Glaucoma Awareness

Luke Evans Excerpts

Wednesday 9th July 2025 Westminster Hall

[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.

[Dr Evans]

Is there a plan or a strategy for considering a glaucoma pathway? Will the Government also commit to the workforce? The Health Service Journal has noted that the plan, as it stands, has no delivery chapter. Where is the delivery chapter for the 10-year health plan?

[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.