Healthwatch England called for an investigation into eye care support to prevent additional costs from deterring low-income households visiting opticians for regular checkups, following a survey revealing the high impact of costs.
While a healthy two thirds (69%) of respondents had attended an eye test in the last two years, 23% of those that hadn’t named financial constraints as their main reason – and almost three quarters (72%) of those who did attend felt pressured to get additional products or services.
Louise Ansari, chief executive of Healthwatch England, commented: ‘Regular visits to the optician are essential to help keep your eyes healthy and identify any issues. However, there are clear signs that the extra costs people face could discourage those struggling financially from visiting opticians.’
Sarah Cant, Director of Policy & Strategy at The College of Optometrists, said that they support the recommendations to better help low-income households so people can meet the costs of eye care, and for a government-funded targeted public awareness campaign to encourage more people to have regular eye tests.
'Financial barriers should not stand in the way of patients getting vital care. Without adequate funding, optical practices will struggle to maintain services—reducing access for those who need it most,' she added.
Adam Sampson, chief executive of the Association of Optometrists, agreed, highlighting the report as 'a stark reminder that urgent government intervention is needed to prevent avoidable irreversible sight loss.'
‘No one should have to choose between paying for the basics like rent and food, and accessing eye care. Healthwatch makes it clear that NHS funding has failed to keep up with reality, leaving both patients and optometrists in an increasingly untenable position,’ he said.
The AOP’s Cost of living campaign also aimed to tackle these issues.
The survey was conducted on 2,568 people between July and September 2024, asking about access to opticians and optician services.
Fear of extra costs
Healthwatch England’s Ansari said: ‘NHS funding to help meet eye care costs has not kept pace with inflation, which, in turn, is causing high-street opticians to rely more on selling additional services to make their businesses viable.
‘It is essential that this situation does not impact on those most disadvantaged in society. This is why the government needs to review the help available for those on the lowest incomes and ensure that more people are aware of how the NHS can help meet the costs of eye care.’
As private businesses, opticians provide free eye care primarily through funding from the General Ophthalmic Services (GOS) contract and additional practice services, such as advanced scans, specialised lenses, contact lenses and different kinds of frames.
The survey emphasised that, while 84% of respondents were eligible for free eye tests, many were still deterred from going due to fear of additional costs from extra services or products which aren’t included in the free eye test and optical vouchers.
Cant added in response: ‘It’s concerning that Healthwatch England’s report has found some patients are voluntarily avoiding essential eye care due to rising costs and insufficient financial support. This not only puts individuals at risk of avoidable sight loss but also deepens health inequalities, particularly affecting children and vulnerable adults who depend most on NHS support.’
Out of those eligible for free eye support, over half (63%) were encouraged to get additional services at an extra cost.
The most frequently offered additional services included: advanced tests (64%), non-reflective coating on lenses (38%), another pair of glasses at a reduced cost (37%) or varifocal lenses (35%).
However, the College defended clinicians, saying: 'We are disappointed that Healthwatch England was not aware of the existing guidelines and standards that all primary eye care clinicians are expected to follow.
‘Optometrists are committed to delivering high-quality, patient-centred care, as outlined in the General Optical Council’s Standards of Practice and the College’s Guidance for Professional Practice. They are expected to ensure patients receive clinically justified care and clear, transparent information about services and costs – and should be trusted to do so.'
Out of the 1,766 patients that shared their experiences of eye tests, many expressed financial concerns: ‘I have an HC2 for free eye tests, but the voucher doesn’t cover the whole cost of contact lenses or glasses, so it’s an expense I ration for when I can save up.’
‘NHS vouchers do not cover [two] pairs of glasses for those who need everyday glasses and reading glasses. Bi-focals for instance are too expensive for people like me on benefits due to disabilities,’ said another.
Respondents highlighted in comments that costs skyrocket as prescriptions increase, with services becoming unaffordable when they or their children were in need of high-prescription lenses thinned, expensive myopia correction spectacles or disease tests.
Ongoing funding struggles
Optical practices and associations supported patients’ calls for increased free eye care funding. Last month, NHS optical voucher values were unexpectedly frozen for 2025/26 at 2024 levels, which has been expected to put a further ‘squeeze on patients’, said Paul Carroll, chair of the Optometric Fees Negotiating Committee (OFNC).
‘Contractors will continue to do all they can to support patients, but it is a false economy which will impact most on children and vulnerable adults and lead over time to more NHS repairs and replacements,’ he added.
In regard to the GOS fees, Professor Irene Ctori, vice-president at The College of Optometrists, called for ‘fair and sustainable funding for these services’ following ongoing delays on funding announcements, which ‘could ultimately exacerbate health inequalities by reducing access to essential eye care, particularly for the most vulnerable patients.’
‘The College firmly supports the OFNC’s calls for an increase in GOS fees and we’re disappointed that the early indications are that NHS England plans to only uplift the GOS budget in line with current inflation estimates,’ she added.
Sampson commented: 'As a member of the Optical Fees Negotiating Committee, we have long emphasised that a properly resourced primary care system could further reduce hospital admissions, cut waiting lists, and ensure timely, patient-centred care.
'This is not an isolated concern. In Wales, there has been a reduction in the value of some NHS vouchers under the new General Ophthalmic Services (GOS) contract, hitting those on the lowest incomes, which we have called out as a mistake.'
Making improvements
The Healthwatch England report proposed the following recommendations:
- The Department of Health and Social Care should review support for the costs of NHS eye care for those on the lowest incomes
- The NHS should consider a targeted communications campaign to spread awareness of what financial help is available
- The primary eye care sector should have clear guidelines for how staff should assist low-income patients without affecting their confidence in seeking care.
