More worrying statistics about the state of public eye health are due to be published in this week's edition of Optician.

According to a survey by Visionary, access to care varies by a factor of ten depending on what Primary Care Trust is supposed to be looking after you. It suggests that recent debates about a postcode lottery for cataract care should be extended to all eye care.

Meanwhile, latest figures from the RNIB show an upward trend in sight loss that urgently needs to be stopped and then reversed.

But where does the responsibility lie?

The obvious answer is with the Department of Health, which needs to mobilise community care schemes to lower the burden on eye hospitals. Dr Michael Johnson explains how this should work in his 'Glaucoma in community' feature on page 12 of tomorrow's edition.

With sight test fees again frozen at £20.70 this week though, practitioners need clear assurances they will be reimbursed fairly for shared care services.

The Local Optical Committee Support Unit (LOCSU) is doing some extensive work in this area and setting up pathways that practitioners can adopt at a local level.

However, findings from Visionary also showed the majority of eye health commissioners have made plans for how patients will be referred in the NHS. This needs urgent attention, given that despite its sceptics the Health Bill was at least expected to benefit optics and eye health.

With most practitioners keen to take on more enhanced services it is vital commissioners are ready for a battle to improve public eye health before it gets any worse.

By Joe Ayling, news editor.

Take part in this week's Optician Poll on the postcode lottery for cataract surgery.