2026-06-09

Is mór agam an deis seo a thapú labhairt ar cheist atá tar éis teacht faoi mo bhráid le cúpla mí anuas. Baineann sé le cúrsaí súile. Issues and concerns that have been raised with me by constituents about our eye care model in Ireland. We know, for example, that public eye care services are under significant pressure. National Treatment Purchase Fund, NTPF, data shows that over 42,000 people are waiting for eye care appointments, with approximately 33% of those waiting longer than one year. While much attention is rightly focused on that side of the thing, what I want to talk about today relates to our community eye care model and whether it is equipped to identify and manage emerging eye health challenges, particularly among children and young people. The current paediatric eye care pathway is focused on early childhood screening and the identification of serious visual impairments, but I do not think this captures the changing nature of eye health among children and adolescents, particularly when we take account of the rapid rise in the incidents of myopia, or short-sightedness. We know myopia typically develops between the ages of eight and 16, after school entry vision screening has taken place. This raises the question as to whether some children are developing vision problems without any structured follow-up or monitoring and, in fact, in many cases a diagnosis is reactive because a child will complain, for example, that they cannot see the blackboard or cannot engage properly with a lesson. By that stage, there would have been some lag in academic outcomes and the vision problem would have presented itself. Emerging evidence from Ireland and abroad would suggest that myopia is becoming increasingly common, particularly in younger age groups, with clinic based data showing the highest rate of myopia now among people in their 20s. While long-sightedness remains more prevalent in clinical populations, adjusted population estimates indicate that myopia is now becoming more prevalent as an eye condition, which shows the changing nature of eye health. We know that undetected vision problems can negatively affect educational attainment, classroom participation, confidence and social development. Also, myopia is associated with a lifelong increase in serious eye disease like retinal detachment, glaucoma or cataracts. This risk of myopia and the severity of it increases with age and we know that high myopia is much more associated with a high risk of vision loss compared with normal vision. This has significant public health implications. Individuals with high myopia face the greatest risk. The overall burden on services is likely driven by the growing number of people with moderate myopia as well. We estimate that 50% of the global population could be myopic by 2050. This is something we need to be very aware of in terms of how we design our eye care model and whether we should have proactive monitoring in place. One immediate action we could take is to encourage and enable independent prescription of medicines for eye conditions by optometrists in Ireland, which is something that is not in place at the moment. International evidence would suggest that allowing those prescribing powers to be made available to optometrists can allow more patients to be treated safely in the community. This reduces unnecessary hospital referrals and eases pressures on ophthalmology services. Large-scale clinical data from a number of studies suggests that electronic medical records can enable this as a potential cost effective tool for monitoring trends in eye health. Will the Minister of State give us a view on the current model of the eye care pathway, especially at a paediatric level? Given our educational system is becoming more reliant on screens and we know there is greater use of screens, that in itself is compounding the issues affecting myopia and increasing its prevalence, as evidenced by the data. Ultimately, can we build an early warning or early detection system into our paediatric eye care pathway?

I thank Deputy Moynihan for raising this really important issue of eye care services in line with emerging trends. I am taking this on behalf of the Minister for Health, Deputy Carroll MacNeill. There are measures either in place or being progressed to address the emerging trends in eye care services, such as those due to an ageing demographic or an increase in the prevalence of myopia. The Health Service Executive provides optical services free of charge to children referred from child health and school health service examinations who are discovered to have sight problems. These children are referred to the appropriate service for treatment. Under the community ophthalmic services scheme, COSS, medical card holders and their dependants aged over 12 can be seen by ophthalmologists, optometrists or dispensing opticians. They can receive an eye examination and be provided with prescribed optical appliances in accordance with a national schedule of approved optical appliances. In 2017, the HSE published two important documents, the Primary Care Eye Services Review Group Report and the national clinical programme for ophthalmology. The review report set out how a significant proportion of eye services could be delivered in a primary care setting. A key recommendation was that children aged between eight and 12 with routine eye care needs should be transferred to the care of local optometrists. These would receive an annual eye exam under the COSS, irrespective of their medical card eligibility. This remains a priority and work is ongoing to implement this recommendation. The clinical programme set out a model of care regarding how the realignment of eye services from an acute hospital setting to the community would be undertaken. The HSE has been developing multidisciplinary integrated eye care teams in accordance with this model of care. These teams facilitate assessment, diagnoses, management and treatment, enabling most patients to be seen in their own locality. Where necessary, patients can be referred onwards to acute ophthalmology services to receive the necessary specialist input. Significant investment has been made in developing and strengthening these integrated eye care teams. There are ten across the six health regions. These teams are also facilitating the large-scale transfer of care from hospital outpatient departments to community settings, with a substantial proportion of referrals assessed, treated and discharged outside the acute system. This has reduced pressure on hospital ophthalmology clinics, enabling acute services to prioritise complex, surgical and high-risk patients, and has improved patient experience through earlier assessment, shorter waiting times and care delivered closer to home. Work is also under way to ensure Ireland has enough trained eye care professionals to deal with increasing demand: The South East Technological University, SETU, is progressing work to establish a bachelor of science honours degree in optometry, with a first intake of students expected in September 2027. I have been working closely with Professor John Nolan and Dr. Fraser Horn, who have done phenomenal work in the last couple of years to embed this into the new technological university. They were very supportive of this "one health" approach. You have to have the eye care professionals in place to deliver an awful lot of the services. I am really struck by what the Deputy said as well about optometrists being able to take that step in regard to dealing with children especially. We have seen how the Minister and the previous Minister have moved in relation to pharmacists now being able to prescribe up to 12 different medications, which is really important. The Department of Enterprise, Tourism and Employment also recently announced that the ophthalmic optician is now an eligible occupation for the critical skills employment permit. Finally, the Department is also considering ways to expend the scope of practice for optometrists to ensure that the eye care needs of people, especially children and older persons, can be met.

I thank the Minister of State for that very comprehensive response. Core to a lot of the emerging healthcare needs we have in Ireland are training and skills, so I am very pleased to see that one of the planks of the Minister of State's answer was making sure we have enough trained professionals. I think that needs to be at the core of how we future-proof our public services and make sure we are able to address demand in the future. I also welcome the steps that are being taken towards embedding this into a community care model, which I think is what these integrated eye care teams will deliver. They are contingent on the number of trained professionals. I ask the Minister of State to take it up with the Minister for Health in a broader piece around the prescribing powers for optometrists to enable them to be a core pillar of how we engage directly with children in the community and to avoid them necessarily having to even go as far as the integrated eye care team, especially if medication or treatment can be prescribed in a low-cost setting. While all the other developments the Minister of State described are very welcome, there is a piece around early detection. Even with the model that is laid out at the moment, it seems to be a referral or reactive, which is a very good and strong way to find this. Given that we know this is going to have increased protection, studies from the US and South Korea suggest that myopia affects 50% of the population towards the middle of their lives, and that that, as the Minister of State knows, brings added risk of eye disease later on in life, how do we build on that early detection piece, in the same way we would have done with dental care and on the back of public health nurse checks in the first years of a baby's life? How do we keep an eye on - pardon the pun - the development of eye health and eye care but also address and ensure we use the data to inform monitoring and planning and learn about the prevalence of myopia? One thing the increased use of screens has taught us is that nobody would have anticipated that it has had a very detrimental effect on the overall state of the eye health of children and adults in the country, which has led to this increased prevalence of myopia. I thank the Minister of State for the response, and she might respond to the other points too.

It is great to have the opportunity to discuss the reform of eye care services in line with emerging trends across the country. Deputy Michael Murphy, who is sitting in front of Deputy Moynihan, has discussed with me several times the issue of getting the right clinicians into the job. We have been really challenged, for example, in south Tipperary in getting a consultant optometrist in there to fill that post. That is why it is really important we have the training skills across the country. We do not have enough positions at the moment. I am strongly of that opinion and we are trying to change that. That is really important. The Deputy talked about eye care. Often when we think of eyes, we think about the glasses or the contact lenses but eye care is very important. There is a huge amount of work done with older people with dementia, macular degeneration and cataracts. It is very important that the quality of life of a person can be so much improved if they have the correct eye care. Myopia - short-sightedness or nearsightedness - is increasing among children both globally and in Ireland. Research indicates that daily outdoor activities and managing children's screen time and sleep time may be beneficial for slowing the progress of myopia. Children discovered to have sight problems, including myopia, during HSE screenings get free treatment from their local HSE integrated eye care team, but I am conscious of waiting lists and where a young child is waiting. I am conscious again of the situation in south Tipperary, which has been raised. We failed over the past two years to get a consultant in post, and that ends up creating very long waiting lists for children. As we all know, regardless of what health issue it is, early intervention is key. I will raise with the Minister again the prescribing element of it, because the more services we can move away from the acute hospital setting and into the community, the better. I thank the Deputy again for raising this.