Glaucoma is the leading cause of preventable vison loss in the United Kingdom and is responsible for almost one third of new vision impairment certifications [1]. The provision of safe and effective glaucoma care even prior to the current COVID-19 pandemic has been challenging. The British Ophthalmological Surveillance Unit found that up to 22 people per month suffered permanent and severe vision loss as a consequence of delayed follow-up, due to insufficient capacity within hospital eye services [2]. Formal Investigation by the Healthcare Safety Investigation Branch [3] made several recommendations including the need for appropriate specialist-led clinical decision making, clinical pathway redesign, improved referral refinement schemes and validation of risk stratification. Limited progress has been made in recent years despite the issuance of national guidance regarding the conduct of “virtual” glaucoma clinics to help increase capacity [4] and an evidence-based appraisal of current referral refinement strategies [5]. Significant barriers to widespread implementation still exist including an incongruence between organisational structures and emerging models of care and the impact of new roles and relationships upon the function of multi-professional teams [6].

The COVID-19 pandemic has altered life for the entire population of the United Kingdom in a manner not previously experienced during the lifetime of the majority. Rapid changes to how people live, work and access healthcare have been enforced with limited resistance by citizens. Existing approaches to the monitoring of chronic conditions such as glaucoma, which are not often immediately life or sight threatening, have been abandoned because of the priority to preserve life. Almost 120,000 patients attended outpatient consultations within the glaucoma service across the Moorfields Network over the past year with a median age of 68 and almost half aged over 70. In anticipation of the mitigation strategies implemented by the U.K. government, we have deferred almost 30,000 glaucoma outpatient attendances.

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