A vision for eye care in the UK

A vision for eye care in the UK

By Thom Renwick, lead for ophthalmology at Roche

Across the UK, more than two million people are affected by sight loss, with macular disease being the most common cause [1], [2]. Each day 250 people begin to lose their sight [3]. Quality of life for someone with severe sight loss is lower than for those with advanced breast cancer, arthritis, and depression [4].

Yet, while many patients value their eyesight above all their other senses, many do not understand the importance of looking after their eyes and going for regular check-ups. In August 2021 a survey of 1,516 adults in the UK found that 80% of respondents felt their sight was more important than any other sense; but only 15% ranked having regular optical appointments more important than medical or dental check-ups.

It is important for those of us working in eye care to explore the reasons behind this and to help raise awareness of how important it is for people to look after their eye health. Patients need to be educated and empowered to ensure they live long and healthy lives.

Eye disease is estimated to cost the UK economy £25 billion annually with ophthalmology being the busiest outpatient specialty in the NHS [5].  As of December 2021, 602,110 patients were on the ophthalmology treatment waiting list, with half of them waiting more than 12 weeks for an appointment [6].During the Covid-19 pandemic, outpatient activity fell dramatically, with just 5.4 million ophthalmology outpatient attendances in 2020/21, compared to 7.9 million in 2019/20 [7].

One study found that referrals for wet AMD at four major eye treatment hospitals fell by 72% in April 2020, compared to April 2019 [8] (neovascular or “wet” AMD is an eye disease that can cause rapid and severe vision loss). This temporary drop in referrals has led to a large backlog of care, with ophthalmology now accounting for 10% of the total NHS elective backlog, and 27,000 people waiting more than a year for treatment [9].

For people with macular disease, these delays can result in rapid deterioration of sight, which, in turn, can have a devastating impact on quality of life and emotional wellbeing. Without swift treatment, a person with wet AMD can lose much of their sight within weeks [10].

A severe shortage of ophthalmologists further exacerbates the situation. A recent workforce census, carried out by the Royal College of Ophthalmologists, revealed that two-thirds of hospital eye units were resorting to the extensive use of locum doctors to fill consultant posts. In the coming years, there is an expected need for 230 extra consultants and 204 staff and associate specialist roles in NHS ophthalmology services [11].

By 2050 it is thought the number of people living with sight loss in the UK will rise to four million, potentially costing the UK economy £33.5bn [12].

So, there is an urgent need to invest in services to raise the awareness of potentially severe eye conditions and to ensure people can access effective treatments in a timely manner.

Now is the time to act.

Roche Products Ltd has recently joined forces with the Royal College of Ophthalmologists, the Macular Society, Fight for Sight, and the Association of Optometrists to form a unique coalition of national organisations dedicated to improving eye care, called ‘The Eyes Have It’.

Through parliamentary engagement, patient support and raising awareness via the media, The Eyes Have It partnership aims to tackle issues such as delayed referrals, service capacity, a shortage of clinical specialists, and support the potential emotional impact both delays to treatment and the burden of treatment for patients with sight loss has.

The group is working to develop solutions to address the backlog and improve access to eye care services for people at risk of, or living with, sight loss, and has come up with a series of recommendations for government.

These include the appointment of a national clinical director, the development of a national eye care strategy to alleviate pressure on hospital eye services, and the implementation of guidance to enable direct referral from community optometry to secondary care. There is widespread discrepancy across the UK where, in some areas, community optometrists, who are highly trained professionals, are not able to refer directly to secondary care without needing to go via the GP [13]. This creates confusion, misunderstanding and delays for patients.

At the end of April, the Health and Care Bill was passed in Parliament paving the way for Clinical Commissioning Groups to be replaced by Integrated Care Systems (ICSs) [14]. There is broad agreement in the eye health sector that the new ICSs will create opportunities in terms of shifting eye care more towards primary care, helping to improve services, but there are also potential pitfalls along the way.

To deliver service transformation, the whole healthcare system, including all levels of care, will need a shared vision for reform, and a sustained, long-term focus.

Join Consultant Ophthalmologist Dr Melanie Hingorani and Conn O’Neill, from Roche Products Ltd at 12.30pm on 19 May at the Health + Care conference in London to explore all these issues and more against a backdrop of the government’s National Eye Care Recovery and Transformation programme.

A Vision for Ophthalmology - Health Plus Care 2022

Roche Products Ltd provides funding to Ovid Health to act as secretariat to The Eyes Have It partnership

DOP: May 2022 / M-GB-00007440

[1] Fight for Sight, Time to Focus (October 2020); https://www.fightforsight.org.uk/media/3302/time-to-focus-report.pdf

[2]  Quartilho, A. et al, “Leading causes of certifiable visual loss in England and Wales during the year ending 31 March 2013”, Eye (2016); https://doi.org/10.1038/ eye.2015.288

[3] Eye health and sight loss stats and facts.pdf (rnib.org.uk)

[4] Fight for Sight, Time to Focus (October 2020); https://www.fightforsight.org.uk/media/3302/time-to- focus-report.pdf

[5] Data on file at NHS Digital, Hospital Outpatient Activity 2020-21: All Attendances, (September 2020); https://digital.nhs.uk/data-and-information/publications/statistical/hospital-outpatient-activity/2020-21

[6] Data on file at NHS England, Consultant-led Referral to Treatment Waiting Times Data 2021-22, Incomplete Commissioner Dec21 (February 2022); https://www.england.nhs.uk/statistics/ statistical-work-areas/rtt-waiting-times/rtt-guidance/

[7] Data on file at NHS Digital, Hospital Outpatient Activity 2020-21: All Attendances, (September 2020); https://digital.nhs.uk/data-and-information/publications/ statistical/hospital-outpatient-activity/2020-21

[8] Thomas, D.S. et al, “Estimating excess visual loss in people with neovascular age-related macular degeneration during the COVID-19 pandemic”, medRxiv (June 2020); https://doi.org/10.1101/2020.06.02.20120642

[9] Data on file at NHS England, Consultant-led Referral to Treatment Waiting Times Data 2021-22, Incomplete Commissioner Dec21 (February 2022); https://www.england.nhs.uk/statistics/ statistical-work-areas/rtt-waiting-times/rtt-guidance/

[10] Foot, B. & MacEwen, C., “Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome”, Eye (2017); https://doi.org/10.1038/eye.2017.1.

[11] Royal College of Ophthalmologists, Ophthalmic Practitioner Training; https://www.rcophth.ac.uk/training/ophthalmic-practioner-training/

[12] RNIB, Coming to terms with sight loss; https:// www.rnib.org.uk/recently-diagnosed/coming-terms-sight-loss

[13] NHS England, Eye Care Planning Implementation Guidance 2021-22 Summary Annex (April 2021); https://www.rcophth.ac.uk/wp-content/uploads/2021/06/Eye-Care-Planning-Implementation-Guidance-2021-22- Summary-Annexe-1.pdf

[14] Health and Care Act 2022 - Parliamentary Bills - UK Parliament

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Dates and venue

26-27 APRIL 2023 + ExCeL LONDON