03 April 2025

Optometrists ‘can help with long waits for hospital care’

by Hannah Williams

The eye care sector has responded to the Healthwatch England report, 'A Strain on Sight: Waiting for NHS Specialist Eye Care' by calling for urgent reforms to reduce waiting times and improve patient experiences.

Based on a self-selected survey of more than a thousand people due for secondary care, the research shows that at the end of 2024 a third of people were waiting longer than the recommended time.

More than a fifth of people reported having multiple appointments before being referred and once referred, 64% waited more than four months for treatment. Most people (70%) said they noticed some deterioration in vision in that time.

Healthwatch, which represents the patient voice, highlights the significant consequences for those waiting for NHS hospital eye care, with many patients experiencing deteriorating vision, mental health struggles and disruptions to everyday life. More than half of the respondents (54%) reported that delays had affected their ability to work, while 69% said their mental health had suffered. Three-quarters of those waiting for treatment said it had impacted their ability to continue with hobbies.

Chris McCann, the deputy chief executive of Healthwatch England, said: "Long waits for eye care are having a huge impact on people's daily lives, including their ability to work, manage daily tasks, socialise or take part in hobbies such as reading."  

One of the main recommendations from Healthwatch England is to expand the role of high-street optometrists in managing eye care and referrals to reduce pressure on NHS services. The report found that 85% of patients waiting for care supported optometrists being able to refer patients directly to specialist services without requiring a GP consultation. Additionally, 65% of respondents said they would be comfortable with optometrists monitoring and treating eye conditions.

The organisation argues that expanding the scope of community optometrists could lead to earlier identification of serious eye conditions and faster referrals to ophthalmology specialists. Delays in treatment for glaucoma, for example, can lead to irreversible sight loss.

Healthwatch England has called on the NHS to commission the full range of enhanced primary eye care services, allowing optometrists to support patients before and after hospital care, as a possible solution to streamlining services and reducing waiting times. "We know that highly skilled optometrists in the community are in every locality in England," said Mr McCann. "Our survey shows overwhelming public support for better using this capacity... This provides an ideal opportunity for them to take on more responsibility for managing people's eye care and referring them for specialist treatment."  

Daro Bjayou, policy officer at FODO, the Association for Eye Care Providers, welcomed the recommendation. "Optometrists already provide high-quality, accessible eye care in communities across England, helping to reduce pressure on hospitals," he said. "By making greater use of their skills, the NHS can reduce waiting times, deliver more care closer to home, and ensure patients get the right support sooner."

Max Halford, ABDO's clinical and policy director, agreed. "We have a highly skilled, registered workforce keen and well placed to support their patients' eye health. Now we need to see the willingness of the government to move its focus from over-run hospital services out into opticians' practices where many patients prefer to be seen.

"Dispensing opticians, with their specialist skills, are well placed to drive the prevention-focused approach rather than a reactive sickness model, one of the suggestions of the recent Darzi report. As the first clinicians most patients encounter upon entering a practice, they are highly trusted professionals who play a vital role in delivering accessible clinical eyecare."

Professor Irene Ctori, vice-president of The College of Optometrists, said: "Healthwatch England's new report shines the spotlight on the unsustainable waiting times for ophthalmology treatment and the critical need for the NHS to deliver on its pledge to shift focus from secondary to primary care for eye care services in England. She added that the report demonstrated "the public's trust in their local optometrist" and support to expand the role in referring for and treating eye conditions as part of "a comprehensive primary eye care service for patients".

Adam Sampson, chief executive of the Association of Optometrists (AOP), said the report pointed to "an immediate fix" to a desperate situation in which patients were losing their sight as they waited for hospital treatment. "We must make sure patients get the care they need in their local high street optician, when they need it, so that avoidable sight loss is consigned to history."

The report also underscores the need for better communication and support for patients on waiting lists. Many individuals reported feeling uninformed about their care, with only 14% knowing who to contact for further information. Only 9% of people waiting for care said the NHS had kept them up to date about when they might get an appointment.

Healthwatch England, a patient champion organisation funded by the Department of Health and Social Care, has also recommended that the NHS record data on ophthalmology waiting lists by condition. It currently groups all ophthalmology treatments together, making tracking waiting times for the most serious conditions difficult. The NHS could improve oversight and ensure it allocates resources effectively by providing more detailed data.

Nearly 600,000 people were waiting for secondary eye care treatment in December 2024, a third of whom had been waiting more than the 18-week target set by the Government. The survey respondents had conditions including cataracts (33%), glaucoma (12%), diabetic retinopathy, macular degeneration, laser treatment, uveitis, detached retina and blocked tear duct.

Eye care is England's busiest NHS outpatient speciality, and demand is increasing as the population ages.

Read the report.