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Response to Mr Michael Clarke’s personal views ‘NHS sight tests include unevaluated screening examinations’

19 March 2014

College Statement

The Royal College of Ophthalmologists Issues a Response to Mr Michael Clarke’s personal views expressed in his paper titled ‘NHS sight tests include unevaluated screening examinations that lead to waste’.

In a personal view recently published on, a leading eye doctor says that opticians are making too many referrals to doctors.

Mr Michael Clarke, Consultant Ophthalmologist at Newcastle Eye Centre, says that apart from trauma and orthopaedics, ophthalmology receives more NHS outpatient referrals than any other speciality.

In response to the Mr Clarke’s expressed views, Professor Harminder Dua, President of the Royal College of Ophthalmologists has issued the following statement.


The views expressed by Mr Michael Clarke in his recent publication on are his personal views, as stated and may not be shared by all ophthalmologists.

Whilst recognising that Ophthalmologists are the only medically trained workforce with expertise in providing a holistic approach to the diagnosis and treatment, including by surgery where needed, of patients with eye diseases; the contribution that optometrists make in looking after the basic eye health needs of the population should not be underestimated. General practitioners also make a significant contribution within the limits of their competencies and access to eye examination equipment. There are a number of eye health related charities that provide valuable support to patients with eye diseases and visual impairment.

There is no denying the serious limitation of capacity within eye departments. We have the lowest ratio of ophthalmologists to population within mainstream Europe. An ageing population and newer treatments becoming available through advances in medicine and surgery and approved by NICE are putting immense pressure on existing capacity. One approach to deal with this problem has been the organisation of shared care programmes with optometrists, which are ophthalmologist led. There are several good examples of this across the country.

Given the large number of qualified optometrists, optometry and GP practices in the country with ‘walk-in’ access means they are the natural first port of call for many patients with eye ailments. They are encouraged to have a low threshold to refer to the hospital eye service with a view that the patients’ best interest is served.

Mr Clarke is right in that inappropriate referrals can cause undue expense, be stressful to patients and overload hospital eye clinics. The answer lies in continuing education, training and feedback to optometrists whilst providing an ophthalmologist led service. A joint endeavour to reduce the number of ‘unnecessary’ referrals and constructive utilisation of the optometrist workforce is the way forward. The quoted 30% figure of inappropriate referrals also equates to a 70% figure of appropriate referrals.

The College is concerned with the restricted practise in appointments to Local Eye Health Networks (LEHN), the governance structure of these bodies and the trend towards awarding eye healthcare contracts without the involvement of ophthalmologists. It must be recognised by all concerned that eye healthcare is not just about primary care.  LEHNs and commissioning groups should include ophthalmologists in planning eye care services.

In the current economic situation and mounting pressure to cut costs, only working together within the limits of our competencies, with mutual respect and trust can we find the right service models that our patients deserve. If we keep the patient’s best interest at the centre, then all else will fall in place.