Lessons from Wales: Building a Community Low Vision Service in Scotland
As Optometry Scotland continue to champion and lobby the necessity for community based low vision services, it is important we reflect on what is necessary to establish a successful Community Low Vision Service (CLVS) that serves communities in Scotland. With the recent Scottish Budget 2026-2027 allocating funds to designing and developing a CLVS, it is a timely opportunity to learn and acknowledge the work of the wider optometry sector, including the experience and operation of the low vision service in Wales. The Welsh model demonstrates that low vision care can be delivered safely, equitably and sustainably in primary care, provided the right foundations are in place from the outset.
The Low Vision Service Wales
The Low Vision Service Wales (LVSW) emerged from the early 2000s, initially as part of the Welsh Eye Care Initiative, it was designed as a nationally commissioned service delivered in primary care optometry. Strong early engagement with ophthalmology and key stakeholders ensured confidence in the shift from hospital-based provision to community delivery.
Since 2016, all low vision services in Wales have been delivered in primary care optometry. This was not simply a relocation of activity. It was a redesign of the system. Ophthalmology and optometry initially collaborated to deliver services, steadily routine low vision assessment and ongoing support moved closer to patients’ homes and is now solely delivered in local community optometry practices. The result has been improved access for patients, reduced hospital burden and a clearer pathway to care and support for people living with visual impairment.
Hannah Thomas, Optometric Advisor for Optometry Wales, when asked about the development of the LVSW states “This demonstrates how a well-designed, community-based model can positively transform access to care for people living with low vision. A nationally coordinated pathway within primary care in Wales is recognised as a significant achievement. It has enabled patients to access timely low vision support and, more recently Certificate of Vision Impairment (CVI) registration, closer to home.”
For Scotland, the message is clear: early and meaningful engagement with hospital ophthalmology departments and wider stakeholders is essential. A CLVS must be positioned as complementary service to secondary care, enabling hospital teams to focus on surgical and complex medical cases, while community clinicians deliver structured low vision rehabilitation and support.
Infrastructure
The Welsh service is underpinned by:
- Standardised training and accreditation
- Agreed record cards and data collection
- Defined equipment lists and procurement mechanisms
- Audit and quality assurance processes
Over time, the scope expanded to include Falls Risk Assessment Tool scoring, depression screening and the ability to complete CVI certification.
These elements were not afterthoughts. They were built into the service architecture. Practical reflections from Wales emphasise that logistics and administration are as important as clinical enthusiasm. Early investment in infrastructure avoided variation in services, confusion from providers and patients and inequity.
For Scotland, this means:
- Ensuring accreditation requirements are robust but proportionate and achievable within current optometry workloads
- Designing documentation, IT and reporting processes at the outset that are conducive and clear
- Embedding CVI and blindness certification pathways from day one, rather than retrofitting them later
- Agreeing equipment specifications and refresh cycles early, with procurement routes that support ongoing supply from patients and practices
If the service is to be equitable across Scotland, these foundations must be nationally consistent, and support must be in place before the service rolls out.
Workforce
The Welsh service is now embedded within Welsh General Ophthalmic Services (WGOS 3), with no waiting lists and equitable access across Wales. Around 27% of Welsh optometrists are accredited in low vision, compared with a UK average of approximately 4%.
That level of participation did not happen by chance. Accreditation was supported, structured and recognised within a funded national framework.
Scotland is well placed to go further. We have a growing cohort of Independent Prescribing optometrists, and all newly qualifying optometrists will hold the IP qualification going forward. Alongside this, Scotland already delivers numerous enhanced services within the community, such as General Ophthalmic Services Specialist Supplementary (GOS SS) allowing complex eye conditions to be managed within the community. A CLVS should be designed to utilise this highly skilled workforce effectively.
Dispensing opticians (DOs) must also be central to delivery. Low vision care is not solely about clinical assessment. It is about rehabilitation, device selection, adaptation and patient education. Current providers of DO Qualifications, the Association of British Dispensing Opticians (ABDO) and Glasgow Caledonian University (GCU), register core competencies in low vision dispensing and support. This presents a timely opportunity to embed collaborative working between optometrists and DOs within a Scottish CLVS, allowing patients to be supported as much as possible.
Crucially, remuneration must reflect professional time, skill and responsibility. A Scottish service cannot rely on goodwill. It must be sustainable for practices of all sizes, including independents practices and those serving rural communities.
Accessibility
Although Wales and Scotland differ in geography and population distribution, both face rural challenges. A primary care led CLVS offers extensive value in areas where travel to hospital ophthalmology departments is difficult.
By embedding services within community practice, patients in remote or rural areas can access care locally, reducing travel burdens and supporting earlier intervention. This is especially important for older patients and those with mobility challenges.
Designing the service with rural Scotland in mind from the outset, including considerations around equipment distribution, procurement, referral pathways and digital connectivity, will be critical to equitable access for patients.
Standardisation
One of the strengths of the Welsh model is its standardised training and accreditation. However, any Scottish model must balance quality assurance with practicality.
Accreditation should align with existing competencies and, where possible, integrate with undergraduate and postgraduate pathways. Given the evolution of optometry training in Scotland, including IP integration and enhanced clinical content, there is an opportunity to design a low vision accreditation framework that builds on existing skills rather than duplicating effort.
If the process is overly complex or administratively heavy, uptake will suffer. If it is structured, supported and proportionate, participation can grow in line with service demand. The training must be accessible for optometry practices in rural areas, placements within hospital ophthalmology can be difficult to find local to practices in rural Scotland. Training must account for the needs of the entire workforce to allow a service that can operate.
Thinking beyond launch
A key lesson from Wales is that a low vision service evolves. The expansion to include Falls Risk Assessment Tool (FRAT) scoring, depression screening and CVI certification reflects a maturing service responsive to patient need.
Scotland should plan not only for launch, but for development. This includes:
- Mechanisms for audit and review
- Clear governance structures
- Pathways for updating equipment lists and clinical guidance
- Ongoing stakeholder engagement
Embedding these processes early will ensure the service remains clinically relevant and operationally robust.
Hannah from Optometry Wales, in relation to thinking beyond initial delivery notes “Robust clinical governance frameworks, referral pathways, and sustainable funding are key. Comprehensive accreditation and training frameworks ensure confidence to deliver effective low vision care. Standardised low vision equipment maintains equity and consistency across multiple settings. Most importantly, collaboration between hospital eye services, community health professionals, rehabilitation teams and third-sector organisations ensure patients are supported holistically.”
A sustainable solution for patients and the NHS
A Community Low Vision Service is not simply a professional aspiration. It is a practical response to rising demand, hospital pressures and the need for equitable access.
By:
- Delivering care locally
- Utilising optometrists and DOs fully
- Engaging ophthalmology as partners
- Embedding CVI processes and governance from the outset
- Investing early in infrastructure and procurement
- Designing accreditation that is achievable and scalable
Scotland can develop a model that supports patients, strengthens primary care and contributes to reducing pressures on hospital ophthalmology departments.
Optometry Scotland Chair, Eilidh Thomson, when asked what the biggest lesson from the Welsh service notes “Wales has demonstrated how a nationally commissioned, community-based low vision model can improve access, consistency and patient experience when properly supported. This provides valuable learning for Scotland as planning progresses to support the future rollout of a sustainable national low vision service that supports the communities it serves.”
Hannah from Optometry Wales when asked about the success of the Welsh Service system states “By embedding low vision services within primary care, Wales has developed a system that is accessible, resilient, and sustainable. It demonstrates how high clinical standards, leadership and collaboration can create a service that truly meets the needs of communities across the country.”
The Welsh experience shows that this is achievable with the right design, structure and funding. The task now is to design a Scottish CLVS that reflects our workforce strengths, geography and service landscape, utilising our skilled workforce of optometrist and DOs. All whilst remaining grounded in the core principle that low vision care should be accessible to the patient and community-based, delivered by skilled and supported optometry professionals, and should provide life changing support for those experiencing sight loss.
Read the full statement from Optometry Wales here.