Glaucoma Awareness

Debate between Ayoub Khan and Shockat Adam

Wednesday 9th July 2025 Westminster Hall

[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.

Coroner Services: West Midlands

Debate between Ayoub Khan and Shockat Adam

Thursday 15th May 2025 Commons Chamber

[Ayoub Khan]

I thank the hon. Gentleman for his intervention; I was going to quote those figures in my speech. He is absolutely right that those 6,000 delays have a direct impact on not just families who want closure, but current cases that need to be worked on. The time spent by the coroner on inquests will naturally impact the basic sign-off of documents in other cases, and where the coroner is not available to sign off, families will have to wait to effect burial. We need modernisation, of course, and I seek support from the Minister on how we can modernise the service.

As I said, I hear of grieving families every week. They are tired, frustrated and often feel helpless, and turn to elected representatives for intervention. I want to share a story from my constituency that highlights the human impacts of these delays. A prominent brain surgeon had lost his father. The funeral, which should have taken place within a day, was delayed for over a week due to coroner backlogs. That surgeon, bound by faith and family duty, remained in mourning and could not return to work until the burial had taken place. His father’s death was more than a personal loss; it had a professional consequence, too. Appointments were cancelled and surgeries were delayed. There are countless examples of where family members, and extended family members, have to remain in mourning, which means that they are not able to do the work that they would ordinarily do.

[Shockat Adam (Leicester South) (Ind)]

I thank my hon. Friend for giving way and for his very powerful speech. Does he agree that any death is very stressful and distressing, but when it is a child, everything becomes amplified? A child’s post-mortem requires a specialist paediatric medical examiner, and a shortage of them in the east midlands, rather than in the west midlands, means that bodies are sometimes taken to other cities, and this is further stressing and distressful for the family. More paediatric medical examiners are required.

--- Later in debate ---

[Ayoub Khan]

I had not actually thought about the loss of a child, but, of course, that must be extremely distressing, especially if the family have to wait for a child’s body to be sent to another part of the country for examinations to take place. In raising this matter in the Chamber today, I hope the Minister will take on board the points that I have made and understand why we believe that there is a desperate need for modernisation, which deals with the issues felt by communities up and down this country.

Let me return to my personal experience. Patients were left waiting because the brain surgeon was unable to attend to them while he was still in mourning. This is what happens when we allow systemic inefficiencies to go unaddressed. They begin to erode the very services on which we all rely and impose hidden costs that cannot be measured, but are there none the less.

This brings us to the heart of the issue: what is causing these delays. There are several factors at play here. Among them is the state of our coroners service. Quite frankly, it is under-resourced, understaffed and overstretched. The people working in this sector are not to blame. They are doing incredible work under immense pressure, but the system is in desperate need of transformation. Let us look at the facts across England and Wales.

[Shockat Adam]

My hon. Friend is being very generous with his time. I would like to echo that fact: Leicester’s coroner services are doing an excellent job. One reason is that the community and any burial committee, especially in the Muslim Burial Council of Leicester, have created a real relationship, thereby overriding any misunderstandings and improving proficiency.

[Ayoub Khan]

Of course, it is important that all communities form a bond with their local coroner, but, ultimately, if the coroner and their staff are limited in numbers, there is always going to be a backlog and delay in processing the very important work of identifying the cause of death and then releasing the deceased.

Let us look at the facts. Across England and Wales, more than 6,000 coroner cases were pending for more than a year—four times higher than in 2017. Birmingham and the west midlands were among the worst affected. Our population is growing. Our communities are increasingly diverse, with more residents who require specific religious considerations, yet the infrastructure has not kept pace. The Government’s funding commitments have not matched rising everyday demand. We do not have enough pathologists and we do not have enough administrative support. We do not have the essential tools that could make a significant difference—tools such as MRI and CT scanning machines, which are used for the sole purpose of conducting non-invasive autopsies. However, we do have access to these facilities, but they are not dedicated to the coroner. It is by taking advantage of technological innovations such as those that we can make life easier for families whose faith prohibits invasive post-mortem procedures. With the right equipment, we can respect those beliefs and still get the data required by law.

Another major issue is the absence of weekend services. In most parts of the country, coroners offices operates Monday to Friday, but people do not stop dying on Fridays. Deaths occur every day. When services close for the weekend, a death that occurs on Friday night may not be processed until Monday or even Tuesday. For families who are religiously obligated to bury their loved ones immediately, the delay is deeply distressing. Introducing weekend operation for coroner and burial services is not a luxury but a necessity. In Birmingham we did have a coroner who would give up his time on weekends, but that has stopped.

To speak plainly about another area of concern, MPs are increasingly being told not to contact a coroner’s office on behalf of constituents. We are told that it constitutes interference. In fact, that is set out in the code of conduct for parliamentarians. I reject that completely. MPs are not asking coroners to change their findings or trying to influence investigations. We are not questioning their professionalism or their judgment. We are simply asking for speed, efficiency and compassion. To suggest that this is interference misunderstands both the role of an MP and the seriousness of the issue. We must be allowed to advocate for our constituents.