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Shockat Adam (Leicester South) (Ind)
I beg to move,
That this House has considered glaucoma awareness.
It is a real pleasure to serve under your chairship for the first time, Mr Pritchard. I thank all right hon. and hon. Members for attending this important debate. First, I declare my registered interest as a practising optometrist for the NHS. As an optometrist for many years, I have had the privilege—sometimes the heartbreak —of looking into the eyes of people whose lives are changing without their even knowing about it. Fundamentally, that is what glaucoma does: it changes lives quietly, and often without warning. Last week was Glaucoma Awareness Week because many people are not aware of the condition.
At this point, I applaud the work done by Glaucoma UK to raise awareness of the condition. It is known as “the thief of sight” for very good reasons. Broadly speaking, glaucoma damages the optic nerve. The optic nerve is made of millions of little nerves and bundles, and each part of the nerve represents a single point in our visual fields. Because vision loss begins at the edges, people do not often realise that anything is wrong until it is too late.
I would like to give two brief but real examples from my experience. First, a woman came into my practice who had been hit by a car, while in her own car, from the side, not once but twice. She came in and read out the bottom line—the tiniest letters that can be seen—and could not understand why she kept missing things on the side: in this case, cars. It became apparent that she was a quite advanced sufferer of glaucoma, and she had lost the majority of what we call peripheral or side vision. Another memorable patient was a gentleman who was brought in kicking and screaming by his wife because he kept knocking off the salt, pepper and ketchup from the dinner table. It became apparent, again: he could see everything clearly straight ahead, but he really could not see anything on the side. He also had a very advanced form of glaucoma.
Glaucoma is the leading cause of preventable blindness in this country, with over 700,000 people affected, but the shocking thing is that more than half of them—350,000 people—are undiagnosed: they are walking and driving around not knowing that they have the condition. They could be one of us—somebody we love, or somebody we work with, as was the case of a former Member of Parliament of this parish, Paul Tyler, a Lib Dem Member, who was diagnosed at a completely routine eye test. In his own words, he might not have been able to carry on his duty as a parliamentarian if he had not gone for a simple eye test where they detected glaucoma. Twenty-five years later, his sight is still preserved.
Mr Gregory Campbell (East Londonderry) (DUP)
I congratulate the hon. Gentleman on securing the debate. He rightly alludes to the issue of regular eye testing. Although we obviously want a response from the Minister, does he agree that if nothing else is achieved from this debate but raising people’s awareness about doing exactly as he recommends—and all of us recommend regular eye testing—to detect conditions such as glaucoma, he will have done us all a service?
Shockat Adam
I could not agree more. If we achieve that one thing today, we will have achieved a great milestone. In its early stages, glaucoma has no symptoms, pain or warning signs—just a slow, silent theft of vision. By the time it is noticed, the damage is permanent; it is as if the fire has gutted the house before anybody has even smelled the smoke. That loss has far-reaching consequences. People lose not only their sight but, more importantly, their independence—their ability to drive, read, cook or even leave the house. Falls increase, isolation grows, and then come the emotional and mental health impacts: fear, depression and loss of identity. At this point, I quickly pay homage to charities such as Vista in my constituency, which has offered valuable support for people living with visual loss.
On the subject of depression and identity, I want to share a moment that has stayed with me; it concerns a rare condition that many people do not know can be a consequence of vision loss. A woman, diagnosed with glaucoma, phoned my clinic, deeply distressed. She said a child was following her—but no one else could see them. She was terrified that she was losing her mind. In fact, she had a condition called Charles Bonnet syndrome, a common but under-recognised condition in which the brain fills in visual gaps with vivid hallucinations. Many people never mention it, understandably fearful that they will be labelled as senile or unstable, and so they suffer in silence. Esme lived with Charles Bonnet syndrome for over a decade, haunted by hallucinations that she knew were not real. Her daughter, Judith, now champions awareness through the incredible organisation, Esme’s Umbrella. These are not clinical oddities; they are real human stories, and far more common than we acknowledge.
We are now facing a growing crisis. Work done by the Association of Optometrists, Primary Eyecare Services and Fight for Sight has shown that glaucoma cases are expected to rise by 22% in the next 10 years and 44% in the next 20 years. That is hundreds of thousands more people needing care, follow-up and support, yet we already have the tools to stop this.
I would like to frame this, Minister, around the three bases of the Government’s own proposals for tackling healthcare. First, we must move from hospital to community. Patients are losing their sight not because care does not exist, but because the pathway is broken and follow-up is delayed. Just recently, a patient of mine was referred to hospital and diagnosed with glaucoma—fine, no problem there. The initial appointment happened without any problems, but the follow-up was postponed. Then the patient missed her appointment, and the one after that was postponed again. By the time I saw that patient again, just over a year later, they had lost two full lines on their visual acuity chart—the chart used by the optician. That is two lines that this patient will never, ever get back. That is the difference between being able to read letters or not; between seeing a grandchild smile or only hearing them.
One of the problems is that current waiting list data measures only first-time appointments, not the ongoing care vital to chronic conditions such as glaucoma. We need published data on follow-up waiting times, because that is where sight is being lost. That data would allow patients to make an informed choice about where they would like to receive treatment.
Here is the reality: hospital ophthalmology is the largest outpatient specialty in the NHS, with 8.9 million appointments in England in 2023-24, according to the College of Optometrists. It cannot carry that load alone. The answer lies in the community. There are over 14,000 qualified optometrists in England, providing more than 13 million eye tests. They are trained, regulated and ready to help.
Community glaucoma services led by optometrists have already demonstrated the ability to reduce hospital referrals by up to 79%. If we implemented a nationally regulated programme, it could free up 300,000 hospital appointments a year. That is not a one-time saving, because glaucoma is a chronic condition. People are not cured of it—they live with it, and must continue with recurring appointments for the rest of their lives. Shared care would allow faster appointments, earlier diagnosis, less vision loss, and critically, more time for hospital ophthalmologists to treat complex cases. It could also save the NHS an estimated £12 million annually.
Wales has already adopted this model; England should do the same. Yet fewer than one in five areas in England offers this service. It is a postcode lottery—one that punishes the most vulnerable, especially given that people from black and Asian communities are up to four times more likely to develop glaucoma and often have the least access to care. We need to raise awareness and create the statutory framework so that everyone—GPs, pharmacists, the public—knows to go the optometrist for an eye test. We need a national roll-out of a statutory integrated glaucoma pathway.
Secondly, we must move from analogue to digital; lack of digital connectivity is another major obstacle. Many optometrists are unable to send digital referrals to local hospitals. Some do not even have access to NHS email and we still cannot access shared patient records. That means crucial information such as medication, medical history and images get lost, delayed or duplicated. This is 2025. It should not be easier to get a takeaway delivered than to refer a patient with a sight-threatening disease. To move forward, we need access to NHS email for all primary eye care providers; shared patient records between optometrists, GPs and hospital services; and an efficient two-way electronic referral system. That kind of interoperability is basic infrastructure and would transform the speed, safety and continuity of glaucoma care.
Finally, we must move from sickness to prevention. The final and most important pillar is prevention.
Ayoub Khan (Birmingham Perry Barr) (Ind)
I congratulate the hon. Member on securing this debate. I know that he is very passionate about this area. More than half a million people suffer from the illness. Would he agree that the issue is about not just a national roll-out and getting an understanding, but a proactive approach where general practitioners make referrals for individuals whom they know are at a higher risk?
Shockat Adam
The hon. Gentleman may have read my speech when I was not looking, as I am coming to that point in a little while.
Regular eye exams are the frontline of glaucoma detection, yet one in four people in the UK is not accessing any form of eye care at all. Minister, we should begin with a mandatory sight test for drivers. The UK is the only country in Europe that gives lifelong licences until the age of 70 without requiring an eye exam. Earlier this year, a coroner in Lancashire issued a prevention of future deaths report linking a fatal crash to undiagnosed sight loss. This is no longer just a health issue; it is a public safety one. We can also incentivise eye tests, perhaps through reduced insurance premiums, employer wellbeing programmes or GP-led initiatives. For those over 40, when glaucoma risks are higher, every routine health check should include a simple question: “When did you last have your eyes tested?”
Finally, we must consider innovation. Most glaucoma patients are prescribed lifelong eye drops, but there is poor compliance. Mr Pritchard, imagine that you were elderly and trying to open up a bottle of eye drops and bring it to your eyes. It is very difficult, especially with arthritis and tremors; difficulty inserting the drops remains a major challenge. But new options are now available. One is called minimally invasive glaucoma surgery, which can delay or even eliminate the need for drops. I urge the Minister to explore commissioning MIGS, especially for suitable patients undergoing cataract surgery. Everybody who lives long enough will need to have a cataract operation. If they are also suffering with glaucoma, we can stop the disease in its tracks before it causes irreversible harms. It is critical that patients with glaucoma who need cataract surgery are able to discuss options with their glaucoma consultant, because if MIGS is not performed during cataract surgery, it may be eliminated as a future option.
The total cost of visual impairment in the UK is now £26.5 billion. That is projected to rise to £33.5 billion by 2032. Glaucoma alone accounts for £750 million, according to the College of Optometrists, and most of that burden falls outside the national health service in lost productivity, in formal care, in people having to give up work to look after family who have lost their sight and in a completely diminished quality of life. In fact, 41% of people surveyed reported severe financial impact due to sight loss, often followed by depression, anxiety and social withdrawal.
This is a silent epidemic and it all leads to a low score in every perceivable index. But it is not inevitable. We already know what works and we already have the workforce and technology. What we need now is collaboration from the optical and ophthalmic industry and a political will. That will help us shift care from hospitals into the community, bring eye care into the digital age and help us prevent sickness such as glaucoma, saving the sight of millions in the future. Let us act now while we can still see what is around us.
Brian Leishman (Alloa and Grangemouth) (Lab)
It is a pleasure to serve under your chairship, Mr Pritchard. I extend my thanks to the hon. Member for Leicester South (Shockat Adam) for securing this important debate. When the time comes, I will welcome an intervention from him to help me pronounce the name of the eye operation that I had, because I can never say it.
I often say that all politics is personal, and that is incredibly apt for me in this debate, because 17 years ago, when I was 25, I was diagnosed with glaucoma. Pre-diagnosis, my knowledge of the condition extended to Edgar Davids, the Dutch footballer who wore what looked like safety goggles when playing because he had glaucoma and could not wear contact lenses.
Unlike many people’s glaucoma stories, mine is a very fortunate one. Before coming to this place, I was a golf professional. At the time, I was giving lessons to an optician, who offered to gift me a pair of glasses as thanks—I know that sounds a familiar story for a Labour politician, but I move on. He did some tests, including for glaucoma, and commented that my eye pressure was extremely high, in the mid-30s. Within the hour, I was in the ophthalmology clinic at Perth royal infirmary and was diagnosed with glaucoma.
Dr Cobb, who became my consultant, saw me at Perth royal that afternoon and has been absolutely incredible ever since. She explained to me that I was very lucky: if I had continued undiagnosed, I would probably have had another decade or so of eyesight and then would have woken up one day, in my mid-30s, unable to see. There would have been nothing she could have done for me; I would have been blind. The glaucoma was totally symptomless, and it is irreversible—those are the real dangers.
Shockat Adam
I always recall a patient of mine who was diagnosed with glaucoma at a very late stage. She came into the practice with a wad of cash and said, “Give me the best glasses and lenses you have, so I can see again.” Unfortunately she had glaucoma, and the vision was lost. There was nothing that money could buy.
Brian Leishman
That is not the first time I have heard that. I have another optician friend, who said that that has been a regular occurrence in his career. Someone may not know that they have glaucoma until it is too late.
I was prescribed eye drops. I went through a few options, with not much success, until I ended up on three different drops: bimatoprost, brinzolamide and brimonidine. All three go in my left eye at bedtime and then again the next morning, and then just brimonidine in my right eye at bedtime and again the next morning.
My right eye needs only one set of drops because it has been operated on. It has had a trabeculectomy—I hope that pronunciation was close enough. The operation was needed to save the eyesight in my right eye. It was an operation under general anaesthetic to make an incision in my eyeball to allow pressure to disperse and not attack my optic nerve. After an overnight stay in hospital, I wore an eye patch for a week, with no bending over for a fortnight and four weeks off work. I had a good report from Dr Cobb, and have had eye drops twice a day and twice-yearly check-ups at hospitals since. I really am lucky.
As well as my thanks to my consultant, I want to record my appreciation for my optician, Eddie Russell of Norman Salmoni, who provides regular check-ups between hospital visits, and for the outstanding care that his practice provides.
All that goes to show that the NHS really is our greatest invention. Personally, I reject the language of the NHS being broken. It is not broken; it is underfunded. The staff deserve more. They deserve the very best.
I cannot emphasise enough how important it is to get tested. Testing could be the difference between retaining one’s eyesight and not. I thank hon. Members for permitting me to share a bit about my ongoing glaucoma journey. Glaucoma cannot ever be cured, but we can try to manage the decline somewhat.
Jim Shannon (Strangford) (DUP)
It is a pleasure to serve under your chairship for the second time today, Mr Pritchard—I am getting a liking for it. I thank the hon. Member for Leicester South (Shockat Adam) for securing the debate. As my party’s health spokesperson, issues such as glaucoma are of great importance to me—the statistics show its prevalence. I would not have thought there would ever be a case in which the hon. Member for Alloa and Grangemouth (Brian Leishman) would be lost for words, no matter what might happen; that is meant as a compliment, by the way.
As it is Glaucoma Awareness Week, there is no greater time to consider this issue. I will start by describing the scale of the issue in Northern Ireland specifically, because that is what I want to highlight. Queen’s University undertook a study that found a 2.83% prevalence of glaucoma in 3,221 people aged 50-plus—I understand that rate is normal, compared with the rest of the United Kingdom—and that around two-thirds of those were undiagnosed. There is an issue to address: those who are undiagnosed. Northern Ireland currently has some 18,000 confirmed glaucoma cases. As I have said to the hon. Member for Leicester South—he knows this story—although my dad is dead and gone, when he was alive he lost his eyesight to glaucoma. Unfortunately—they were probably just not as good at managing it in times past—it crept up on him, and he lost his eyesight. My dad was very fortunate to have my mother to look after him, in every sense of the word. They loved each other greatly. It was never a burden to my mum to look after my dad. That was really important.
I was fortunate to secure a debate on glaucoma and community optometry just last year. The hon. Member for Leicester South made a fantastic contribution to that debate. I greatly admire his knowledge of optometry, and the job he did before he was elected. When he comes to these debates he brings that fount of knowledge, experience and examples, which we all appreciate. There is such an important link between our opticians and healthcare specialists who treat eye conditions such as glaucoma. Data from Specsavers highlighted that in 2023, some 30,000 referrals for glaucoma were made for people aged 40 to 60. Not all those people were diagnosed as such, but the fact was that there were some concerns, and the treatment for them was able to start.
I have some stats for Northern Ireland that I want to quote for the record. Regarding the adoption of innovative glaucoma technologies, such as iStent inject, two of the biggest eye surgery hospitals in the country—Altnagelvin area hospital and Belfast city hospital—now routinely offer such combined procedures to comorbid glaucoma and cataract patients. The focus is now on making sure that no glaucoma patients miss out on the opportunity to intervene in glaucoma at the time of routine elective cataract surgery. The advances are incredible at this moment in time.
As of March 2025—which has just passed—almost 50,000 people were waiting for ophthalmology outpatient appointments in Northern Ireland. That is a massive number, and the Minister in the Assembly back home really needs to take that on. In Northern Ireland, the prevalence of glaucoma in people aged over 50 is, as I said, comparable to other parts of the United Kingdom, and indeed other parts of Europe. The figures that we have seem to be relevant wherever we are in the United Kingdom, but also across the whole of Europe. Interestingly, around two thirds of people with glaucoma were not aware of their glaucoma, as the hon. Member for Leicester South said in his introduction. If that is generalisable from the study sample to the whole population, that rate is higher than in other comparable populations.
Glaucoma is the second most common reason for certification as sight impaired, or severely sight impaired, in Northern Ireland. On average, 13.1% of certifications are caused by glaucoma, although that varies a lot year on year. I want to tell the Minister what we are doing itenn Northern Ireland in relation to the iStent inject surgery. That is a massive, technological, medical, modern way forward. It is good to be able to report it in this debate.
Iqbal Mohamed (Dewsbury and Batley) (Ind)
Under the 10-year plan, the Government want to invest in the NHS and bring services into the community. There are examples of that around our country, and maybe in Northern Ireland. There are trusts in London with diagnostic hubs that better manage glaucoma. There are regions with community glaucoma services that have reported halving hospital referrals, improving access and saving millions. There are also pilots, such as in the Royal Devon’s Nightingale model, that reduce appointments from two hours to 30 minutes. Does the hon. Gentleman agree that investing, reorganising and having a joined-up service with advanced detection will save money for the Government and save people’s sight?
Jim Shannon
The hon. Gentleman is absolutely right. To be fair, the hon. Member for Leicester South was clear that there is an opportunity to advance greatly under the 10-year NHS plan to solve the problems. There are better ways of doing things and reducing waiting times.
We are fortunate to have two hospitals in Northern Ireland, the Altnagelvin area hospital and Belfast city hospital, where new treatment is starting and also where cataract operations can take place. Cataract operations also take place in Downe hospital, just outside my constituency. Optometrists have a key role to play because they can spot the early signs of glaucoma during routine tests. For patients with stable glaucoma, optometrists have a role in monitoring eye health and helping them manage their condition.
Ahead of this debate I was in touch with Glaukos on the steps that can be taken both nationally and within the devolved Administrations to improve the outcomes for those diagnosed with glaucoma. In his intervention, the hon. Member for Dewsbury and Batley (Iqbal Mohamed) made it clear that there could be great advances in glaucoma and for eye care and doing things better. Glaukos has educated me on the iStent injects that are implanted during cataract surgery or in a stand-alone procedure—the very things that the hon. Member for Leicester South referred to. These little stents unblock drainage and lower eye pressure with minimal risk or cost. Perhaps that is something the Minister could commit to looking at and engaging with as a means of treatment for those with glaucoma.
The Minister is always well versed on the technologies and advances. I know that when he replies to this debate he will give us some encouragement. I should say I am pleased to see the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), in his place. I love doing debates with him. He and I share a passion for the subject matter. He brings a wealth of knowledge to these debates and I thank him for that.
To conclude, there are thousands and thousands of people living with the condition, but there will be thousands more to come. That is what we want to try to address. Ensuring affordable and accessible treatment is imperative. As I previously stated, and as the hon. Member for Leicester South who introduced the debate has stated, we must not underestimate the impact that our local opticians have in detecting these kinds of issues early on. I therefore urge people out there to prioritise their eye health while they can.
Irene Campbell (North Ayrshire and Arran) (Lab)
It is a pleasure to serve under your chairship, Mr Pritchard. I thank the hon. Member for Leicester South (Shockat Adam) for securing this important debate on glaucoma.
In my previous role in the NHS I was part of a working group made up of consultants, GPs, high street optometrists and others. The group was set up to create a primary care eye care service in NHS Ayrshire and Arran. Eyecare Ayrshire was set up as part of a redirection strategy to ensure that people were accessing the services most appropriate to their symptoms. It promotes that the best person to see for minor eye problems is a local optometrist, a high street optician, rather than attending a GP or A&E. The service has been very successful and continues to operate. Really importantly, it directs people to go to the optometrist. That can be vital if there are any other underlying or undiagnosed eye conditions. As we have heard today, early intervention can be crucial.
Last week I attended the event hosted by the hon. Member for Torbay (Steve Darling) with Glaucoma UK and Glaukos, which did a great job of raising awareness of one of the leading causes of irreversible blindness. As we have heard, over 700,000 people live with glaucoma in the UK, yet over half do not know it and it is predicted to rise by 44% over the next 20 years. It is vital that we embrace early intervention and improve access to services and treatment before serious deterioration.
By 2050 the cost of blindness is estimated to be £33.5 billion, putting immense pressure on the NHS as well as those suffering from blindness. There are treatment options, as we have heard today, for those suffering from glaucoma, including eye drops, laser treatments or traditional surgery. Glaucoma UK recommends that optometrists receive improved education and training on combining those procedures to ensure that patients get the best care possible.
It is also important to acknowledge the disparity of services across the UK. In NHS Ayrshire and Arran, the total number of people living with sight loss is 1,000 over the national average. That is obviously a real concern. We need to make sure that people are aware of the need to have routine check-ups, and of the services available to them. Over the years there have been many redirection campaigns to highlight services, and it may be time to reintroduce that approach. I know from my experience in the NHS that identifying these diseases early is key to preventing them from becoming much worse. I encourage the Government to consider the recommendations highlighted.
Helen Morgan (North Shropshire) (LD)
It is a pleasure to serve with you in the Chair, Mr Pritchard. I thank the hon. Member for Leicester South (Shockat Adam) for securing this important debate and raising awareness of a life-changing condition following Glaucoma Awareness Week.
The hon. Member for Alloa and Grangemouth (Brian Leishman) outlined his personal experience, and particularly how regular checks are important as the condition is symptomless in its early stages. I thank the hon. Member for Strangford (Jim Shannon) for sharing his dad’s experience. And the hon. Member for North Ayrshire and Arran (Irene Campbell) brought her NHS expertise to the debate, so I feel slightly underqualified to be completely honest. Ironically, given that we are talking about eyesight, I did not print my speech in a larger font, so please bear with me.
Millions of people across the country are affected by sight loss, and hundreds of thousands of people have glaucoma. If untreated, glaucoma can have a profoundly detrimental effect on people’s quality of life and long-term health, yet one in every 10 people on an NHS waiting list is waiting for their first ophthalmology appointment. Ophthalmology waiting lists grew longer and longer under the previous Conservative Government, who oversaw a doubling of waiting times in England alone. Meanwhile, more than half a million people are waiting for follow-up appointments. As our population continues to age, demand is likely only to increase.
As with so many conditions, early intervention is key. One elderly patient in my constituency was sent for an urgent referral following a routine eye test. He was warned that if he was not seen in the next few weeks, he was at risk of losing sight in the affected eye. The appointment came through in time, only for it to be cancelled, along with the replacement appointment. By the time he was able to see a specialist, it was too late and he lost sight in that eye. This entirely avoidable incident demonstrates how it is crucial that we address the chronic shortage of ophthalmologists to deliver the care that people deserve.
A starting point would be to deal with the broken training system. Far too few specialist training spaces are offered, despite many graduates being keen to work in the field. A little over a decade ago, there were four and a half applicants per training place, and it has surged to 10 applicants per place. It is simply not good enough.
How will the Government deliver the ophthalmology workforce we need? In particular, will they look to reduce the extraordinary shortage of training places in this and other specialties? Will they consider publishing waiting list data for follow-up care? Transparency on waiting lists for follow-up appointments, not just for initial referrals, would help patients to make informed choices about the care they need and would illustrate the postcode lottery in NHS eye care.
Liberal Democrats know that fixing the front door of our NHS is crucial to achieving better outcomes on glaucoma and all conditions that impact sight. That means sorting out primary care and community services, so I am pleased to see that the Government agreed with that aim in the 10-year plan published last week. Fixing primary care means investing in local GP surgeries and giving everyone the right to see a GP within seven days, or 24 hours if they are in urgent need, and providing 8,000 more GPs to deliver that. It means ensuring that everyone over 70 and everyone with a long-term condition has access to a named GP.
As the hon. Member for Leicester South reminded me in our Opposition day debate on primary care in the autumn, optometry is a critical part of primary care and needs to be delivered locally. For glaucoma specifically, that means investing in eye services in the community and empowering the training of trusted, qualified optometrists to manage the condition. Optometrists are already in place to manage glaucoma across Wales and Scotland, so we have a strong base of evidence to inform that work. Research suggests that the additional training required is rewarding for optometrists, for the ophthalmologists training them and, more importantly, for the patients they are treating.
However, in England, glaucoma services vary drastically, depending on which integrated care board area people live in. With major organisational changes to the ICB structure under way, this could be an opportunity to standardise a better, more consistent, community-focused approach. Could the Minister set out how the Government will encourage true partnership between qualified optometrists and ophthalmologists, delivering care in the community wherever possible? What hurdles stand in the way of such an arrangement?
Finally, we need to ensure the highest possible uptake of regular eye tests so that we can catch this condition early and prevent damage to people’s sight. As somebody who has a close relative with glaucoma, I have my eyes tested regularly. It is not too unpleasant, and it gives me the reassurance I need that I am not currently developing the condition. The number of sight tests, including domiciliary visits, has still not recovered since the pandemic.
Given the scale of the challenges of ensuring that people are tested, of treating them when glaucoma is found and of training sufficient staff in a context of surging demand, the Government should produce a dedicated eye health strategy, as advocated by groups such as the Thomas Pocklington Trust. There clearly needs to be substantial work across the sector to strengthen eye care as part of primary care and better incorporate optometrists, to repair a broken training arrangement and to ensure that people get the eye tests they need.
Dr Luke Evans (Hinckley and Bosworth) (Con)
It is a pleasure to serve under your chairmanship, Mr Pritchard. I, too, thank the hon. Member for Leicester South (Shockat Adam), who is a colleague both in my region and in primary care. His powerful testimonies about patients and what they suffer are exactly why he is an asset to this House. He presents information that we all need to hear when we debate health issues.
The hon. Member for Alloa and Grangemouth (Brian Leishman) spoke about the fantastic Perth royal infirmary. It is lovely to hear a success story. We do not hear enough success stories about the NHS, because the good news, despite what we hear in this place, is that the NHS broadly does a fantastic job for many patients, and we should never forget that. The experience he described is what we want to see across the country when it comes to dealing with glaucoma.
The hon. Member for Strangford (Jim Shannon) is nothing if not tenacious and consistent because, when I checked the records, I saw that in April 2024 he introduced a similar debate to raise this cause and to make sure people hear about it. He is a credit to his party and the people he represents when it comes to raising health issues.
The hon. Member for North Ayrshire and Arran (Irene Campbell) talked about NHS working groups. I have worked in places that have had PEARS—primary eye care acute referral schemes. Patients love them, GPs love them and I think the opticians and those who work in the services love them too, because they allow better joined-up care, which is what we all want.
Glaucoma is actually a spectrum of conditions. Ocular hypertension affects 3% to 5% of people in the UK aged over 40. Primary open angle glaucoma affects about 2% of people in the UK older than 40, but when we break that down, it affects 1% of people aged 40, 3% of people aged 60 and about 8% of people aged 80. With a growing elderly population, we can see why this is a problem. Primary angle closure glaucoma affects about 0.4%. There are also some rarer ones, but the point is that glaucoma affects about 700,000 people, who could potentially go blind.
Are the Government considering the call of the Association of Optometrists, and it is a simple one, to commission a national glaucoma pathway? I ask the Minister to think about that.
The National Institute for Health and Care Excellence guidance on glaucoma is very clear:
“If any of the following risk factors for glaucoma are present, consider advising people to have their eyes examined by an optometrist…Older age. People 60 years of age or older should be examined every 2 years until they are 70 years of age, when they should be examined annually—free examination is available through the NHS…Family history of glaucoma. People older than 40 years of age who have a first-degree relative (parent, sibling, or child) with open angle glaucoma should be examined annually—free examination is available through the NHS…Ethnicity. People older than 40 years of age who are of black African family origin should be examined…Certain people are entitled to…NHS-funded eye examinations by optometrists…These include people …With a family history…as described above…Aged 60 years or older…In receipt of certain benefits”
or
“Who have been advised by an ophthalmologist”
to have a follow-up. This is really important, as we have heard today, when we are talking about awareness. People should get their eyes checked, check their availability and, if they are 60 or over, make sure they understand that they can get their eyes checked through the NHS.
This issue was raised in a debate at the end of April 2024, just a few weeks before the election. It is worth looking at what was said by the then shadow Minister, the hon. Member for Gorton and Denton (Andrew Gwynne), who went on to be a Health Minister:
“I have a degree of frustration with the Government’s approach to the issue. Given the statistics, I would like to see the Minister commit today to turbocharge access to ophthalmology services and make eye tests more commonplace for people who do not routinely test their eyes, but also to get people access to eye care services once conditions have been diagnosed.”—[Official Report, 30 April 2024; Vol. 749, c. 51WH.]
And he finished his remarks by saying:
“We will support the Government in the remaining weeks or months that they have to get this policy right, but mark my words: the next Labour Government see this as a priority and we will act.”—[Official Report, 30 April 2024; Vol. 749, c. 53WH.]
Now that we are one year into this Government, it is worth checking the record to see whether that priority has been given.
Forgive me for being a bit of a pedant, but I checked Hansard to see how many times glaucoma has been mentioned. There have been four mentions since the election, only two of which were in the context of health. One mention was made by the hon. Member for Leicester South last month, and the other was made by the hon. Member for Strangford in a debate on rare retinal disease. That does not seem like it is a priority.
I am being a bit of a pedant, but I also looked through the 10-year plan again, and there were two mentions of eye care, one of which was “ophthalmology” and the other was “optometrists”. The Minister will argue that it is a strategy document, but it raises the question: what is the plan for glaucoma?
The last Government concentrated on several areas. These included early detection and greater use of community optometry, with an emphasis on the importance of routine tests. There was £500 million a year for sight tests and optical vouchers, supporting more than 12.5 million NHS sight tests provided free of charge. The budget was demand-led rather than limited by volume, and the public were encouraged through campaigns and social media advertising to get tested. Integrated care boards expanded local services for minor and urgent eye care, pre- and post-cataract checks and glaucoma referral filtering. The post-covid backlog recovery programme also received £8 billion.
I am getting death stares from you, Mr Pritchard, so I will move on to my main points and my questions for the Minister.
Mark Pritchard (in the Chair)
The shadow Minister needs to be brief. He has had five minutes, and I gave six minutes to the Liberal Democrat spokesperson. I will give the shadow Minister another 30 seconds.
Mark Pritchard (in the Chair)
To be clear, it is important that the Chair is both neutral and fair in the distribution of time.
The Minister for Care (Stephen Kinnock)
Thank you, Mr Pritchard. It is a pleasure to serve under your chairship.
I thank the hon. Member for Leicester South (Shockat Adam) for securing this important debate to raise awareness of glaucoma. I enjoyed our meeting some time ago, when we discussed this and other related issues at length. I am keen to ensure that we keep that dialogue going, and not just in this Chamber. This is a timely debate as it follows Glaucoma Awareness Week, which ran from 30 June to 6 July.
Losing one’s eyesight can be devastating, and I pay tribute to the charities that do so much to help people live with glaucoma or to research a cure, such as Glaucoma UK, the Glaucoma Foundation and the Royal National Institute of Blind People, to name just a few.
Last week, the Prime Minister set out our plan to get the NHS back on its feet and fit for the future. Underpinning our plan are three big shifts: from hospital to community, from analogue to digital and from sickness to prevention. The plan was developed through extensive engagement with the public, patients and staff, including the eye care sector. All three shifts are relevant to preventing and managing conditions such as glaucoma in all parts of the country. More tests and scans delivered in the community, and better joint working between services, will support the management of conditions, including glaucoma, closer to home.
I turn to glaucoma detection. This Government take glaucoma very seriously, as it is one of the main causes of sight loss. It is a time-sensitive condition, and early detection and treatment can help to slow down or prevent vision loss. I acknowledge the vital role played by community optometry in protecting people’s eye health across the country. That includes the hon. Member for Leicester South, who of course is an optometrist and has significant expertise in this sector. I also pay tribute to all the hon. Members who have contributed to this debate with such passion and conviction.
Sight tests play a vital role in the early detection of glaucoma. Most glaucoma patients are identified through routine sight tests. It is not possible to “feel” glaucoma; it does not cause any symptoms and the eye pressure does not always cause pain. That is why regular sight tests are so essential, so that conditions such as glaucoma can be diagnosed and treated as early as possible.
It is recommended that everyone should have a sight test every two years, and more often if it is considered clinically necessary. The NHS invests over £600 million annually in the provision of sight tests and optical vouchers, and high street opticians deliver more than 13 million NHS sight tests annually, which are free of charge for eligible patients. NHS sight tests are widely available across the country for millions of people and those who are entitled to receive them include children, individuals over the age of 60, individuals on income-related benefits and individuals diagnosed with glaucoma or considered to be at risk of glaucoma.
We understand that some people might not prioritise sight tests, compared with other healthcare, or they might not know that sight tests are recommended every two years. That is why we always look for opportunities to remind the public through social media. I was pleased that the Department supported Glaucoma Awareness Week and highlighted the importance of regular sight tests through our social media platform last week. I will also take this opportunity to urge anyone who might be watching or reading this debate, “Visit your optician if you have not had a sight test in the last two years. Please check on the NHS website to see whether you are eligible for any help in paying for a test.” NHS sight test providers in the high street also display information about NHS sight test eligibility.
Some high street optical practices are also being commissioned by integrated care boards to provide glaucoma referral refinement services. Moving more care into the community is one of the key priorities in our 10-year plan; we want to see care happening as locally as possible for patients. Where a patient has been identified as having raised eye pressure, local glaucoma referral refinement schemes provide additional tests to confirm whether a referral into secondary care is absolutely necessary. These schemes can save patients time and worry, and reduce unnecessary referrals, while freeing up space for others who need specialist attention in hospital. More than 70% of ICBs currently have some coverage of referral refinement in place.
For those patients who do need to be seen in secondary care, it is vital that they have access to timely diagnosis and any clinically necessary treatment. We have wasted no time in getting to work on cutting NHS waiting lists and ensuring that people have the best possible experience during their care. We promised change and we have delivered early, with a reduction in the list of over 230,000 pathways, including ophthalmology. The waiting list has been reduced by over 24,000 patients since July 2024; it has fallen from 606,819 to 582,385 as of February 2025. In addition, we have exceeded our pledge to deliver an additional 2 million operations, scans and appointments, having now delivered over 4 million additional appointments.
Dr Luke Evans
The Minister will probably be aware of the Full Fact and Sky News report that examined the speed at which appointments are being delivered. The Government have indeed delivered 4 million appointments, but under the last Conservative Government there were 5 million appointments within a similar time period, so we are actually seeing a slowdown in appointments. How will that affect people with eye conditions or other health conditions?
Stephen Kinnock
I thank the hon. Gentleman for that intervention. In our manifesto, we of course set a target of 2 million additional appointments within the first year of a Labour Government, and we have delivered 4 million. The key thing is to ensure that we get people off the waiting list. Regarding the figure of 5 million that he referred to, I do not know whether there was more activity, but somehow it was not helping to reduce the waiting lists, because we saw the waiting lists rise consistently. The key metric is, of course, the waiting list being reduced, and I am very pleased to say that, when it comes to eyecare, a reduction of 24,000 patients has been delivered since July 2024.
That marks a vital first step to delivering on the commitment that 92% of patients will wait no longer than 18 weeks from referral to consultant-led treatment, in line with the NHS constitutional standard, by March 2029.
In addition to making progress on reducing waiting lists, we recognise the challenges facing ophthalmology services as one of the largest out-patient specialities in the NHS, and demand is set only to increase due to the ageing population. NHS England has worked with 11 ICBs to test a new way of delivering eyecare that aims to reduce pressure on hospital eye services.
The new model is emblematic of our shift from analogue to digital, as it uses IT connectivity between primary and secondary care services to improve the referral and triage of patients, with patient data and images being assessed by clinicians to determine whether patients need a secondary care appointment. It is called the single point of access approach. The SPOA approach reduces unnecessary hospital appointments, reduces the time from referral to treatment and allows more patients to be managed in the community. The ICBs testing the SPOA model have consistently demonstrated a reduction in unnecessary secondary care appointments and a significant reduction in wait times, both in time to treatment and to follow-up care. NHS England is continuing to share the learning from the accelerator sites for the SPOA with ICBs.
I want to see more ICBs adopting that approach for the benefit of patients, including those with suspected or diagnosed glaucoma. I believe that the SPOA has tremendous unharnessed potential and is a great example of how, by harnessing technology, we can improve the way the overall system works and facilitate the interface between primary and secondary care that we know is at the heart of so many of the challenges that we face across our health and care system.
Looking at the shift from sickness to prevention, although glaucoma cannot be cured, if it is caught early, treatment can prevent sight loss. The National Institute for Health and Care Excellence plays a crucial role in evaluating new medicines, medical devices and other technologies to determine their clinical and cost-effectiveness before recommending them for NHS use. NICE has published guidelines on the diagnosis and management of glaucoma. It has also published guidance on interventional procedures that provide recommendations on whether glaucoma-related procedures are safe and effective enough for wider use in the NHS.
A number of treatments are available for glaucoma, including eye drops, laser treatment or surgery, aiming to lower eye pressure and prevent or slow down optic nerve damage to reduce the risk of sight loss. Although there are treatments for glaucoma, it is a lifelong condition that requires regular monitoring. Historically, that has taken place in hospital but, in line with our aim to move more care from hospital to the community, there is no reason why, when clinically appropriate, that activity could not be undertaken outside of hospital. We know that some ICBs are already commissioning glaucoma monitoring in the community.
We must also recognise that, if diagnosed late, glaucoma can sadly lead to irreversible sight loss. The hon. Member for Leicester South spoke passionately from clinical experience about the significant impact that sight loss can have on an individual. Emotional support is therefore vital. There are various resources that aim to improve the support, including mental health support, available to patients through their sight loss journey. That includes NHS England’s patient support toolkit for commissioners and providers and the RNIB’s 2023 patient support pathway. Those sit alongside talking therapies and psychological therapies, which are widely available and to which patients can refer themselves directly. We are also taking steps to update the form for certificates of visual impairment to improve the signposting of patients to local support services.
Finally, I recognise the potential for research and innovation to help us to understand sight loss and to develop new treatments, including for glaucoma. The Department for Health and Social Care funds eyecare research through the National Institute for Health and Care Research. NIHR infrastructure funding provides investment in research expertise, specialist facilities, a research workforce and services that help to support and deliver research studies through a range of clinical areas, including eyecare research. That includes the NIHR Moorfields Biomedical Research Centre, which received funding of almost £22 million for five years from 1 December 2022, and is solely dedicated to eyecare research. The Moorfields BRC has been key in advancing research through a range of studies and clinical innovations in the glaucoma field. One of its flagship projects is a large-scale trial investigating the use of vitamin B3 to slow the progression of glaucoma. Recruitment for that study is ongoing at multiple sites across England.
As I have set out, the Government take glaucoma extremely seriously. Community optometry continues to play a vital role in preventing glaucoma. We are committed to improving eyecare services and patient outcomes, to reducing avoidable sight loss and, in particular, to harnessing the power of technology to drive those improvements forward. I also hope that this debate has further helped to raise awareness and may prompt a few more sight tests as a result. Once again, I congratulate the hon. Member for Leicester South on securing this important debate.
Shockat Adam
It has been a real pleasure to serve under your chairship, Mr Pritchard. I thank each and every hon. Member for their contribution. I think we have achieved the first objective, which was to raise awareness of glaucoma, and we should keep the conversation going. As my neighbour, the hon. Member for Hinckley and Bosworth (Dr Evans) said, we have an ageing population. If nothing is done, very soon there will be more than half a million people walking around with this condition. That is why it was pleasing to hear that the Minister remembered our meeting, which was early on in our tenure; I can assure him we will continue to have that meeting every time he sees me about eye health.
I would like to take this opportunity to thank the people in the Public Gallery: we have people from the Worshipful Company of Spectacle Makers, the General Optical Council, the College of Optometrists and Glaukos —my apologies if I have forgotten anybody there. We must utilise optometry as the primary eyecare provider that it is, and treat it as such, equivalent to how we treat our GPs and pharmacy colleagues. We need a statutory framework to regulate the whole process of detection, monitoring and treating glaucoma. Working collectively with the optical and ophthalmic bodies and the Government, we can surely do our best to keep people from suffering preventable sight loss and the devasting impact that that has on their lives.
Question put and agreed to.
Resolved,
That this House has considered glaucoma awareness.