Eye Health and Macular Disease

Maria Caulfield Excerpts

Tuesday 11th January 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Nokes. I want to start by thanking the hon. Member for Strangford (Jim Shannon) for securing this important debate. Before the Christmas recess, the last sitting in Westminster Hall was on surgical fires, and it is a pleasure, so soon after the recess, to be debating with him again.

The prevention, early detection, access to diagnosis and treatment of eye conditions is such an important issue, and we have heard from many Members, including my hon. Friend the Member for Darlington (Peter Gibson), who raised the impact on people’s day-to-day life, on simple steps such as trying to catch a train, and the impact of e-scooters and street pavement furniture. There was also a very moving speech from my hon. Friend the Member for Great Grimsby (Lia Nici). We cannot replace that insight and knowledge of how living with sight problems has an effect on every aspect of life and the simple improvements that can make a big difference.

There are many conditions that affect the eyes, as we have heard about today, and many of them share common risk factors, including some that are unavoidable, such as age and medical conditions such as diabetes, which the hon. Member for Strangford so eloquently described. However, we have not touched on some lifestyle factors that can impact on eye health—for example, obesity and smoking play their part. After age, smoking is the second-most consistent risk factor for age-related macular degeneration, with an increased risk of up to four times. Obesity is also a risk factor for age-related macular degeneration, but also for diabetic retinopathy, retinal vein occlusions and stroke-related vision loss. Morbid obesity is associated with higher eye pressure, which can increase someone’s risk of glaucoma.

When addressing eye health, it is important to tackle some of the low-hanging fruit of what can be preventable in affecting someone’s eye health. The UK is a world leader in tobacco control, and we remain committed to reducing the harm caused by tobacco. Later this year, we will produce a new tobacco plan that will set out how we will support people to give up smoking or to not start in the first place, because there are still 6 million people in England who smoke, which obviously has a knock-on effect on the possibility of eye problems further down the line.

We are also committed to a healthy living and weight loss management programme through our obesity strategy, building on the progress made on nutrition labelling. New rules on products that are high in fat, salt and sugar will come into force from October this year and, from January next year, we will introduce restrictions on the advertising of such products before the 9 pm watershed. We are also delivering a £100 million investment in promoting healthy lifestyles. In the years to come, all of those measures will have a knock-on effect on the number of people presenting with eye conditions.

That said, as we have heard today, there are many unavoidable causes of eye problems. Diabetes is one of the lead causes, and the diabetic retinopathy screening programme offers annual screening to millions of eligible people with diabetes. I place on record my thanks to all the staff of that screening programme who have carried on during the pandemic, because for the first time in 50 years, diabetic retinopathy is no longer the leading cause of certifiable blindness in adults of working age. That is a tremendous achievement.

There are other causes that can affect people of any age. For children, the healthy child programme sets out the schedule of child health reviews from pregnancy through the first five years of life. That includes examining the eyes of the newborn at six weeks and during the two-year review, as well as recommending that children should be screened for visual impairment between the ages of four and five. As we heard from the hon. Member for East Londonderry (Mr Campbell), we know that at all ages, regular sight testing can lead to early detection of eye conditions. My hon. Friend the Member for Great Grimsby spoke very well about the importance of the appointment with the optician. Combined with early treatment and prevention, we can prevent people from losing their sight, so today’s message of “Attend your eye tests” is very important indeed.

[Jim Shannon]

I thank the Minister for her very positive response. This is not just about a person’s visits to their opticians, but their appointments with their GP as well, especially if they are diabetic like me and attend their GP’s clinic twice a year. They should do a retinopathy test as well: the GP’s clinic can do all the things that can indicate whether that person’s sight is going backwards, staying level, or indeed improving. There are lots of things that people can do, and part of that is attending their GP appointments. Do not miss them: they are equally important.

[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.