Managing ocular pathology in the community & ensuring competency (minor eye conditions, glaucoma, independent prescribing)
Authors: Evans Josephine 
Published: January 2025

In the United Kingdom there is a plethora of enhanced schemes that are funded by the National Health Service (NHS), where specially trained optometrists manage ocular pathology in the community. These will be summarised, including the need to ensure competency and quality.

Minor Eye Conditions Services (MECS) provide a symptom‐led appointment to investigate conditions such as red eye, ocular discomfort/pain, blurred vision, and flashes or floaters. Patients may be self‐referred or referred from general medical practitioners, pharmacists, NHS nationwide helpline, or other optometrists. In some geographical areas, patients with these symptoms cannot access hospital eye casualty unless they have first been examined under MECS. MECS optometrists need to undergo accreditation, which includes distance‐learning and practical skills.

If there is suspicion of glaucoma following a routine eye examination, repeat or further investigations by community optometrists are commonly funded by the NHS to reduce the number of false positive referrals into secondary care. This is often a prerequisite to a hospital appointment. Less commonly, glaucoma management is being shared with community optometrists in stable or low risk clinical cases. These optometrists are required to have additional, specialised accreditation.

Cataract community‐based pre‐operative assessments, which include a discussion about the risks and benefits of surgery for the individual patient, are funded by the NHS in some areas of the UK to reduce false positive referrals. Cataract post‐operative care is increasingly provided in the community for uncomplicated cases to relieve hospital capacity.

Optometrists in the UK can undertake an independent prescribing qualification, enabling them to prescribe any licensed medicine for conditions affecting the eye and surrounding tissues. The qualification typically takes one to two years and involves theoretical and practical study and examinations, in addition to supervised clinical experience. Depending on geographical location, optometrists may be able to provide NHS‐funded prescriptions under a local scheme.

In addition to the advantages of releasing hospital capacity and decreasing the number of false positive referrals, these schemes provide convenient, local, and timely care to patients, often with evening and weekend appointment availability.

These schemes are, unfortunately, not funded nationally across England, resulting in considerable variation in the availability and characteristics of schemes. Furthermore, accreditation requirements differ depending on geographical location. Limited NHS IT infrastructure creates another disadvantage, resulting in a lack of communication between primary and secondary care, especially with referral feedback, and even between optometrists providing basic and enhanced services.

Community optometry enhanced services were necessitated in the UK by the modest numbers of ophthalmologists per capita and ageing population with increasing ocular pathology. The use of these schemes increased during and after the COVID pandemic. There have been major benefits in accessibility to eye care services and in increasing the capacity of hospital clinicians for managing the more serious or complex cases that cannot be managed in the community.