Written Evidence by Glaukos


About Glaukos


  1. Glaukos Corporation is an ophthalmic medical technology innovator focused on the development and commercialisation of breakthrough products and procedures designed to transform the treatment of glaucoma. We have pioneered Trabecular Micro Bypass Glaucoma Surgery (MIGS) and we lead the global glaucoma market with micro-scale injectable therapies that advance the existing glaucoma standard of care worldwide.
  2. We welcome the opportunity to respond to this enquiry and will focus our response on the role of independent sector providers in the provision of ophthalmic care and the clearing of NHS ophthalmic backlogs.


Glaucoma, cataracts and the ophthalmology backlogs


  1. The cost of glaucoma on the health service and economy is enormous. Every six minutes, someone in the UK is told they are losing their sight[1], with delays in treatment due to postponed appointments causing patients serious indirect health consequences. There are already two million people in the UK living with sight loss severe enough to have a significant impact on their daily lives[2], putting huge financial strain on the health and social care services and on patients’ families. Current estimates put the lifetime cost of blindness at £33.5bn by 2050[3].
  2. Even prior to the COVID-19 pandemic, the sheer volume of patients requiring ophthalmic care was considered the greatest challenge to glaucoma treatment in the UK. Specsavers’ 2022 Eye Health report also warns that the current waiting lists for key glaucoma treatments are the “longest they have ever been”, and that this is compounding a tidal wave of avoidable blindness[4]. The importance of addressing this crisis and clearing backlogs quickly and successfully to improve patient safety is clear.


Independent Sector Treatment Centres and future costs for the NHS


  1. Cataract surgery is the most common NHS elective surgical procedure[5] and forms the lion’s share of the large ophthalmic backlogs (currently at approximately 643,000) facing the NHS[6]. Between 10% and 15% of patients with cataracts also suffer from concomitant glaucoma. Although cataracts and glaucoma so often come together, they are very often treated separately. This is particularly true in independent sector treatment centres (ISTCs) which have been contracted by the NHS to deal with existing cataract backlogs[7].
  2. The Royal College of Ophthalmology has highlighted the need to improve patient safety and quality of service for patients being treated in the independent sector[8]. The disparity in care between in-house NHS treatment and in the ISTCs for cataract patients with existing co-morbidities such as glaucoma is a particular problem, risking patient safety and increasing costs in the long run. 
  3. The reduction in the cataract backlog by the use of ISTCs is claimed by many to be the exemplar of reducing backlog numbers quickly and effectively. However, by not utilising the opportunity to treat glaucoma at the same time as cataracts during surgery, this is storing up future health problems, all of which will require significantly higher public spending than would otherwise be required:
    1. Cataract patients with advanced glaucoma must wait longer for glaucoma treatment. This worsens their condition and places a greater burden on the health and social care services as their sight deteriorates, increasing the risk of unintended or unexpected harms to people during the provision of health care;
    2. Cataract patients with early-stage glaucoma often treat their glaucoma with eye drops, but this option commonly fails as patients are very often unsuccessful at using their drops correctly and consistently. Early surgical intervention can reduce or eliminate the need for eye drops, saving patients’ sight for many years and preventing a significant financial cost for the health service;
    3. Reducing or eliminating the need for years of eye drops reduces the cost of medication placed on the health service;
    4. For all patients with cataracts and glaucoma, treating the two conditions in two separate procedures is much more expensive for the health service than a single combined procedure; and
    5. Performing two separate invasive procedures is much riskier than a single combined procedure, unnecessarily risking patients’ safety and placing a significant financial burden on the health service in the form of compensation and reparative work.


Solution: Trabecular micro bypass performed alongside cataract procedures


  1. Trabecular micro bypass involves the implantation of stents into meshwork that has become blocked within the eye. This allows excess fluid to escape, lowering eye pressure and preventing damage to the optic nerve and resulting sight loss. This surgery has been approved by NICE and can be performed alongside cataract surgery, taking only a few extra minutes at the end of the operation. This quick, cost-effective procedure does not affect the surgical throughput of a theatre, offers a key means of addressing the treatment backlog for people living with concomitant glaucoma and cataracts, and can avoid the need for ongoing public expenditure outlined in Paragraph 7.
  2. Ensuring a comprehensive rollout of this alternative patient pathway (cataract + trabecular micro bypass) in the NHS and ISTCs would offer an efficient, safe, and effective solution for patients with cataract and glaucoma. This would come at minimal short-term cost, but would improve patient safety, as well as prevent the imposition of large costs on the health and social care systems.


November 2022

[1] https://www.fightforsight.org.uk/about-the-eye/facts-about-sight-loss/

[2] https://www.rnib.org.uk/professionals/health-social-care-education-professionals/knowledge-and-research-hub/key-information-and-statistics-on-sight-loss-in-the-uk/

[3] https://www.fightforsight.org.uk/media/3302/time-to-focus-report.pdf

[4] https://www.specsavers.co.uk/reports/state-of-the-uks-eye-health-2022

[5] https://allaboutcataracts.co.uk/faq/how-many-cataract-surgeries-per-year-uk/#:~:text=Phacoemulsification%20%E2%80%93%20which%20is%20the%20technique,the%20NHS%20in%20the%20UK

[6] https://www.rcophth.ac.uk/news-views/what-does-our-plan-for-patients-mean-for-nhs-ophthalmology-services/?news_type=news

[7] https://www.gov.uk/government/news/over-50-new-surgical-hubs-set-to-open-across-england-to-help-bust-the-covid-backlogs

[8] https://www.rcophth.ac.uk/wp-content/uploads/2021/11/RCOphth-Three-Steps-to-sustainable-patient-care.pdf