All Wales Contact Lens Service Position Statement: September 2025

The Welsh Optometric Committee (WOC) believes that all patients within Wales who require clinically necessary contact lenses should have timely and equitable access to the specialist practitioners who can fit and care for them.

There exists a cohort of patients who require clinically necessary contact lenses to achieve best corrected vision, or for cosmetic reasons. These patients typically have a degree of ocular disfigurement, or corneal ectasia (most commonly, keratoconus). Currently, access to these services varies across the 7 health boards, creating financial, geographical and social barriers. Whilst a defined group of these patients will be unsuitable for primary care (needing particularly specialist lenses or and bespoke solutions), the skills and capacity to provide support to significant share of these patients exists within primary care optometry across Wales.

In October 2023, reforms to Welsh General Ophthalmic Services (WGOS) saw the introduction of enhanced services traditionally delivered in secondary care, into primary care capacity. These reforms aim to reduce workloads in hospital clinics (both initial assessments and follow-ups) and enable the primary care ophthalmic workforce (Optometrists, Contact Lens Opticians and Dispensing Opticians) to work at the top of their clinical scope. Specialty Contact Lens services represent a further key opportunity to reduce unwarranted variation and provide a more comprehensive and consistent service at a local level.

The current inequity in service provision may lead to financial, geographical and social barriers against the population. The extensive research into service provision carried out by WOC (detailed in the full proposal) highlights opportunities to replicate examples of effective service delivery, to align with the Welsh Government directive for the Health and Social Care sector, working towards A Healthier Wales (as published 2021) to bring care closer to home, reduce hospital wait list times, and provide equitable service across the nation.

Optometry: Delivering a Healthier Wales (published 2021) set out 3 year and 10 year goals for the profession and its’ impact on the public. The introduction of an All-Wales Contact Lens Service aligns with the goal originally set for 2024: 

Specialist contact lens care will be part of the new contract and there will be at least one primary care optometrist or contact lens optician that provides NHS specialist contact lens fitting and aftercare appointments in each cluster.

WOC’s review shows that the majority of specialist contact lens service provision, where available, is delivered solely within a secondary care hospital setting often following an initial referral from primary care optometry. However, the skillset for helping many of these patients is available from many primary care optometry practices throughout Wales. By offering enhanced services at a local level, supported by a nationally consistent framework for remuneration and ongoing education, practitioners can deliver improved patient outcomes in a timely manner, aligning with the Welsh Government’s vision for care closer to home.

Equity in access should be the standard, not the exception.

WOC therefore recommends NHS Wales to commission a nationally consistent All-Wales Specialist Contact Lens Service in primary care, integrated with continued secondary care services, for those patients who require these solutions.

• All Wales CL Service Proposal, A Review and Recommendations for Welsh Government (Welsh Optometric Committee, 2019, updated 2025)
• Optometry: A Healthier Wales 2021 to 2031 (published 2021, Welsh Government)
• The Strategic Workforce Plan for Primary Care, 2024/25-2029/30 (published 2023, HEIW)
• A healthier Wales: long term plan for health and social care (published 2018, updated 2024, Welsh Government)