Dr Konstantinos Bouras is a Consultant Ophthalmic Surgeon and Clinical Director at Moorfields CUH, Moorfields Eye Hospital and Moorfields Private. Here, he discusses the pressing challenges facing the UK’s ophthalmology sector and the need for sustainable policy measures to enable equitable access to ophthalmology services
Ophthalmology remains one of the most heavily burdened outpatient specialties in the NHS. With demand for services climbing year on year, the mismatch between capacity and clinical need is becoming increasingly untenable. The roots of this crisis are multifaceted, and while innovation and resilience have driven adaptations across the sector, a coordinated policy response is now essential to safeguard the future of eye health services in the UK.
The growing demand for ophthalmology services
The primary challenge is one of scale. Demand continues to outstrip available resources, propelled by an ageing population and the rising prevalence of chronic diseases. NHS funding, however, has not kept pace, remaining static or even regressing in real terms. This structural gap places unprecedented strain on already stretched services. Clinics operate at full capacity, with limited ability to absorb the growing workload, despite the advent of virtual clinics, telemedicine, and new treatment modalities.
A further concern is the exponential growth in diabetes, particularly type 2, which is now directly fuelling a surge in retinal diseases. Without bold and systemic national prevention strategies, this ‘diabetes time bomb’ threatens to overwhelm ophthalmic services altogether. In tandem, the increasing involvement of independent providers delivering NHS care is leading to a fragmentation of service delivery. While this may ease immediate capacity issues, it risks weakening long-term investment and continuity within the NHS itself, creating a two-tiered system underpinned by divergent priorities.
New technologies and training an already overstretched workforce
The workforce crisis compounds these pressures. New technologies and evolving models of care demand a broader range of skills and roles, from imaging technicians to virtual review staff, but recruitment has not kept pace. Funding for training and staffing expansion remains insufficient. Physical infrastructure also lags behind the sophistication of today’s diagnostic technologies. Optical Coherence Tomography (OCT) and other advanced imaging tools are essential to modern ophthalmic care, but the facilities to house more of them for virtual clinics are often lacking.
Policy measures need to address inequities in eye care provision
Geographic and socioeconomic disparities further compound the inequities in eye care provision. Urban centres may be overwhelmed, while rural or under-resourced areas struggle to access even the most basic diagnostics or follow-up care. Vulnerable groups, in particular, risk falling through the cracks of the system.
Addressing these systemic challenges requires a policy response that is both flexible and equitable. Commissioning must shift away from a one-size-fits-all approach and become responsive to population-specific needs. Regions with higher deprivation indices, ageing demographics, or elevated rates of chronic disease should receive proportionately greater support. Integrated Care Systems (ICS) must embed eye health into their strategic planning processes and ensure that ophthalmology receives attention commensurate with its growing burden.
Investment in Community Diagnostic Centres is also essential. These centres must be equipped to perform basic triage and retinal imaging, particularly in under-served regions. Moreover, national screening programmes should expand beyond diabetes to include conditions such as glaucoma, high myopia, and age-related macular degeneration. These are often asymptomatic in the early stages but benefit significantly from early detection.
Eye health in the digital age
Technology also brings new challenges to eye health, particularly in relation to lifestyle and screen exposure. The ubiquity of digital devices has contributed to a sharp rise in dry eye syndrome, largely due to reduced blink rates, and may be accelerating the onset of myopia, particularly in children. Prolonged screen time also disrupts circadian rhythms due to blue light exposure, while poor posture during device use poses musculoskeletal risks.
Mitigating these effects requires both awareness and practical interventions. The 20-20-20 rule, taking a 20-second break every 20 minutes to look at something 20 feet away, may not always be feasible, but frequent screen breaks and conscious blinking can offer meaningful relief. For children, prioritising outdoor time and minimising near work are critical preventative strategies. Moreover, regular eye examinations are increasingly important for all age groups.
Moving forward, the role of Artificial Intelligence in ophthalmology presents both promise and caution. AI-driven tools are already being trialled to screen for diabetic and hypertensive retinopathy, among other conditions. Large-scale datasets can be mined for insights into treatment responses and disease progression, offering new avenues for research. AI also holds potential to support non-medical professionals, such as technicians and optometrists, in triaging and decision-making, especially in areas facing workforce shortages.
However, safeguards are essential. Questions of medico- legal responsibility, accuracy and supervision remain unresolved. Without clear governance, the benefits of AI could be undermined by the risks it introduces. Its integration must be balanced, augmenting rather than replacing human oversight, and tailored to enhance efficiency without compromising safety.
The challenges facing ophthalmology are urgent, complex and interconnected. They cannot be solved by technology or innovation alone. What is needed is a robust, coordinated, and equitable policy response that addresses the structural pressures of funding, staffing, and infrastructure while empowering communities with early access to preventative care. Only then can we ensure a sustainable and inclusive future for eye health services across the UK.
