Glaucoma Care Needs Independent Optometrists — But Only If Funding Catches Up

The College of Optometrists has set out a strong case for optometry-led glaucoma referral filtering services and shared care pathways, describing them as safe, effective and acceptable to patients, with outcomes comparable to hospital care for appropriate cohorts. The evidence base suggests these models offer long-term system benefits by releasing hospital capacity, reducing delays, improving patient flow and improving outcomes for higher-risk patients.

That makes glaucoma a clear example of where independent optometrists can play a bigger role in delivering care in the right place, at the right time. These pathways ensure patients are seen in the most appropriate setting, make better use of workforce skills and support long-term sustainability at a time when demand on eye care services continues to rise.

For independent optometrists, that creates a real opportunity. Community-based glaucoma referral filtering and shared care can help deliver more local, accessible care while supporting hospitals to focus on patients with the greatest clinical need. In practical terms, it is a model that strengthens the role of primary eye care rather than treating it as a backup to secondary care.

The patient experience is another important part of the picture. The College notes that satisfaction with both glaucoma referral filtering and shared care pathways is consistently high, with patients valuing shorter waiting times, less travel, greater convenience and better communication. There are also wider benefits, including lower carbon emissions from reduced travel, which fit with broader environmental sustainability goals.

As the College puts it, “The evidence is clear that maintaining hospital-only glaucoma pathways is not viable.” It says rising demand, limited hospital capacity and unwarranted variation are creating increasing risks for both patients and the wider system. In its view, optometry-led glaucoma referral filtering services and shared, community-based pathways for low-risk patients offer a proven, scalable solution that aligns with priorities around integrated care, outpatient recovery, prevention, early diagnosis, population health management and the optimal use of resources.

That is a powerful argument, but it also raises an important concern: funding. If independent optometrists are expected to take on more glaucoma care, the service model must be properly commissioned and sustainably paid for. The challenge is similar to what has long surrounded eye test funding — the policy case may be strong. Still, without adequate financial support, implementation becomes inconsistent, and practices are left carrying more responsibility without the resources to match.

In that sense, glaucoma care may be heading toward the same crossroads as other parts of primary eye care. The opportunity is clear, the clinical case is strong, and the benefits to patients and the wider system are compelling. But if commissioners want independent optometrists to help deliver this shift, funding has to follow the ambition.

Reference: The College of Optometrists, Safety and effectiveness of glaucoma services:
https://www.college-optometrists.org/category-landing-pages/clinical-topics/glaucoma/safety-and-effectiveness-of-glaucoma-services