Seeing the way forward for eye care in the UK

Eyesight is the sense that most patients fear losing the most(1) yet unfortunately some patients don’t know, that as part of their well-being, they should attend their optical practice every two years. Some people should attend more often, including under 16-year-olds (if clinically required), those who have diabetes, or glaucoma, and people with a family history of glaucoma. The leading causes of sight loss are corrective refractive error, age-related macular degeneration (AMD), glaucoma, cataracts and diabetic retinopathy.(2) Regular sight testing and early detection of eye conditions during a sight test, followed by timely intervention and management can prevent sight loss.

Free NHS eye examination

One barrier to patients accessing eye care is the cost element.(3) Scotland is the only country in the UK that provides free universal NHS eye examinations. England, Wales and Northern Ireland only provide free NHS eye exams to those who are:

• Under 16.
• 16, 17 or 18 and in full-time education.
• 60 or over.
• Registered as partially sighted or blind.
• Diagnosed with diabetes or glaucoma.
• 40 or over and your mother, father, sibling or child has been diagnosed with glaucoma.
• At risk of glaucoma.
• A prisoner on leave from prison.
• Eligible for an NHS complex lens voucher.

People who get the following benefits are also entitled to a NHS eye examination:

• Income Support.
• Income-based Jobseeker’s Allowance.
• Income-based Employment and Support Allowance.
• Pension Credit Guarantee Credit.
• Tax credits and meet the criteria.
• Universal Credit and meet the criteria.

And those who have a low income and are named on a valid NHS HC2 certificate for full help with health costs.

All other patients presenting for routine/emergency eye care need to pay unless there is a locally arranged eye care scheme that provides emergency care. It’s extremely disappointing that the Westminster Government doesn’t prioritise eye care, as more often than not they don’t recognise the optical profession as primary care providers. This has been demonstrated a number of times in the last month where no increase in General Ophthalmic Services (GOS) fees were provided in England, for the fifth consecutive year and optical practices were the last to be directed in the provision of essential and urgent care in relation to eye health within the COVID-19 pandemic.

Sight loss

If eye care was recognised as the public health tool that it can be and pathways changed to enable free eyecare to be delivered, universally; if investment was made by spending to save as it costs less to see patients in primary care than secondary, freeing capacity in secondary care; if the highly skilled optical clinical workforce were allowed to work at the top of their competencies to help prevent, treat and monitor eye health problems in the community, far more sight loss could be avoided.

Regardless of the above and sadly, not all sight loss is preventable. Being diagnosed with sight loss can cause immediate fear and panic. Optical staff are trained to support patients with sight loss and low vision by providing advice on spectacles, contact lenses, visual aids, lighting, advances in technology for computers and mobile phones to be used to help when they are out socialising, travelling, shopping etc. enabling patients to maintain their independence.

There is also advice available on modifications that can be made to homes and workplaces. Optical staff will signpost to charities and organisations that provide support groups and communities for those who have suffered some or complete sight loss. The practical and emotional support offered by organisations including the Macular Society, International Glaucoma Association, Diabetes UK, Blind Veterans UK, the Royal Society for Blind Children, SeeAbility and RNIB to name but a few is invaluable.

References
1 The College of Optometrists (2013). Britain’s eye health in focus: A snapshot of consumer attitudes and behaviour towards eye health. 2 https://www.rnib.org.uk/professionals/knowledge-and-research-hub/key-information-and-statistics
3 https://www.rnib.org.uk/knowledge-and-research-hub/research-reports/prevention-sight-loss/access-eye-care