According to figures from the National Treatment Purchase Fund (NTPF), at the end of July, 43,000 people were waiting for outpatient appointments, with almost 14,000 of these already waiting more than 18 months.

A further 9,100 people were on waiting lists for inpatient eye procedures compared to 7,700 at the end of 2019.

Commenting on the figures, the Association of Optometrists Ireland (AOI) said that eye care waiting lists are “out of control” and urgent reform of services is needed.

“In the south west, people can be waiting up to five years for cataract surgery. However, waiting times are shortest, at approximately one year, in the north west. This is because of the proven Sligo Post-Cataract Scheme.

“AOI is calling for the protocol to be sanctioned as policy nationwide by the Minister for Health and his department. This is the most immediate and readily deliverable action which can be taken to address waiting lists,” commented AOI president, Patricia Dunphy.

The Sligo scheme involves the hospital ophthalmology department and optometrists in the region working more closely together to reduce hospital appointments for cataract care.

Cataract surgery accounts for a significant number of waiting list cases, which is why reducing hospital attendances for cataracts has such a big impact.

“There is no reason or logic not to expand the scheme. In terms of cost, it is 50% less expensive to provide appointments in the local community at an optometrist than in hospitals. In the context of COVID-19, managing patients at their local optometrist reduces travel and public contact,” Ms Dunphy noted.

AOI has also called on the Government to work towards a new community-based National Children’s Eye Care Programme, which would be led by optometrists.

The HSE recently decided to run a pilot scheme for eye examinations and glasses prescriptions for 8-12 year-old children in Westmeath and Offaly. This move was welcomed by AOI, but it is concerned that this may lead to a ‘postal lottery’ for children’s eyecare.

“Local optometrists are engaging with the scheme and would support it being broadened and expanded, with the target of it developing into a national programme with protocols.

“Optometrists can meet many of children’s public eye care needs much more quickly than hospital eye departments. Directing appropriate children towards a community care pathway will help them to be seen quicker, and reduce hospital waiting lists and capacity problems,” Ms Dunphy said.

She added that treatment delays not only lead to poorer eye health outcomes, they “also impact on independent living and can lead to the need for carers, care homes, mental health services and unemployment benefits”.

According to the charity, restrictions introduced to suppress the spread of the virus have impacted those with vision loss disproportionately.

It carried out a survey of some of its service users recently and this revealed that 75% of blind and visually impaired people were unable to meet national recommended guidelines on physical activity during the COVID-19 pandemic, while 90% said their physical activity had been severely limited.

One in five had not left their homes since March, while 50% said that the pandemic had a serious detrimental impact on their mental health.

“For some blind and vision impaired people who live alone, the ability to get out and walk, run or cycle is just not possible because of the need for a guide or pilot. With the physical distancing requirements, physical activity is just not possible for many, and these findings suggest, it’s really taking its toll on our members,” commented the NCBI’s deputy chief services officer, Aaron Mullaniff.

He emphasised that regular physical activity is vital to reduce the severity of chronic conditions and to support mental health.

“Consequently, with well known links between exercise and mental health, it was not surprising that almost one in two respondents stated that COVID-19 physical and social restrictions had a serious negative impact on their mental health,” Mr Mullaniff noted.

In an attempt to tackle this issue, the Vision Sports Ireland team has investigated alternative ways of supporting socially-distant exercise.

Vision Sports Ireland is the body dedicated to the promotion of sports and leisure activities for those who are blind or vision impaired. It formally merged with the NCBI in March.

Supported by volunteer guides recruited from the Parkrun community, the collaboration is facilitating walking, jogging and running utilising a long cane or extended tether to maintain the required distance.

Traditionally the long cane has been used for navigation by people who are blind or vision impaired, however this solution sees the cane being held either end by the guide and participant, making it possible for the pair to effectively navigate and exercise in outdoor areas and parks while communicating around hazards.

This programme has been trialled across locations in Dublin and Kildare, with positive feedback received from all guides and participants.

“For some blind and vision impaired participants, this was the first time they had left their homes to exercise since the restrictions began in March, which is very alarming. It is vital people who are blind and vision impaired are given a way to return to their sport of choice, just like their sighted peers,” commented NCBI head of advocacy, Kevin Kelly.

For more information on how to get involved with this programme, email visionsports@ncbi.ie.

*Pictured is a guide safely navigating St Anne’s Park in Dublin with a participant using a long cane approach

According to the Association of Optometrists Ireland (AOI), all services, both urgent and non-urgent, will be available, including routine eye exams. However social distancing and safety measures will be followed at all appointments.

“From Monday, contact your optometrist if you have eye care needs, even if non-urgent. The recommended approach is to phone the optometrist in advance to discuss your needs and to then make an appointment based on this,” explained AOI president, Patricia Dunphy.

A number of adaptations have been made to comply with safety requirements. These include:

-Numbers will be managed in each premises at all times, to allow people to remain two metres apart

-Contact with equipment will be minimised and sterilised after use

-Where close examinations are required, personal protective equipment (PPE) will be used.

The AOI is meeting with the Minister for Health, Simon Harris, today to discuss the measures being taken and also to talk about what optometrists can do to help alleviate eye-care waiting lists and demand. Prior to the pandemic, eye care already had one of the largest healthcare waiting lists in the country.

The AOI also insisted that optometrists should be granted prescribing rights for antibiotic eye drops.

“There are a number of conditions where an optometrist completes an examination and makes a diagnosis, but must then refer the patient back to the GP for their prescription.

“This includes widely used topical antibiotics for conjunctivitis, blepharitis and removal of corneal foreign bodies. We are also now in the hay fever period of the year. Optometrists are already suitably qualified to fast-track this,” Ms Dunphy noted.

Meanwhile, the AOI also reassured people that it is safe to continue to use contact lens, as long as good hygiene is practised.

Anyone with any concerns about their eyes should contact their optometrist by phone first.

Sjögren’s syndrome causes a patient’s white blood cells to attack the body’s tear and salivary glands, causing severe dry eyes and dry mouth. The dry and irritated eyes can significantly impact a person’s vision, day-to-day activities and quality of life.

The disease is most common between the ages of 40 and 60 and women are nine times more likely to suffer from it than men. It is estimated to affect 3-4% percent of adults in Ireland.

An international team, led by scientists from the Royal College of Surgeons in Ireland (RCSI), compared samples from the eyes of patients with the disease to samples from patients who were not affected.

They found that those with Sjögren’s syndrome had abnormal levels of a certain molecule – microRNA-744 – that controls eye inflammation. This molecule works like a switch, turning the production of cells on and off.

The scientists found that high levels of this molecule caused uncontrolled amounts of inflammation from cells that destroy the glands and damage the surface of the eye.

They were able to reduce this molecule, which in turn reduced the levels of inflammation, in a laboratory setting.

“This is a first step toward a potential new treatment, although much more pre-clinical testing is needed before we can develop it into something that is ready for patients. However, our research provides the opportunity to possibly treat the root cause of the disease rather than just the symptoms,” explained Dr Joan Ní Gabhann-Dromgoole, a lecturer at the RCSI and the study’s co-author.

Meanwhile, the scientists also found different levels of other microRNAs in the cells of patients compared to the cells of people without the condtion. They believe this could be used to help diagnose patients with Sjögren’s syndrome, for which there is currently no test.

The study was carried out in collaboration with the Royal Victoria Eye and Ear Hospital in Dublin and the Cedars-Sinai Medical Centre in the US. The findings are published in the journal, Scientific Reports.

According to the Irish College of Ophthalmologists (ICO), while all elective and routine ophthalmology work has been postponed for now, “patients with emergencies are and will continue to be cared for”.

“These are very challenging times for our healthcare workers, patients and for the wider population as we navigate the COVID-19 pandemic in this country.

“While all elective and routine ophthalmology work has been postponed at this time, I wish to reassure patients that if you or any of your family members experience sudden vision loss or significant pain in your eye, it is important that you contact your eye doctor and seek medical advice,” commented ICO spokesperson and clinical lead for ophthalmology, Prof William Power.

He explained that measures are in place in ophthalmology departments in hospitals “to ensure that urgent ophthalmic patients can be seen”.

“A telephone triage is in place, with appointments available for patients who are concerned about sight loss or pain.

“Our primary concern is for the welfare and safety of patients and our healthcare staff during this pandemic and we will continue to provide advice, care and support in this regard,” he said.

For more information on the ICO, click here.

Currently, antibiotic eye drops can only be prescribed by GPs, however, they are overrun due to the COVID-19 crisis.

According to the Association of Optometrists Ireland (AOI), optometrists should be granted prescribing rights as they are “available and suitably qualified to assist”, and such a move would take some of the pressure off GPs.

In a letter to the HSE and the National Public Health Emergency Team (NPHET), the AOI insisted that optometrists “can do more to relieve pressure on both primary and secondary care for patients in the community”.

“There are a number of conditions where an optometrist completes an examination and makes a diagnosis, but must then refer the patient back to the GP for their prescription. This includes widely used topical antibiotics for conjunctivitis, blepharitis and removal of corneal foreign bodies. We are also now entering the hay fever period of the year.

“As part of emergency legislation to respond to the COVID-19 crisis, the AOI recommends that optometrists be granted prescribing rights for certain medications to treat an identified range of eye conditions. All optometrists already have the necessary training completed to provide this,” the letter stated.

It said that parallel to this, pharmacists should be able to claim remuneration for such prescriptions as normal under the Primary Care Reimbursement Service.

Meanwhile, the AOI reminded the public that optometrists are deemed an essential service, which can remain open during the current crisis. It advises anyone with eye care needs to phone their optometrist for information or advice on services, many of which remain available.

For example, people can call for contact lens supplies, which can be prepared for collection. Physical distancing is in place in all premises.

“In cases of emergencies, optometrists will be available to examine patients, while carefully following guidelines on sterilisation and the use of masks and gloves to prioritise patient safety,” the AOI added.

The Association of Optometrists Ireland (AOI) is asking members of the public to call ahead for advice and information, however it said that many of their needs can “continue to be met without unwanted contact”.

For example, if someone loses or breaks their glasses, their optometrist can prepare new glasses for collection while observing social distancing. Similarly people can call for contact lens supplies, which can be prepared for collection without close contact.

In circumstances where people have immediate eye care concerns, they should ring their optometrist for guidance.

In cases of emergencies, optometrists will be available to examine patients, while carefully following guidelines on sterilisation, and using masks and gloves to prioritise patient safety.

Patients who need eye drops or prescriptions should phone their GP.

“The message from AOI is that any patient with eye care needs or concerns should phone their optometrist to discuss and agree a safe way that their needs can be met,” commented AOI chief executive, Sean McCrave.

According to the figures from the National Treatment Purchase Fund (NTPF), over 17,000 of these people had already been waiting at least one year, while 12,000 had been waiting at least 18 months.

A further 7,700 people were also waiting for inpatient eye procedures.

Responding to the figures, the Association of Optometrists Ireland (AOI) insisted that Ireland has “an unsustainable over-reliance on providing public eye care in hospitals and HSE Clinics, which clearly do not have the capacity to meet demand”.

It insisted that optometrists should have a bigger role in providing public eye care.

“Major delays in diagnosis and treatment are compromising eye health throughout the country. In the south west, people can be waiting up to five years for cataract surgery.

“There are 700 community-based optometrists across Ireland who are trained, skilled and have the necessary equipment to make better public eye care available,” explained AOI chief executive, Sean McCrave.

The AOI is calling for public eye care services, which optometrists can provide, to be increased, including the national roll out of the Sligo Post-Cataract Scheme.

Cataract surgery accounts for a large amount of the capacity problems experienced by eye services. However, the Sligo scheme, which involves greater collaboration between Sligo Hospital and optometrists, has led to this region having the the shortest waiting time for cataract surgery.

The AOI also pointed out that it is 50% less expensive to provide appointments in the local community at an optometrist than in hospitals. The roll-out of such schemes could save the state up to €32 million, it noted.

“Loss of vision impacts greatly on independent living and can lead to the need for carers, care homes, mental health services and unemployment benefits.

“Delivering more public eye care in the community, including a greater role for optometrists, would greatly improve eye health in Ireland. It would bring Ireland into line with services in other European countries and put in place a sustainable model of care for the future,” Mr McCrave added.

Age-related macular degeneration (AMD) is a painless condition that affects a tiny part of the retina called the macula, which is located in the back of the eye. It affects central vision, making it blurry. Central vision is necessary for everyday activities such as reading, driving and watching television.

Over 7,000 people are newly diagnosed with AMD every year in Ireland. Once advanced, the condition can be treated, but not cured. 

German researchers set out to determine an accurate estimate of the likely demands placed on healthcare services by AMD throughout the EU up to the year 2050.

To do this, they pooled data from 26 studies, involving over 55,000 people, with an average age of between 60 and 81.

They found that the number of new cases is projected to rise by 75% up to 2050. In fact, by that year, an estimated one in four older adults in the EU will have AMD.

Based on these figures, the researchers estimate that 77 million people in the EU will have the condition by 2050, compared with 67 million in 2015.

The biggest increase will be seen in those aged 75 and older.

Meanwhile, the number of new cases of advanced AMD is also set to increase from 400,000 per year to 700,000 per year by 2050.

“This will require considerable additional healthcare service and resource allocation, which should be considered already today in all European healthcare systems,” the researchers from the University of Bonn warned.

Details of these findings are published in the British Journal of Ophthalmology.

Retina 2019 is a three-day gathering of researchers and clinicians from all over the world. As part of this event, a public engagement day will take place on November 16, which will allow members of the public to hear about the latest advances in this field.

The event, which has been organised by Fighting Blindness, will be of interest to anyone living with sight loss. As well as focusing on common conditions, such as glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy, it will also focus on rare conditions, such as retinitis pigmentosa.

The opening address will be made by actress and Fighting Blindness ambassador, Victoria Smurfit, whose daughter, Evie, has Startgardt disease, which is a rare genetic form of retinal degeneration that causes a progressive loss of sight.

“Retina 2019 is a pretty special opportunity for people with sight loss to be able to hear the latest developments on advances being made to improve and ultimately cure various types of sight loss.

“But perhaps equally special is the opportunity for some of the world’s leading researchers and clinicians who have come to Dublin, to be able to gain insights firsthand from people with rare conditions on the challenges they face,” explained Fighting Blindness CEO, Kevin Whelan.

The public engagement day will take place all day on November 16 at the Radisson Blu Hotel, Golden Lane, Dublin 8. For more information, or to register, click here.

An estimated 246,000 people in Ireland are blind or visually impaired. However, around three-quarters of all sight loss cases are preventable. Fighting Blindness offers the following tips to better safeguard your children’s eyesight:

-Spend time in the great outdoors. Research suggests that time spent playing outside contributes to a decrease in the risk of short-sightedness

-Don’t leave children to their own devices. Teach them to hold a smartphone or tablet at arm’s length from their eyes and encourage them to look away from the screen every few minutes

-You are what you eat. It is not just carrots that are good for children’s eyesight. Oranges, oily fish, peppers, eggs, dairy and nuts have some of the biggest health benefits for eyes. If your child has been diagnosed with a retinal disease, make sure to check with your doctor first about the diet most appropriate for them

-Sun’s up! It is vital that children wear sunglasses to protect their eyes from the sun. Children’s eyes are more vulnerable to sun damage due to their larger pupils and clearer lenses

-Put them to the test. Ensure that your child has their first eye test from a qualified optician by the age of three years, and every year after that until they are 16 years old

-Safety first. Physical activity and sport are important for children, but make sure they use safety eye wear that is appropriate for their sport to protect against eye injury

-Be on the lookout. If you notice an inward or outward turning in a child’s eyes, delays in tracking moving objects, squinting or holding material close to their face, speak to your GP or optician. Many conditions can be treated more effectively once picked up early.