An emphasis on glaucoma

The issue of backlogs in glaucoma pathways, and how optometry could play a role in addressing this, was highlighted at 100% Optical 2023 (February 25 – 27).

Specsavers’ Paul Morris, director of professional advancement, and Giles Edmonds, clinical services director, led a presentation highlighting results from the State of the UK’s Eye Health Report and updating on the key factors affecting eye care in the UK.

Morris particularly highlighted information from the report relating to glaucoma.

Professor Anthony King, chair of Glaucoma UK, described the pressure on ophthalmology services due to increased demand, the need for consistent care models, and the changes that need to be made.

The speakers gave OT an overview of the challenges they see in glaucoma care, and the opportunities for optometry.

A growing concern

Outlining the scale of the problem, Paul Morris, director of professional advancement said: “Glaucoma affects such a broad spectrum of the population – 2% of the population over 50 – and by the time you get to your late 70s or 80s, it’s as many as one in eight or higher.”

“That’s a huge number of the people who are sat in our consulting rooms day-in, day-out,” he said, adding: “I think the challenge that we have, ourselves, is to make sure that we’re really cognisant of that, but also reaching those people who may never ever have thought to access eye care.”

King advised referring patients to the Glaucoma UK website, particularly if they have glaucoma or if they have a family member with the condition.

“We’re always time constrained when we’re having face-to-face interactions with people, and the Glaucoma UK website will answer most questions, and provides a helpline for people who may not find the information they are looking for there,” he said.

Morris highlighted the importance of educating patients that “it’s not just a test of how well you can see, it’s not just about getting contact lenses or the most suitable frames for you – it’s about looking after yourself and those around you.”


King highlighted a need to ensure that optometry services are well-represented in more socially-deprived areas.

“Ultimately, if we’re relying on case detection to identify people who have glaucoma, we need those opportunities to be in socially-deprived areas as well as less socially-deprived areas,” he said.

Primary care solution

Morris emphasised the prevalence of glaucoma, adding that, with an ageing population, “It’s vital that we get the core foundations to make sure that we can do lots of this management ourselves,” adding: “I personally see it as being a big part of our work in the future.”

“We are the only natural partner to secondary care in the community, because we have similar equipment, we have similar skillsets, and we can make a huge difference to local people who we serve for a variety of purposes, day-in day-out, long into the future,” he continued.

The primary challenge is the increasing need for diagnosis and monitoring of patients with glaucoma, King suggested.

While this has been a “predictable” increase, he said, “there has been no significant expansion of ophthalmology services to accommodate this.”

The problem has existed for some time, King said, and was exacerbated by the pandemic, which saw primary care detection services, and hospital and primary care monitoring services close.

This has created a backlog of patients requiring follow-up, monitoring and treatment.

The solution is not simple, and requires an increase in capacity to see more patients, and considering alternative ways of delivering care.

King pointed to expanding primary care and opportunities to “diagnose and deliver,” in addition to refining secondary care pathways, as a way to create a more efficient process and increase capacity.

National pathways

Giles Edmonds, Specsavers clinical services director, spoke to OT about the need for a nationally commissioned pathway that defines the roles of optometrists, clinical technicians and ophthalmologists.

Changes are underway for the GOS contract in Wales that could allow more glaucoma patients to be seen in the community, he said, while Scotland has launched the NHS Education Scotland Glaucoma Award Training (NESGAT) scheme, and Northern Ireland has Local Enhances Services 1 and 2.

He also urged optometrists that: “We should be getting ourselves ready – upskilling and improving our capability – whether that’s professional certificates, higher certifications or independent prescribing.”

Morris agreed that addressing the challenge of glaucoma will require upskilling and working with higher qualifications, as well as “working with ophthalmologists locally to find out what we can do to improve the outcomes, not just for them but for the patients who we might never meet that would otherwise be behind others in the queue that needn’t be there.”