Eye Health and Macular Disease

Steven Bonnar Excerpts

Tuesday 11th January 2022 Westminster Hall

[Steven Bonnar (Coatbridge, Chryston and Bellshill) (SNP)]

I commend the hon. Member for Strangford (Jim Shannon) for bringing forward this debate on a hugely important subject. Macular disease is the biggest cause of sight loss in the UK, with up to 40,000 people developing wet age-related neovascular macular degeneration every year, with wet macular degeneration being the worst of all known eye diseases.

Age-related macular degeneration is a common condition that affects the middle part of a person’s vision. It usually affects people in their 60s and 70s, rising to a rate of around one in 10 people aged 75 and above. However, it can strike at any age. It can happen in one eye or both and, as we have heard from the hon. Member for Great Grimsby (Lia Nici), it affects the middle part of a person’s eye. AMD can make things such reading, watching television, driving or even facial recognition difficult. Other symptoms can include seeing straight lines as wavy or crooked—which was how the hon. Lady established that she had a problem—objects looking smaller than normal, colours seeming less bright, or seeing things that are not even there.

AMD is not painful and does not affect the appearance of the eye. It does not cause complete or total blindness, but it can make everyday activities incredibly difficult. Without treatment, vision may worsen gradually over several years, which is known as dry AMD, or quickly over a few weeks or months, known as wet AMD. The exact cause is unknown; it has been linked to high blood pressure, being overweight, smoking or having a family history of AMD.

I am sure Members agree that the figures and statistics prove the seriousness of the disease, and why pre-emptive measures should and must be taken. I am proud that that is exactly why we are leading the way in optometry in Scotland. We are currently the only country in the UK to provide free, universal, NHS-funded eye care examinations. Since 2006, adults in Scotland have been able to attend a free eye health check biannually, with children under the age of 16 and adults over the age of 60 entitled to an annual visit. That proves that the Scottish Parliament is committed to delivering a world-leading eye care service for its people.

An NHS eye examination in Scotland is more than just a sight test. It provides a general eye health check that can detect early signs of sight-threatening conditions and other general medical conditions, including diabetes, high blood pressure, cardiovascular disease, tumours, dementia, or even arthritis. Optometrists in Scotland deliver a system of eye care services in which all areas of the ophthalmic workforce are truly at the top tier of their professional competency and expertise. That enables higher quality, safe, effective and person-centred eye care services to be delivered in the community and closer to people’s homes, freeing up hospital services to focus on the most complex eye conditions and urgent patient cases.

Community optometrists are already the first point of contact for any eye problems and they can diagnose and treat a number of conditions without the patient requiring an appointment with their GP or an ophthalmologist, easing pressures on an already burdened health service. An increasing number of community ophthalmologists are also registered independent prescribers and can issue patients with an NHS prescription to treat their eye problem or condition.

I was fortunate enough to be able to visit one of the opticians in my constituency of Coatbridge, Chryston and Bellshill just yesterday. Tuite Opticians in Coatbridge is a family-owned optician currently run by Eamonn Tuite, which has been at the heart of our town since 1973. Tuite understands the needs of the community it serves and always goes the extra mile to ensure the best healthcare and support are provided to all service users. As a result, it not only provides eye examinations in the practice, but also a bespoke service for the housebound, ensuring minimum fuss is required by the patient for such a vital check. I am pleased to be able to place on record my gratitude to the optometrist Stephen Kirley, who took the time to explain to me in great detail the impact of macular degeneration on individuals and why early intervention is so important in treating the disease.

That all lies within and is covered by the free eye test and the fantastic policy of the Scottish Government. By ensuring there are no barriers to accessing eye care, optometrists such as Stephen have a positive impact on patients’ health needs. In return for every eye test carried out, the Scottish Government provide practices such as Tuite with a fee to cover the cost of its work and ensure the business can continue to support as many in the community as possible.

Tuite Opticians was kind enough to carry out my own eye test yesterday and I sure all Members will be happy to learn that I have a clear bill of health—all the better for keeping a beady eye on this Government.

[John McDonnell]

I went for my eye test yesterday. I could not get an appointment in Hayes, my constituency, so I went to Uxbridge. Unfortunately, at the same time the Prime Minister did an official visit to the eye test and disturbed it. How inconsiderate could he be?

[Steven Bonnar]

That is so surprising. This Prime Minister is known for his consideration of others.

I put my thanks to Tuite Opticians on the record, not only for having me, but for its tremendous commitment to the wider community of Coatbridge for over 30 years.

[Jim Shannon]

I thank the hon. Gentleman for his positive contribution to this debate. The other good thing about going to an optician, is that if he has any concerns, he can refer the patient on—it does not necessarily have to go through the GP. I did that when I went to my optician in the Cathedral Quarter in Belfast to get all the tests necessary and ultimately was given the all-clear. An optician can put someone’s mind at ease.

[Steven Bonnar]

I thank the hon. Member for his intervention. He is absolutely right. The optician can highlight so many things. We know the burdens across the NHS, particularly on our GPs and this can lighten the load. However, as he correctly outlined, unfortunately, in England, Wales and Northern Ireland, the situation can sometimes be difficult. Optical practices are not so fortunate in that there is no governmental support and provision for free eye tests for the general public.

In England, a typical eye examination costs between £20 and £25 for all, except children, the elderly or people registered as partially sighted or blind. Having a monetary value attached to an eye examination would undoubtedly deter those unable to afford the crucial health test and endanger their long-term health and hamper the early prevention tactics that so evidently work. This in a country where health care should be free at the point of need is unacceptable. I believe it is unacceptable to administer a charge. The rest of the UK should follow suit. We have heard repeated calls for a national strategy—the example set by Edinburgh should be followed. Scottish citizens do not have to pay to have their eyes examined. Seeing is a privilege that so many of us will struggle to appreciate, but ensuring that there is universal access to eye tests means that those who require them do not have to think of any cost ramifications.

Scotland not only leads the way in the universal accessibility of eye tests but is the first country in the UK to enable access to important treatments for macular disease. Treatment depends on the type of AMD. Dry AMD accounts for 80% or 90% of cases. There is no treatment, but vision aids can help reduce the effects on day-to-day life. Wet AMD, which affects 10% to 20% of sufferers, may require regular eye injections and, very occasionally, as we heard from the hon. Member for Great Grimsby, a light treatment called photodynamic therapy, to stop vision getting any worse.

The other nations of the UK are missing a trick not only in determining new treatment methods for macular disease, but when it comes to understanding the importance of addressing such issues in terms of the impact on the wider health and social care system.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I am very grateful to the hon. Gentleman for all that he is saying with regard to macular degeneration. From speaking to surgeons such as James Neffendorf at King’s College Hospital, I know that treatments are absolutely crucial, but what will help to save people’s eyesight, whether in Scotland, England, Northern Ireland or Wales, is the public awareness of macular degeneration, so that those signs can be picked up earlier across the United Kingdom. Will he agree that the Government should ensure that there is a public campaign across the country to pick up those signs earlier, so that people can know when those symptoms arise and get best treatment early on?

[Steven Bonnar]

That is a fantastic idea. Any attention that we can draw to this, we must.

Macular degeneration, both wet and dry, leads to visual impairment, which can in turn lead to depression in many patients. The loss of one’s sight is so catastrophic that it often leads to clinical depression or other mental health issues—up to a 50% increase compared to non-affected patients. Furthermore, sufferers also have a 25% increased risk of developing dementia. The role of optometrists in administering primary care in the community is therefore critical to identifying these conditions at an early stage and minimising the impact on other areas of healthcare. If the protection of the wider health service is not a reason to address the shortcomings in eye care, I am not sure what is.

Eye care and macular health is vital. It is important that we, as a Parliament of the people, address needs in this area and remove any barriers, financial or otherwise, to affording our constituents the ability to access sufficient care on a regular basis. Universal free eye examinations enable optometrists to detect sight-threatening and other medical conditions without depending on how much money a person has or the ability to pay. Let this Parliament follow the example of the Scottish Parliament; let this Parliament put healthcare at the heart of everything that we can achieve. Only by doing so will we fulfil our duties to protect all citizens and communities within our reach.

--- Later in debate ---

[Maria Caulfield]

Absolutely: we have heard today about the impact that overall health has on eye health. We know that NHS sight test numbers were impacted at the peak of the pandemic, but there has been a strong recovery, with 9.7 million sight tests carried out between April and December last year. Again, I thank the NHS, and particularly primary eye care providers, for their efforts.

It is vital that once a problem is detected, individuals have access to timely diagnosis and any necessary treatment. Age-related macular degeneration is one of the leading causes of sight loss in the UK, and is a devastating disease that can seriously impact a person’s life. The vast majority of people with age-related macular degeneration suffer from “dry” degeneration, for which there is currently no effective treatment, although vision aids can reduce its impact. For those with “wet” degeneration, this condition can be far more serious and sight-threatening. There are a number of available treatments for that form of AMD, and I point colleagues to the National Institute for Health and Care Excellence’s guidelines: a person should be referred within one day if their condition is considered to be wet active AMD, and offered vascular endothelial growth factor drugs within 14 days of a referral. It is important that patients are able to access that treatment, as indicated by NICE.

Although we do have some effective treatments for macular disease, we do not rest on our laurels. Medicine continues to evolve, and we heard from my hon. Friend the Member for Sedgefield (Paul Howell) about the potential of sleep masks—evidence is still being collected about that treatment. We also heard from my hon. Friend the Member for Great Grimsby, who is the expert in this area, about the exciting developments in stem cell research and the possibilities that they could create in future.

During this time, the NHS has continued to prioritise urgent and life-saving treatments, including for sight-threatening eye conditions. I am pleased that the number of ophthalmology patients seen last October was almost back to a pre-pandemic level.

To help the NHS drive up activity, we have provided £2 billion this year through the elective recovery fund, and a further £5.9 billion of capital funding will support elective recovery, diagnosis and technology. That does include—my hon. Friend the Member for Hendon (Dr Offord) asked about this—the ability to expand capacity for new surgical hubs that will drive through high-volume services, such as cataract surgeries, so that they are high on the agenda in tackling the backlog. The NHS has also been running the £160 million accelerator programme, which includes 3D eye scanners and other innovations that are helping to develop a blueprint for elective activity in the NHS.

Ophthalmology is one of the largest out-patient specialties. Change is needed to ensure the NHS can both be sustainable for the future and deal with the growing numbers of people needing eye care services. To address these challenges, NHS England has developed the national eye care recovery and transformation programme to work across all systems and look at everything from workforce to the services provided. It is working with local systems to prevent irreversible sight loss as a result of delayed treatment.

In recognition of this important work, I am delighted that NHS England is recruiting a national clinical director for eye care. That person will oversee services at a national level, which will filter down to tackle the inequalities and disparities we have heard about in certain parts of the country. Much good work is happening, but it is important that the public health outcomes framework is used to identify gaps in services. The framework tracks the rate of sight loss across the population for three of the commonest causes of preventable sight loss—age-related macular degeneration, glaucoma and diabetic retinopathy. The data is openly available and is being used to match areas where services and outcomes need to be improved.

I want to touch on the points raised by the hon. Member for West Ham (Ms Brown) about her constituent, Darren, and those raised by the right hon. Member for Hayes and Harlington (John McDonnell). I am concerned about issues around laser surgery and the impact they are having. I am happy to meet the right hon. Gentleman and the hon. Lady, and other colleagues, to discuss that. The Care Quality Commission regulates that area, but I am concerned by the information shared today and I am happy to look at the issue further. It is important that the situation of people with minor eye ailments is not made worse by having surgery that may, or may not, be suitable for their needs.

We have had a good debate today. I hope I have reassured colleagues that eye health procedures, treatment and diagnoses are part of the post-covid recovery process. I take on board the points made by my hon. Friend the Member for Great Grimsby that this is about more than just diagnosing and treating; it is about improving the lives of those with sight loss, to enable them to live the most productive and fulfilling lives they possibly can. I am pleased to hear that the Royal National Institute of Blind People and ACAS were instrumental in helping her and others who are trying to improve the workplace experience. My hon. Friend the Member for Darlington also pointed out that technological changes can have a positive impact but that things such as electric cars can have a negative impact on people with sight loss, as those vehicles are so quiet.

To conclude, maintaining good vision throughout our lives is very important. Some preventable factors, such as smoking and obesity, can help improve eye health, but there are many unavoidable issues that we need to deal with.

[Steven Bonnar]

Are there plans in any part of the national strategy to remove the financial impediment, so that English, Welsh or Northern Irish people can get a free eye test?

[Maria Caulfield]

Many people in England qualify for a free eye test. We are not seeing that issue as a barrier to people coming forward, but I have outlined the many measures we are putting in place to improve the outcomes for people with significant sight loss problems. As we emerge from the pandemic, our priority remains tackling the elective backlog and ensuring that we have high-quality, sustainable eye care services for the future.