Patients with complex eye conditions in the UK are at risk of losing their sight due to delays in treatment, as clinicians increasingly prioritise simpler and more lucrative procedures, experts have warned.
Dr Ben Burton, president of the Royal College of Ophthalmology, has cautioned that the system is on the brink of collapse, while Labour MP and former surgeon Dr Peter Prinsley has raised concerns that parts of the country could become “ophthalmic deserts” due to a lack of specialist care.
A crisis in eye care
The crisis is partly driven by the increasing fees paid to independent providers by the NHS for cataract removal. Dr Prinsley, MP for Bury St Edmunds and Stowmarket, explained that because cataract procedures are relatively quick, consultants can perform several in a single day, making them financially attractive.
This has led to a surge in NHS consultants taking on more private work, sometimes setting up clinics near hospitals that carry out NHS-funded procedures. As a result, fewer NHS appointments are available for patients with more complex eye conditions, such as glaucoma and macular degeneration, which require more specialised care.
Dr Burton warned that the situation is reaching a breaking point.
“We’re heading off a cliff, it’s not sustainable, and it’s not safe. Someone needs to step back and see the bigger picture.”
Rising cataract procedures, longer waits for others
According to figures from NHS England, the number of cataract procedures has risen sharply in recent years. In 2023-24, 676,000 cataract surgeries were performed, a significant increase from 451,000 in 2019-20 – an almost 50% rise.
However, patients with other serious eye conditions are facing lengthy delays. NHS England data shows that only 393,600 patients (66%) began ophthalmology treatment within 18 weeks. Currently, 589,508 patients are waiting to start treatment, with 9,481 (1.6%) waiting over a year.
Dr Burton criticised the growing trend of clinicians opting for simpler procedures, leaving complex cases to an already overstretched NHS workforce.
“These are the same consultants who were treating irreversible macular disease, screening babies for blindness, and managing glaucoma, a blinding irreversible condition. While they are not stopping NHS work completely, many are doing significantly less, which has serious consequences.”
He warned that ophthalmology could face the same challenges as NHS dentistry, where accessing treatment has become increasingly difficult.
The impact on patients
Patients with complex conditions are already suffering due to delays in treatment.
Bernice Evans, 82, from Cambridgeshire, has wet age-related macular degeneration and has had to wait 16 weeks for vital eye injections—twice the recommended waiting period.
“It does make you worry, particularly when I can’t see the stuff I am used to being able to see. You almost go back to the start again when you’ve not had an injection,” she said.
Robert Cooper, director of strategic engagement at the Royal National Institute of Blind People (RNIB), warned that the expansion of independent cataract services was destabilising NHS eye care.
“Some patients are experiencing deteriorating vision because of delays in receiving the treatment they really need,” he said.
Ed Holloway, chief executive of the Macular Society, added that NHS eye care services are underfunded and struggling to meet the needs of an ageing population.
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“In many areas, the situation has reached a crisis point – and it is only getting worse. Urgent action is needed now to prevent avoidable sight loss and ensure people receive the care they deserve.”
Calls for urgent reform
The financial incentives behind cataract procedures have played a significant role in the crisis. The tariff paid by the NHS for cataract surgery has risen sharply in recent years. From 2019 to 2022, the fee for the most complex cataract procedures increased from £861 to £1,216. However, last year, the NHS cut fees for the two most complex procedures by 12%, bringing the tariff down to £993. Meanwhile, the fee for the simplest cataract procedures has risen from £739 to £837.
Dr Prinsley argued that reforming the NHS payment system for ophthalmology procedures could help prevent further decline.
“What needs to happen is that the tariff needs to change. It’s a simple thing to fix. But we haven’t got long to deal with this. If we allow the status quo to persist, NHS ophthalmology services will collapse, and we will be left with an ‘ophthalmic desert’.”
The NHS response
An NHS spokesperson acknowledged the challenges but emphasised that efforts are being made to address the issue.
“While the NHS has increased the number of cataract operations and brought down backlogs following the pandemic, we know some patients with complex conditions are waiting too long for care.
“The NHS is working with local commissioners and providers to assess the impact of the rapid growth of the independent sector and ensure the sustainability of services for all eyecare conditions.”
Despite these reassurances, experts and campaigners continue to call for urgent intervention to prevent thousands of patients from losing their sight due to avoidable delays.
