Glaucoma Care (England)

I beg to move,

That leave be given to bring in a Bill to make provision about the detection, treatment and monitoring of glaucoma by optometrists in England; to make provision about the full integration of optometry and ophthalmology services for the purpose of glaucoma care in England; and for connected purposes.

I refer hon. Members to my entry in the Register of Members’ Financial Interests; I am a practising NHS optometrist. I also thank the Minister for Care for coming to the Chamber for this valuable debate.

As a practising optometrist of many years, one of the heartaches of the role is this: during a routine examination, I can detect a condition that will forever change the life of the person who is sitting in my chair, and the patient is blissfully unaware of it. That is exactly what glaucoma does—it changes lives quietly, and often without warning. Glaucoma is known as the thief of sight, and for a very good reason. It damages the optic nerve at the back of the eye, with each nerve fibre representing a different point in the visual field. Because the loss begins in the peripheral vision, people often do not realise that anything is wrong until it is too late.

If Members would like a glimpse of what an advanced glaucoma sufferer sees, may I ask them to cover one eye completely and, with the other eye, to look through an aperture created by their hands and touch their fingertips to their palms? As the condition progresses, the aperture gets smaller and smaller and smaller, until eventually nothing is left. Imagine trying to navigate a busy high street, to cross a road or simply to move safely around one’s own home.

This is not simply theoretical; let me give the House two brief but very real examples from my experience. I saw a woman who on two separate occasions was hit by a car from the side while driving her own car, before she finally came in for an eye test. She was unaware that there was a problem, because she could see number plates and road signs perfectly. What she could not see was the side of her vision eroding.

Another heartbreaking experience when a pensioner came to me with a handbag packed with what looked like her life savings. Cash in hand, she explained that she would spend whatever it took if I could just give her a pair of glasses that would allow her to see her two loves: her love of painting and her grandchildren. Unfortunately, no amount of money would be able to restore her sight, because glaucoma, as well as being silent, is usually irreversible.

Glaucoma is the leading cause of preventable blindness in the UK. Over 700,000 people are affected by it, and, even more concerningly, more than half of them are undiagnosed. That is 350,000 people walking and driving around, not knowing. It could be any one of us, or someone we love or work with. Indeed, a former Liberal Democrat Member of this House, Paul Tyler, was not diagnosed until a routine eye test.

In its early stages, glaucoma rarely has symptoms, and there are rarely any warning signs—just a silent, slow theft. By the time it is noticed, the damage is usually permanent, and the loss has far-reaching consequences. People lose not only their sight, but their independence and their ability to drive, read, cook and even leave their house. Falls increase and isolation grows, and then come the emotional and mental health impacts: fear, depression and the loss of identity.

Furthermore, with an ageing population, we face a growing crisis. Glaucoma cases are expected to rise dramatically in the coming decades, with a growth rate that outstrips the ageing population. A study from 2017 suggests that over the next 20 years, glaucoma cases will rise by 44%. That is hundreds of thousands more people who will need care, follow-up and support, and I fear that data will prove to be an underestimate.

Let me be blunt. Patients are losing their sight not because care does not exist, but because the pathway is broken and the follow-up is delayed. I recently saw a patient who was referred to the hospital and diagnosed with glaucoma. That bit was absolutely fine—the initial appointment happened—but the follow-up was postponed and then they missed an appointment. This meant that, by the time they came to see me again a year later, they had lost a significant amount of their visual field, to such an extent that even their central vision—their acuity—was affected. That anecdotal example corroborates the findings of major chains such as Specsavers. The problem is that current waiting list data provides a measure only of first appointments, not of the ongoing care that is vital to chronic conditions like glaucoma. We need published data on follow-up waiting times, because that is where sight is being lost.

Here is the reality. Hospital ophthalmology is one of the largest out-patient specialities in the NHS, with 8.9 million appointments a year in England between 2023 and 2024. It is estimated that glaucoma care accounts for about 20% of all hospital eye service appointments, with around 1 million visits annually across England alone. In 2024-25, it was reported that 600,000 people were on a hospital waiting list for an ophthalmology appointment. However, the ongoing care, such as the need for regular planned follow-ups for glaucoma patients, is often overlooked, with the numbers not hitting the headlines like those waiting for an initial assessment or surgery. NHS hospitals cannot carry this load alone.

Thankfully, this is where the Government’s own NHS 10-year plan—in particular its ambition to shift care out of hospitals and into the community, and its focus on prevention, not sickness—closely aligns with the transformation needed in glaucoma care. There are over 14,000 qualified optometrists in England, providing more than 13 million NHS-funded eye tests. They are trained, regulated and ready to help. Community glaucoma services, led by appropriately qualified optometrists with the approved equipment, have already demonstrated the ability to reduce hospital appointment referrals by up to 71%. If implemented nationally alongside an optometry-based glaucoma monitoring service, it may be possible to release 300,000 hospital appointments every year. That is not a one-time saving; glaucoma is a chronic condition, and these are recurring appointments for people who are living with the condition, not cured of it. Making full use of the skills and capacity already in primary care takes significant pressure off hospital services, enabling them to focus on tasks that can be managed only in a hospital. This could save the NHS an estimated £12 million annually.

At present, 10 integrated care boards have no glaucoma case-finding or referral management services. Many patients in those areas who are referred to hospital could instead be retained in primary care optometry with appropriate commissioning, rather than being added to the existing waiting lists. Even more concerningly, 21 ICBs—half of them—do not commission a glaucoma monitoring service in the community and rely simply on the hospital eye service to follow up glaucoma patients for the rest of their lives. That is where the sight loss occurs, as the hospitals simply do not have the required capacity. This is a postcode lottery that punishes the vulnerable, especially when people from black and Asian communities are up to four times more likely to develop glaucoma and often have the least access to timely care.

Unlike in Wales and Scotland, where a “shared care” service for glaucoma is commissioned by every health board, optometry-led and properly integrated between primary care optometry and ophthalmology, often the approach of NHS commissioners in England is hospital-led. The recent draft “Getting It Right First Time” model, developed with minimal input from primary care optometry, risks reinforcing England’s hospital-led approach and undermining the Government’s own ambition to shift care from hospitals to the community.

We also see worrying behaviour at ICB level, with several ICBs removing the limited community glaucoma services that they had in place to make short-term savings. That is extremely myopic. Given the ongoing financial pressures on ICBs, we do not expect individual ICBs to make significant progress in commissioning optometry-led glaucoma pathways that fully integrate optometry and ophthalmology without clear direction from the Government.

The total cost of visual impairment in the UK is estimated to be £26.5 billion, and it is set to rise to £33.5 billion by 2032. Glaucoma alone accounts for £750 million. That is not just a cost to the NHS, but a cost of lost productivity, informal care and diminished quality of life. This is a silent epidemic, but it is not inevitable.

What am I asking for? What can be done to begin to tackle this silent epidemic? Fundamentally, I am asking for a national direction from the Department of Health and Social Care to ICBs that they should commission a uniform primary care glaucoma service that utilises qualified high street optician practices. Only by doing so will we end the postcode lottery in glaucoma care.

We already know what works, we already have the workforce, and we already have the technology. We now need clear direction and political will.

That Shockat Adam, Marsha De Cordova, Jim Shannon, Brian Leishman, Jeremy Corbyn, Ayoub Khan, Iqbal Mohamed, Mr Adnan Hussain, Paulette Hamilton, Mark Pritchard and Adrian Ramsay present the Bill.

Shockat Adam accordingly presented the Bill.