The provision of eye care in Wales is innovative and progressive, utilising the full clinical skills and competencies of optometrists. This was underpinned by legislative changes to introduce Wales General Ophthalmic Services (WGOS) in 2023, resulting in more than 90,000 additional optometry appointments in 2024-25 compared with the previous year.2
112,000 people in Wales are living with sight loss (3.5% of the population). This is predicted to increase to 133,000 by 2032, and double by 2050.1
There are over 1,200 highly trained optometrists3 in Wales delivering more than 865,000 NHS sight tests each year4. They check vision and eye health, and can also diagnose, monitor, and treat eye conditions like cataracts and glaucoma. Many optometrists have additional higher qualifications, including the ability to prescribe medications, and can manage patients with more complex eye care needs, avoiding the need to send patients to already over-stretched hospitals.
By building on this strong foundation and continuing to prioritise primary and community eye care, the next Welsh government can further advance optometry services, making sure everyone can get the specialised care they need quicker and deliver better outcomes for patients.
Digital infrastructure and connectivity in eye care are currently lagging behind other NHS primary care providers in Wales. There is an urgent need to invest to enable the safe two-way communication between primary and secondary care, including both an electronic patient record and electronic referral system. Better shared care between ophthalmologists and optometrists in hospitals and the community will ensure optometry is fit for the future, and enable patients to access high-quality, timely and safe eye care.
We are calling for:
fully digital two-way communication between optometry practices and health boards, including the abolition of paper-based claim forms for WGOS services
optometrist access to digital, shared electronic patient records, and full roll-out of an electronic referral system, with feedback from hospitals to referring optometrists
progress on the development of an electronic prescribing system for optometry, linking with the Electronic Prescription service currently being rolled out between GP practices and community pharmacies
investment in the standardisation of digital imaging and file sharing, including supporting the adoption of international imaging standards and the procurement of appropriate technologies to enable image and file sharing
The case for change
To ensure patients receive timely and coordinated care, it is essential for community optometrists - especially those prescribing and delivering glaucoma, medical retina and urgent eye care services - to be able to access shared electronic patient records and make seamless digital referrals. These systems must also enable feedback following patient referrals, such as what treatment their patients have received.
Digital images shared between primary and secondary eye care are not always readable on different machines, so patients often have images repeated at the hospital after referral. This can lead to delays that cause avoidable sight loss. Standardisation of digital imaging via adoption of existing international specifications would resolve this, and we hope the future Welsh government will support The College of Optometrists and partners’ work in this area.
Benefits for patients and the health service:
✔ speed up referrals, diagnoses and treatment
✔ reduce the risk of avoidable sight loss due to delays
✔ improve multidisciplinary working, learning and service expansion
✔ reduce admin burden and free up optometrist time for clinical work
✔ deliver greener services
✔ improve data collection for decision-making and research
We are calling on all political parties and health policymakers to make full use of the highly skilled Welsh optometry workforce. Optometrists must be seen by the public as the first port of call for eye care in Wales. We are calling for the next Welsh government to deliver the promised target of creating 30,000 additional primary eye care appointments a year for patients who historically would have been seen in hospital.5 Investment and progress in digital communication is key to enabling this.
The case for change
People are suffering preventable sight loss due to delays in accessing the hospital eye service, and demand for eye care is rising. Ophthalmology is the busiest outpatient speciality in Wales, with more than 1 in 20 people waiting for an ophthalmology appointment, and accounting for 1 in every 8 patients (over 80,000 people) on the NHS Wales waiting list. Demand is projected to rise by 40% over the next 20 years, driven by an ageing population and chronic conditions such as diabetes and glaucoma.6
Wales has 1.97 ophthalmologists per 100,000 population, below The Royal College of Ophthalmologists’ minimum recommended ratio of 3 to 100,000 to deliver effective hospital eye services.7 Many sites, particularly in rural areas and west Wales, face significant recruitment and retention issues.
The new WGOS optometry pathways are intended to reduce pressure on hospital ophthalmology and GPs by enabling the management and monitoring of low-risk patients within community eye care. Advanced community-based services include the provision of low-vision aids, medical retina and glaucoma monitoring by highly qualified optometrists, and primary care “eye casualty” services for urgent cases. The new Welsh government must commit to maintaining and growing these services for the benefit of patients across Wales.
Benefits for patients and the health service:
✔ faster access to eye care, closer to home
✔ reduced preventable and irreversible sight loss by earlier detection and management of conditions
3. Invest in a sustainable, skilled optometry workforce
3. Invest in a sustainable, skilled optometry workforce
Our call to action
Wales faces an increasing demand for eye care, but there’s no national plan to ensure enough optometrists are trained, retained and supported - particularly in rural and underserved communities. A lack of a national primary eye care workforce strategy impacts recruitment, upskilling and equitable service delivery to meet rising demand.
We are calling for:
a national workforce strategy for optometry to ensure patients have access to highly trained optometrists across Wales - especially in rural and deprived areas - and to prioritise upskilling to provide advanced community services
adequate funding for Welsh universities to support optometry students undertaking undergraduate and postgraduate clinical learning both on and off campus
continued funding and resources for both primary and secondary eye care settings to offer clinical training and experiences for pre-registration and postgraduate prescribing and specialist qualifications
continued additional investment in optometric higher qualifications, independent prescribing and training to support service improvement, leadership and educating others.
The case for change
It is vital that investment in education and training is adequate to ensure Wales has the optometrists it needs, now and in the future. This includes ensuring optometry remains an attractive profession for young people in Wales. A strong and skilled workforce means patients get timely, high-quality care wherever they live.
Recent successes such as Advanced Training Practices (ATP)8 should be invested in and developed. These are community-based optometry practices established as a hub of excellence for postgraduate optometrists to undertake independent prescribing clinical placements. In 2025 Health Education and Improvement Wales (HEIW) set up 22 ATPs and facilitated 389 independent prescribing clinical placement sessions. In addition, over the past three years more than 250 optometrists have benefited from sponsored opportunities in advanced qualifications such as Low Vision, Glaucoma and Medical Retina. Three Teach and Treat Eye Care Centres in North, West and South Wales have been essential for delivering higher qualifications. The next government must continue to invest in and expand these vital opportunities for optometrists to develop their skills and support their patients.
Benefits for patients and the health service:
✔ reduced pressure on the hospital eye service
✔ sustainable delivery of high-quality eye care in the community, meeting the needs of an ageing population and growing rates of eye disease
✔ reduced postcode lottery of access to advanced community eye care
Everyone in Wales should be able to access the eye care they need, regardless of their location and socioeconomic circumstances. Optometrists working in the community are in an ideal position to deliver public health messages on health and lifestyle, in addition to their crucial core role in eye health. They can identify conditions such as diabetes and hypertension and, due to their location on high streets, they have high patient coverage.
We are calling for:
more public health interventions and a public education campaign to encourage people to attend for regular eye examinations, specifically targeted at more deprived communities
enhanced investment in the Making Every Contact Count (MECC) approach in Wales, including funding, support and training for optometrists9
The case for change
It is vital for the public to understand the importance of regular eye examinations, which are crucial in detecting the early signs of eye disease and preventing sight loss. Regular eye examinations also provide the opportunity for optometrists to identify many wider health conditions such as high blood pressure, high cholesterol and diabetes, which may not otherwise be picked up, especially by those not in regular contact with other health professionals.
47% of patients surveyed in Wales said they would seek treatment at their GP, pharmacy, A&E, or not at all if they had an eye problem10 rather than an optometrist
Studies show that there is a link between low income and sight loss. 48% of people with sight loss say that they live in a household with a total income of less than £300 a week, compared to 19% of people with no sight loss. People with low vision are also more likely to live in more deprived areas.11
Benefits for patients and the health service:
✔ patients get the right care, in the right place, at the right time
✔ reduced pressure on GPs and A&E
✔ identify wider health conditions early that may not otherwise have been picked up
In 2024-2025 optometrists delivered12:
865,000
over 865,000 NHS-funded sight tests
280,000
more than 280,000 urgent examinations
26,000
more than 26,000 independent prescribing appointments
1.4 million
In excess of 1.4 million paper forms were handled by NHS Wales eye care service in 2023/24.13
1 in 20
1 in 20 people in Wales are currently waiting for an ophthalmology appointment and demand is projected to rise by 40% over the next 20 years.14
