Glaucoma and Community Optometry

Gregory Campbell Excerpts

Tuesday 30th April 2024 Westminster Hall

[Jim Shannon]

Thank you for bringing me and us all back to focus, Dame Caroline. The reason why I said that is that the Minister has been to Northern Ireland and always has an interest in health issues, and I know that his journey was to Queen’s University to explore such issues. That is the connection. The fact it is a lovely place is just wonderful, but that is not the reason why we are here.

The approach to making the system more fit for purpose must be UK-wide. Whenever we ask for what we are going to ask for at the end of this debate, I know that the Minister and the shadow Minister will have similar ideas to mine. I understand that health is devolved in all the regions, but it is clear that we need joined-up thinking to a joint problem. That is what I wish to highlight this morning.

Visual impairment and sight loss cost the UK economy some £36 billion each year, yet we allow 22 people to lose their vision to preventable causes each week. That is the thrust behind what I am aiming for today: to stop 22 people losing their eyesight this week. We can work alongside the optometrists and the opticians, and have a partnership whereby people can have their eyesight tests done more often. I will give some examples. Maybe people do not think of having their eyesight tested regularly, but they should. Optometrists in my area have told me that they are happy to work with the NHS or the health and personal social services in Northern Ireland to make that happen.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate my hon. Friend on securing the debate. On the frequency of eye testing, does he agree that the issues we are discussing today are symptomatic of other parts of the health service? People ignore eye problems and get to the point where problems could have been solved had there been earlier detection and more frequent eye testing. Even if nothing else transpires from this debate, if we do a little to try to ensure that people have regular eye tests, we can prevent some of the problems we are discussing from getting worse.

[Jim Shannon]

I thank my hon. Friend for his intervention, and say to the Minister: that is the thrust of this debate. If nothing else comes from this debate but the answer was along those lines, I would be more than happy. That does not mean that I will sit down now, Dame Caroline— I want to give a wee bit more background and a couple of examples.

Visual impairment and sight loss cost the UK economy £36 billion. The loss of sight is the loss of independence and confidence, and for many it is the loss of their life as they know it. If it can be prevented, it must be, so it is about prevention, early diagnosis and checks. This morning my focus—excuse the pun—will mainly be on glaucoma, a group of eye diseases that damage the optic nerve, usually due to changes in pressure inside the eye, or ocular hypertension. Data from Specsavers revealed that there have been some 30,000 referrals for glaucoma in people aged 40 to 60 just in the last year. Many more have been missed, accounting for nearly a third—30%—of all glaucoma referrals.

Some years ago I spoke at an event in Cambridge. I was asked to come along as a health spokesperson to an eyesight and visual impairment event that took place at a university in Cambridge—not the University of Cambridge but one of the other ones. They were doing tests and I got my eyes tested for glaucoma. It was rudimentary, but the guy said, “I don’t want to worry you, but I think you need to go and have your eyes tested when you get home.” Whenever I got home I went to my optician right away. I could not understand it, because I had seen the optician a month before and was sure that my eyesight was okay, but the Cambridge guy had given me a wee graph that seemed to show that there were issues relating to glaucoma that needed to be addressed fairly quickly. Why is that important? Because my father had glaucoma, and they say it needs to be checked because it is hereditary and passes from generation to generation.

When I got home I went to see my optician right away and told her what was going on. I explained the circumstances and took her the graph. She said, “Look, Jim, I checked your eyes. I do not see anything wrong with them, but do you want them checked thoroughly?” I said, “Yes, definitely.” So she sent me to the eye clinic in Belfast’s cathedral quarter and I got my eyes checked. Everything is done there, 24/7—all the eye checks that are humanly possible. For ages after, my eyes were stinging. The guy came out after an hour and said to me, “I have done every possible check on your eyes. There is nothing wrong with them.” That was good news after a very thorough check. Since then, my optician has done a thorough check for glaucoma on my eyes, simply because it is hereditary and to ensure my peace of mind. I tell that story because it worked out well for me, but it does not work out well for everyone.

Typically, there are no symptoms to begin with, as glaucoma develops slowly, affecting the periphery of the vision at first. That means that hundreds of thousands of people in the UK currently have glaucoma. Betty in my office gets an annual eye test because her father had glaucoma and she was aware of the issue. When I asked my younger staff when they had last had their eyes tested they said, “Not since school. I don’t need glasses so why should I get an eye test?” I immediately asked them to book a test, and told them that it is like an MOT that needs to take place. The MOT tells us if our car runs okay and what repairs we need; it is the same when we get our eyes tested. The eyes may be known as the window to the soul, but they are also undoubtedly the window to the view of overall health that can be found in an eye test. Eye tests are imperative for finding an early diagnosis of diabetes, for example, and a host of other health concerns.

I remember two occasions when opticians saved the lives of gentlemen who came to see me in my office. One guy I know well came in and he was a terrible colour. I said, “Are you okay?” and he said, “To tell you the truth, I don’t feel at all well. I have been to the doctor who told me to see an optician, and I’m going there now.” I said, “I hope you’re okay.” He was as grey as a badger and it was really quite worrying to see him. He went straight from the optician, who referred him, just up the road to the Ulster Hospital. He had a tumour close to his eye and brain, which was removed in an urgent operation. The other person, who went to a different optician in Newtownards, had the same problem, was also referred to the hospital and also had a tumour removed.

Tests at the optician’s are incredibly important. They can diagnose not only glaucoma but many other things, so it is important to have them. 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 to manage their condition.

Alarmingly, a fifth of the population—some 21%—still do not know how often they should visit the optician for a routine check-up. The same percentage either cannot remember their last eye examination or have never had one. Opticians in my Strangford constituency, and particularly in Newtownards town, have told me they are anxious and keen to ensure that people have regular tests. It is about how to ensure that can happen. I hope the Minister will respond to requests, including from the shadow Minister, and is able to reassure us on how we can encourage a UK-wide method to help.

For those with glaucoma or suspected glaucoma who are referred to hospital, long NHS waiting lists, exacerbated by the pandemic, remain a problem. Alarming figures show that around 650,000 people are waiting for NHS ophthalmology appointments. Will the Minister indicate the steps that can be taken to reduce that number and help those 650,000 people to retain their eyesight? There are steps that we can and must take. I always try to be constructive; it is important to come with a positive attitude on how to do things better. We should be big enough to accept that changes need to be made, and then we can do it.

Although optometry services remained open for urgent care during the covid-19 pandemic, the number of sight tests dropped by 4.3 million in 2020—my goodness—which was a 23% decline compared with tests administered in 2019. In respect of that dramatic drop and the need for improvement, perhaps the Minister could suggest methodologies to address and target those who have fallen out of the system. The drop in the number of eye tests resulted in large reductions in referrals from primary care to hospitals. That is where the fall seems to be, and perhaps where it needs to be addressed. As a result, sight loss has increased hugely since the pandemic.

How can we increase referrals from primary care to hospitals? If we do that, we will have moved a long way. I will give some examples from Northern Ireland—not about how nice it is to visit, Dame Caroline, but about the issues of vision and health. In Northern Ireland there are two glaucoma referral and refinement pathways. By contrast to England, they are available at all community practices, as long as clinicians have the right accreditation in glaucoma care. It is fortunate that my GP service and many others have such access. Through the services, patients have their glaucoma tests completed in the community, and the results are then shared securely with the patient’s ophthalmologist. This joined-up approach helps to streamline the experience for the patient and ensures that optometry practices and ophthalmologists work together for the benefit of the patient. I always try to be constructive in my comments and give examples of what we do, because if we do something well, others need to know, and if the Minister does something well here on the mainland, we need to know about that in Northern Ireland as well.

There is also an ocular hypertension monitoring service in the community across Northern Ireland. The scheme allows optometrists to manage in the community patients who would previously have been seen by the hospital eye services. A significant number of patients—some 2,000 to date—have been discharged to the scheme. That is an example of how it is proactively engaging and working. It has helped to free up the capacity in secondary care to manage more complex cases.

Those successful services show that community optometry, alongside other primary care providers, is responsible for delivering the shift from secondary to community care and is able to do so at almost no cost to the taxpayer, given that it uses existing capacity. What we have is an example of how things can be done—and perhaps spread across all of this great United Kingdom—in a better way. Those working alongside optometrists, who wish to ensure that people have their tests regularly, are keen to assist and to make changes. When the Minister speaks to the Association of Optometrists—as he probably already has—I believe he will find that he is pushing at an open door and that the ideas that he and the Department have are ones that optometrists have too.

Overall, Northern Ireland has shown how a model focusing on glaucoma care in the community can be effective. The challenge in Northern Ireland is that these services sit outside the general ophthalmic services—GOS—contract, which means that they rely on non-recurrent funding and are not subject to a regular uplift in fees; indeed, fees have never been reviewed. Given the success of these services, the push in Northern Ireland is for their funding to be put on a more stable, recurring footing and to be subject to the same process for fee uplifts as GOS. I have another ask to put to the Minister, in a constructive fashion: will he see whether the fees in place can be reviewed and how best the system could be used to improve things?

I know that the shadow Minister will make an incredible speech. By the way, I am not giving him a big head; that is what he always does, because he understands these issues incredibly well and brings forward his own ideas and his party’s ideas to this process.

I want briefly to highlight the difficulties arising with cataract surgery. It is wonderful how cataract surgery can improve people’s eyesight. I am a type 2 diabetic, but some years ago, before I was a diabetic, I went to see about surgery, not for cataracts, but to improve short-sightedness. I did not have the surgery, because I was not entirely confident about it, and shortly after, I became a diabetic. I tell that story because a good friend of mine in Greyabbey—I will not mention his name—was a type 1 diabetic and went for some corrective surgery to his eyes. Unfortunately, he ended up losing his eyesight; that is not the fault of anyone, but the diabetes complicated the issue, and he is now registered blind. Again, there are complications in relation to eye surgery for those who are diabetic, just by the nature of what happens.

Cataract surgery is currently the most common NHS elective surgical procedure, accounting for the majority of the large ophthalmic backlog facing the NHS. My mother has had one of her cataracts removed; she has a second one to remove, but I suspect that, unfortunately, her state of health means that the second procedure will not be done. Between 10% and 15% of those with cataracts suffer from concomitant glaucoma, and I am bringing the issue into the debate because cataracts are often treated separately. I suggest that we consider how we could do the two together—the glaucoma and the cataract surgery.

I have been informed by a company named Clarity that there is an opportunity to treat patients for cataracts and glaucoma at the same time. It is obviously more cost-effective, and although I know we should not always dwell on the cost, we cannot ignore it. If there is a way of doing simpler, easier and cheaper surgery more effectively, let us look at that. I am ever mindful that the Minister has four competent members of staff behind him, who will clearly keep him right, so might they be able to do some research on that?

Treating cataracts and glaucoma together expedites patient backlog reduction and helps save people’s sight by preventing the further progression of glaucoma. The treatment is quite innovative, new and effective, and it is important that we should do it. Micro-scale injectable therapies produced by Glaukos can advance existing glaucoma standards of care and improve patient safety by removing the need for invasive secondary surgery and tackling ophthalmic backlogs. So many people wait for their cataract operations and for improvements to their glaucoma. If we catch things early, we can save the sight, and that is a critical factor. Again, can the Minister look at that and ascertain whether the approach I have just referred to could be a cost-effective way forward? I am sure he knows about it, but if he—and indeed the shadow Minister and others—does not, I would be happy to have a response later. The treatment seems to me to be a win-win, so will the Minister confirm whether the Government will initiate it urgently?

Local optometrist services form a vital part of the eye care patient pathway and of directing patients to vital sight-saving medical technologies. It is incredible to live in an age when 50% of all cancer patients can survive and people’s eyesight can be saved if it is checked and their problems with glaucoma are diagnosed. Are we not fortunate to live in this age? Although I am not the oldest person in the room—I suspect that my colleague on the left-hand side, my hon. Friend the Member for East Londonderry (Mr Campbell), might just be a tad ahead of me by a couple of years—I have seen the great advances we have made in medical technology. We are doing great things, and we could do more. Is it not incredible that all we really need is to check? It is not terribly costly, but if we check, we make the difference.

Optometrists are the ones who are properly trained in the pathway. We must ensure that pathways are clear and that funding is available to ensure that, instead of 22 people a week losing their sight in the United Kingdom of Great Britain and Northern Ireland, no one at all loses their sight and their independent life—something that could have been prevented. I know that the Minister shares my goal and that the shadow Minister definitely shares it, as does my hon. Friend the Member for East Londonderry. As a result of today’s debate, I hope we will have a progressive strategy going forward, and I am anxious to hear what the Minister and the shadow Minister have to say, so that we can feel that they understand the path towards achieving this goal and will focus on and direct it.