“Am I going to go blind?”
It’s a question optometrists hear all too often. Tragically, in many cases, despite our best efforts, the answer is yes. Few things are more disheartening in our profession, especially when that blindness could have been prevented.
Glaucoma is a progressive eye disease that damages the optic nerve, often due to increased intraocular pressure. The optic nerve contains over a million tiny fibres, each carrying vital information from the eye to the brain. As a nerve gets damaged, a permanent light is switched off in our visual field. In most cases, this damage is gradual and painless. By the time a person begins to experience symptoms, which can range from the embarrassment of constantly knocking over the salt and pepper and condiments on the dinner table to the life-changing consequences of knocking a pedestrian over while driving the disease has advanced beyond repair, it’s often like smelling smoke long after the fire has destroyed the house.
Glaucoma cannot be cured, but it can be controlled with early detection and consistent treatment, typically in the form of daily eye drops or minimally invasive surgery (MIGS). Early action preserves vision and independence.
Yet despite this, glaucoma is the leading cause of preventable blindness in the UK. Over 700,000 people are living with the condition, and more than half remain undiagnosed. That’s 350,000 people unknowingly at risk—walking, working, and driving among us. With vision loss comes a steep personal and societal toll: loss of mobility, increased falls, depression, loneliness, and long-term care needs.
The cost of inaction is immense. The total economic burden of visual impairment in the UK is now £26.5 billion, projected to rise to £33.5 billion by 2032. Glaucoma alone accounts for £750 million annually, with most of this cost borne outside the NHS—in lost productivity, informal care, and reduced quality of life.
We are at a turning point. With an ageing population, glaucoma cases are set to rise by 22% in the next decade and by 44% in 20 years. This looming crisis demands bold, strategic action, and we need it now.
1. From Prevention to Early Detection
The government rightly champions “prevention before cure.” Glaucoma is the perfect candidate for this principle in action. Let’s introduce routine sight tests at milestone birthdays (e.g., 40, 50, 60) as part of Well Man/Woman Health Checks via GP referral. Make eye tests mandatory for drivers. The UK is the only European country that offers lifelong licences without regular visual assessments before age 70. Launch a national awareness campaign to educate the public on the risk of glaucoma and the importance of regular eye exams. This is a particular emergency for the Afro-Caribbean and Asian communities, who are four times more likely to develop the condition.
2. From Hospital to Community Care
Ophthalmology is already the largest outpatient speciality in the NHS, with 8.9 million appointments in 2023–24. Our hospital services are under immense pressure, and optometrists are ready to help. There are over 14,000 qualified optometrists in England, delivering more than 13 million NHS-funded eye exams each year. Community-based glaucoma care, led by optometrists, has proven to reduce hospital referrals by up to 79%. National rollout could save 300,000 appointments annually. This is not about new infrastructure, it’s about using the skilled workforce we already have.
3. From Analogue to Digital
The lack of digital connectivity in eye care is a barrier to safety and efficiency. To move forward we must grant NHS email access to all primary eye care providers. Enable shared electronic records between optometrists, GPs, and hospital ophthalmologists and implement two-way electronic referral systems with real-time updates.
Basic digital integration would revolutionise the continuity of glaucoma care, reduce delays, and prevent irreversible harm.
We Can Keep the Light On
I recently saw a patient who had been diagnosed with glaucoma after referral. But the follow-up appointment was postponed, then missed. By the time they returned a year later, they had lost two full lines on the visual acuity chart.
That’s the difference between reading your letters and not between seeing your grandchild’s smile and only hearing it.
Glaucoma is a silent thief, but it doesn’t have to succeed.
Together, we can protect the sight and the independence of hundreds of thousands of people across the UK. We already know what works. We already have the workforce. We already have the technology. The government can remove the postcode lottery and establish a statutory national framework for Glaucoma in eye care, utilising the expertise of optometrists and ophthalmologists. We can send out the alarm on this silent thief and save the precious gift of sight.
The Silent Thief: Tackling the Glaucoma Crisis
