Virtual Clinics Cut NHS Eye Care Delays, Study Finds

A recent study led by University College London (UCL) and published in BMJ Open has found that technician-led, community-based virtual eye clinics can significantly reduce waiting times for routine NHS ophthalmology appointments. The findings offer a scalable solution to the growing backlog in eye care services, particularly for patients with stable glaucoma and medical retinal conditions.

Pilot Pop-Up Clinic in Shopping Center Shows Promising Results

The study evaluated the impact of a “pop-up” virtual eye clinic established in Brent Cross shopping center in North London in September 2021. The clinic was created at the height of the COVID-19 pandemic to help reduce the growing backlog of appointments across the Moorfields Eye Hospital network. Over the study period, researchers analyzed 69,257 appointments attended by 39,357 patients between June 2018 and April 2023.

Unlike traditional in-hospital care, this innovative clinic relied on technicians trained to conduct routine eye scans, with results reviewed later by clinicians. The model preserved in-person time with specialists for urgent or complex cases, and the results were notable. In the first five months of operation, appointment delays decreased by an average of 8.1 days per week, even as national backlogs continued to grow.

Significant Impact on Post-Pandemic Appointment Delays

Prior to the clinic’s introduction, NHS ophthalmology waiting times were rising sharply due to COVID-19 disruptions. By March 2023, over 628,000 people in England were waiting for ophthalmology appointments, with more than 27,000 waiting for over a year. In contrast, patients within the Moorfields network experienced a reversal in delay trends following the launch of the technician-led clinic.

In November 2021, patients with stable chronic conditions were being seen six months later than scheduled. By April 2022, after the clinic's introduction, delays had dropped to just two months. This was a marked improvement compared to pre-pandemic trends, where appointment delays were increasing by 0.9 days per week, accelerating to 2.0 days per week during lockdowns.

A Scalable Model for the Future of Eye Care

Lead author Siyabonga Ndwandwe (UCL Research Department of Primary Care and Population Health) highlighted the potential of technician-led, virtual review clinics to reduce appointment delays, especially in the context of ongoing workforce shortages and limited hospital infrastructure. The model aligns with the UK government’s 2024 “Change NHS” campaign, which emphasizes decentralized care, digital integration, and preventative health strategies.

Co-lead author Dr. Dun Jack Fu of the NIHR Moorfields Biomedical Research Center added that the study, drawing on one of the world's largest specialist eye centers, demonstrates the relevance of virtual models in the post-pandemic era. He noted that expanding such clinics to locations like shopping centers could be a transformative step in modernizing ophthalmology services and improving access across the NHS.

Study Limitations and Future Outlook

The study, part of the HERCULES project (Healthcare Exemplar for Recovery from COVID-19 Using Linear Examination Systems), acknowledges several limitations. It did not include an external control group, which limits direct comparison to other regions. Additionally, while the focus was on glaucoma and medical retina patients, the clinic has since expanded to serve cataract and newly referred patients, potentially underestimating its full impact.

Nonetheless, the data strongly support technician-led virtual clinics as a viable, scalable solution for managing chronic eye conditions and addressing the NHS’s long-standing appointment backlog.

Reference:

Siyabonga Ndwandwe et al, Impact of a community-based asynchronous review clinic on appointment attendance delays across an eye hospital network in London, UK: an interrupted time series analysis, BMJ Open (2025). DOI: 10.1136/bmjopen-2025-098820