Ahead of World Glaucoma Week and the planned second reading of the Glaucoma Care (England) Bill in Parliament, The Royal College of Ophthalmologists and the UK and Eire Glaucoma Society has published a joint statement outlining its view on the future of glaucoma care.
Glaucoma is a leading cause of irreversible sight loss and there are extremely worrying waits for follow-up appointments in many parts of the country. Clearly improvement is needed – but we, as ophthalmologists and glaucoma specialists, are concerned that the Glaucoma Care Bill introduced by Shockat Adam MP would risk patient safety and goes against the evidence-based models developed by clinical consensus.
Shifting diagnosis and monitoring of glaucoma wholesale from hospitals to optometry practices would be a mistake – both for patient safety and financially. Up to 50% of glaucoma diagnoses referred from optometry practices to hospital eye services are inaccurate.[1] Expecting all optometrists to also take responsibility for detecting and managing progression of this complex disease would be unfair. The risks to patient safety would be significant, as would the potential costs for cash-strapped NHS bodies if patients receive unnecessary treatment.
Our focus must instead be on working to improve that accuracy of diagnosis in optometry, through appropriately commissioned repeat measures and enhanced case finding.
Crucially, there are cost-effective and evidence-based models that can be rolled out quickly to improve glaucoma care for patients. We support the diagnostic asynchronous virtual review model outlined in GIRFT’s glaucoma best practice pathway, and it is important that ICBs commission this model in future.
The referral process can also be streamlined in other simple ways. For example, when optometrists refer to secondary care via a single point of access, this ensures that patients are referred to the right care setting first time. This model has slashed waiting times and costs – a pilot in North Central London cut triage times from 11 days to one day and a national rollout is expected to save the NHS £170 million each year. [2]
It is vital that we avoid fragmenting care. Patients with glaucoma will often need lifelong treatment, so it is vital that we improve how we follow-up and manage patients or discharge those who no longer require ongoing review.
Optometrists are a crucial part of the eye care workforce and there will need to be close partnership working between optometry and ophthalmology to deliver these improvements to glaucoma care. We must ensure patients are risk stratified and monitored in the environment most appropriate to the risk of lifetime blindness, under consultant ophthalmologist oversight. This pathway needs to allow two-way movement of patients, images and patient data.
GIRFT’s Glaucoma Best Practice pathway, which was developed following extensive engagement with patient groups and optometry and ophthalmology organisations, will provide an evidence-based template for how we can safely improve provision of care – including into community locations across England.
It is vital that we all now work together to support implementation of this best practice, and make a step-change in tackling the risks of avoidable irreversible sight loss for people with glaucoma.
[1] British Journal of Ophthalmology. “Clinical Effectiveness of the Manchester Glaucoma Referral Scheme”. Gunn PJG, et al, 2019.
[2] RNIB and PA Consulting. “The Value of Vision: Six interventions to improve eye care”. 2025.