow-up but included in the total, it is unknown if they were first/subsequent or in-person/ tele-consultations
11Source: www.health-ni.gov.uk/publications/hospital-statistics-outpatient-activity-statistics-201920 
12Source: beta.isdscotland.org/find-publications-and-data/health-services/hospital-care/acute-hospital-activity-and-nhs-beds-information-annual
13Source: www.statswales.gov.wales/Catalogue/Health-and-Social-Care/NHS-Hospital-Activity/Outpatient-Activity/outpatient-attendances-by-treatment-function
14gov.wales/optometry-recovery-guidance-amber-phase-covid-19 
15www.optometryscotland.org.uk/wp-content/uploads/2020/03/PCAO202005.pdf
16www.locsu.co.uk/covid-19-urgent-eyecare-service-cues
17www.locsu.co.uk/cues-filling-the-gaps-a-year-on