Research
Welcome to our Research page. Here, you’ll find a collection of articles, papers and reports that highlight our dedication to improving eye care throughout England.
From Hospital to Community: Multi‑Locality Eye Care Service Evaluations in England
Community-based glaucoma and cataract pathways delivered through primary care optometry support national NHS objectives to reduce hospital demand and shift care closer to home. Services including glaucoma referral filtering, community glaucoma monitoring, and integrated cataract pathways are provided by accredited optometrists working to defined clinical pathways and management plans. While individual services have previously been evaluated in isolation, this poster brings together a multi-locality evaluation of glaucoma and cataract services delivered through Primary Eyecare Services across England. Using routinely collected clinical and hospital data, it demonstrates effective referral filtering, high cataract conversion rates, and the safe retention of appropriate patients in community care, alongside reductions in patient travel and associated carbon emissions.
Bhan, A., Mackley, T., Craven, W., Gibson, L., & Hughes, A. (2026). From hospital to community: Multi‑locality eye care service evaluations in England [Poster presentation]. Association for Research in Vision and Ophthalmology Annual Meeting, Denver, United States.
A patient-centered evaluation of Glaucoma Monitoring Services in Primary Care Optometry
Community Glaucoma Services enable the monitoring of patients with glaucoma and related diagnoses in primary care optical practices, offering an alternative to hospital-based care. These services, delivered by accredited optometrists working to clinical management plans, are designed for low-risk cases such as ocular hypertension, suspected glaucoma, or stable early chronic open-angle glaucoma. Previous pilot evaluations have shown these services to be safe and effective, with high patient satisfaction and significant reductions in both patient travel and carbon emissions. This poster presents the first multi-locality, patient-centred evaluation of glaucoma monitoring services, highlighting their impact on patient experience, system efficiency, and environmental sustainability.
Mackley, T., Bhan, A., & Hughes, A. (2025, 5th – 6th November). A patient-centred evaluation of Glaucoma Monitoring Services in Primary Care Optometry [Poster presentation]. UK and Éire Glaucoma Society (UKEGS) Annual Conference, Edinburgh, Scotland.
Outcomes of Glaucoma Enhanced Referral Services (GERS) based in Primary Care Optometry in England from 2021 to 2025
Glaucoma Enhanced Referral Services (GERS) are a form of glaucoma referral filtering used in primary care optometry following sight tests, aiming to reduce unnecessary referrals to Hospital Eye Services (HES). Recommended by NICE and GIRFT guidelines, GERS enables accredited optometrists to conduct comprehensive clinical assessments for patients with signs suggestive of glaucoma or ocular hypertension. Previous evaluations have demonstrated the effectiveness of GERS in reducing false positive referrals and improving NHS efficiency. This study presents the first large-scale, multi-locality evaluation of GERS outcomes across 13 Integrated Care Boards in England from 2021 to 2025, providing updated evidence on the impact and value of these services for patients and the wider health system.
Mackley, T., Bhan, A., & Hughes, A (2025, 5th – 6th November). Outcomes of Glaucoma Enhanced Referral Services (GERS) based in Primary Care Optometry in England from 2021 to 2025 [Poster presentation]. UK and Éire Glaucoma Society (UKEGS) Annual Conference, Edinburgh, Scotland.
Outcomes of Glaucoma Repeat Reading Services (GRRS) in Primary Care Optometry in England from 2021 to 2025
Glaucoma Repeat Reading Services (GRRS) are an integral part of glaucoma referral filtering in primary care optometry, designed to reduce unnecessary referrals to Hospital Eye Services (HES) following routine sight tests. Endorsed by NICE and GIRFT, GRRS aims to minimise false positive referrals by enabling accredited practitioners to repeat key measurements in cases of raised intra-ocular pressure or suspicious visual field defects. While earlier evaluations were limited in scope and dated, this study presents a comprehensive review of GRRS outcomes across 26 Integrated Care Boards in England from 2021 to 2025, offering updated insights into the effectiveness and impact of these services on patient care and system efficiency.
Hughes, A. Mackley, T., & Bhan, A. (2025, 5th – 6th November). Outcomes of Glaucoma Repeat Reading Services (GRRS) in Primary Care Optometry in England from 2021 to 2025 [Poster presentation]. UK and Éire Glaucoma Society (UKEGS) Annual Conference, Edinburgh, Scotland.
Reduction in travel-related carbon emissions using a Single Point of Access and triage service for ophthalmology referrals
This poster, presented by Amy Hughes, Helen Haslett, Gayatri Nair, Vijay Balaji, Lisa Gibson and Rupesh Bagdai at the Oxford Ophthalmological Congress, highlights how a Single Point of Access (SPoA) triage system in Mid and South Essex reduced travel-related carbon emissions by 49%. By deflecting nearly 20% of ophthalmology referrals to primary care services or returning them to the referrer where secondary care wasn’t needed, the service saved over 7,000 km in travel and 1,320 kg of CO₂e, supporting both greener NHS goals and more efficient patient care.
Hughes, A., Haslett, H., Nair, G., Balaji, V., Gibson, L. & Bagdai. R. (2025, 7th – 9th July). Reduction in travel-related carbon emissions using a Single Point of Access and triage service for ophthalmology referrals [Poster presentation] Oxford Ophthalmological Conference, Oxford, England.
Impact of commissioned primary care integrated cataract pathways
This poster, presented by Amy Hughes, Wendy Craven and Anna Bhan at the Oxford Ophthalmological Congress evaluates integrated cataract pathways across six Integrated Care Boards in England. The findings show a high cataract conversation rate (91.8%), over 10,000 secondary are appointments saved, 17 tonnes of CO₂e emissions avoided, demonstrating how primary care-led pathways can enhance access, reduce hospital pressure, and support a greener NHS.
Hughes, A., Craven, W. & Bhan, A. (2025, 7th – 9th July). Impact of commissioned primary care integrated cataract pathways [Poster presentation] Oxford Ophthalmological Conference, Oxford, England.
Outcomes of Glaucoma Enhanced Referral Services (GERS) based in Primary Care Optometry in England from 2021 – 2024
This poster, presented by Tom Mackley, Amy Hughes and Anna Bhan at the Oxford Ophthalmological Congress, shares outcomes from over 14,000 patients assessed through Glaucoma Enhanced Referral Services (GERS) between 2021 and 2024. Nearly half (49%) were safely managed in primary care, avoiding referral to hospital services. The findings demonstrate the value of GERS in reducing false positives, easing pressure on glaucoma clinics and improving patient flow, supporting national guidance and offering a scalable model for wider adoption across the NHS.
Primary Eyecare Glaucoma Service (PEGS): A mixed methods service evaluation
Service: Community Glaucoma Service
Citation: Dinsdale, M., Fenerty, C. H., Craven, W., Ireland, R., Gunn, P. J., Hilton, R., … & Harper, R. A. (2024). Primary Eyecare Glaucoma Service (PEGS): a mixed methods service evaluation. Eye, 38(18), 3481-3487.
Reassurance on false negatives in the Manchester COVID19 Urgent Eyecare Service (CUES)
Service: CUES
Citation: Williams, E., Craven, W., Wilson, H., Dhawahir-Scala, F., Jinkinson, M., Newman, W. D., & Harper, R. A. (2022). Reassurance on false negatives in the Manchester COVID19 Urgent Eyecare Service (CUES). Eye, 36(1), 12-14.
Development and implementation of Greater Manchester COVID19 Urgent Eyecare Service
Service: CUES
Citation: Harper, R. A., Dhawahir-Scala, F., Wilson, H., Gunn, P. J., Jinkinson, M., Pretty, I. A., … & Newman, W. D. (2021). Development and implementation of a greater Manchester COVID19 urgent eyecare service. Eye, 35(3), 705-708.
Clinical effectiveness of the Manchester glaucoma enhanced referral scheme
Service: GERS
Citation: Gunn, P. J., Marks, J. R., Konstantakopoulou, E., Edgar, D. F., Lawrenson, J. G., Roberts, S. A., … & Harper, R. A. (2019). Clinical effectiveness of the Manchester glaucoma enhanced referral scheme. British Journal of Ophthalmology, 103(8), 1066-1071.
