Losing Sight: Why eye care in Wales needs urgent attention

More than 80,000 patients in Wales who face the greatest risk of permanent sight loss are waiting too long for sight saving treatments – enough to fill the Principality Stadium 

RNIB Cymru

The Senedd’s Health and Social Care Committee warns that immediate action is needed to address delays in ophthalmology services and prevent avoidable sight loss. Its inquiry report calls for steps to be taken within months, not years, citing the National Clinical Strategy (commissioned by Welsh Government and delivered through NHS Wales) as a clear blueprint for change.

While recent reforms in primary care and investment in cataract surgery have delivered benefits, the Committee concludes these measures cannot compensate for systemic weaknesses in hospital-based care. This article explores why secondary care remains under severe pressure and why sustained investment is essential to safeguard vision and quality of life.

Ophthalmology: the busiest outpatient specialty in NHS Wales

At the end of March 2025, around 80,700 patients assessed as Health Risk Factor R1—the highest risk category for irreversible harm—were waiting beyond clinically safe timeframes for treatment. This represents 50.1% of all R1 pathways. No health board currently meets the national standard of 95% seen within target timeframes.

Ophthalmology accounts for one in every eight patients on the NHS Wales waiting list, and 1 in 20 people in Wales are currently waiting for an ophthalmology appointment. 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.

Primary care reforms: progress

Reforms in primary care optometry, such as the Wales General Ophthalmic Services (WGOS) contract, have enabled optometrists to manage low-risk patients and urgent cases in the community.  

In October, the Welsh Government announced an additional £3 million funding boost for optometry services as part of the 2025-26 contract, following a £3.9 million uplift earlier in the year. These investments aim to reduce hospital pressure by shifting thousands of appointments to community settings.

Progress is evident: approximately 3,000 appointments per month have already moved from hospitals to community optometry, with a target of 30,000 additional appointments. A separate funding package announced in June aims to deliver 20,000 extra cataract surgeries, targeting the longest waits and reducing reliance on outsourcing. However, these gains are overshadowed by persistent delays in hospital-based care.

The human impact

Behind these statistics are real people living with uncertainty and fear. Patients have described the emotional toll of delayed treatment and its practical consequences;

Sara Crowley shared how delayed treatment cost her independence and employment, leading to financial insecurity and depression.

RNIB Cymru shared stories of grandparents losing sight before meeting their newborn grandchildren, highlighting the preventable harm caused by delays.

Edward Kenna, who is living with macular degeneration, described feeling “condemned” to lose his sight.

Further, RNIB Cymru have highlighted that considerable underreporting of harm incidents masks the true scale of the problem, saying there is “almost certainly a significant underreporting of the scale of harm befalling patients”, and that this shows “the system is not working”. Between June 2021 and September 2023, only 45 harm incidents were recorded, despite tens of thousands of patients waiting beyond safe timeframes.

The Committee heard communication failures and lack of emotional support—such as Eye Care Liaison Officers—compound the distress.

Systemic challenges

The Committee identified several systemic issues, based on evidence from stakeholders:

• Workforce shortages: Wales has just 1.97 consultant ophthalmologists per 100,000 population(based Royal College of Ophthalmologists data), well below the recommended 3 per 100,000. Recruitment and retention challenges persist, particularly in west Wales, leading to reliance on locums and fragile service delivery (Royal College of Ophthalmologists).
• Estate and equipment limitations: Consultant Ophthalmologist and national clinical lead for ophthalmology, Rhianon Reynolds described hospital facilities as outdated and unsafe; she described leaking roofs, cramped spaces, and broken equipment disrupting surgery and extending waiting times.
• Digital delays: Despite an £8.5 million investment in the OpenEyes electronic patient record (EPR) system, rollout has been slow (Digital Health and Care Wales). Nearly five years after launch, most health boards still lack a functioning EPR or electronic referral system, limiting integration between primary and secondary care (Health Boards).
• Fragmented governance: Rhianon Reynolds stated that progress on the National Clinical Strategy has been hampered by unclear accountability and lack of dedicated oversight. RNIB Cymru and Wales Council of the Blind expressed frustration at the absence of milestones, deadlines, and significant investment to implement reforms.

Committee’s Recommendations

The Committee makes 16 recommendations, including:

• Establishing a cross-sector ophthalmology oversight board before the 2026 Welsh general election.
• Committing to a multi-year, ring-fenced investment programme for secondary care, matching the £30m recurrent funding provided to primary care.
• Expediting full rollout of the OpenEyes EPR and electronic referral system by March 2026.
• Mandating regional working and developing three regional centres of excellence.
• Prioritising estate upgrades and equipment replacement.
• Increasing ophthalmology specialty training places and publishing a strategic workforce plan by February 2026.

The Welsh Government has six weeks to respond formally to the Committee’s recommendations before the report is debated in Plenary.

Article by Sarah Hatherley, Senedd Research, Welsh Parliament