Young children missing out on eye care during “critical window” in Ireland

Data released to Optometry Today by the Health Service Executive (HSE) under the Freedom of Information Act shows that in June 2025 one in three children under the age of five on the ophthalmology waiting list had been waiting for more than a year – comprising 1520 children in total.

The HSE confirmed that one in four young people on the ophthalmology waiting list between the ages of five and 18 had waited longer than a year.

In Ireland, optometrists currently play a limited role in publicly-funded eye care for children.

There is no national pathway for children to receive state-funded sight tests and glasses from optometrists.

Children who fail school screening are frequently referred into the hospital, where they face lengthy waiting times to be seen.

Optometry Ireland optometric adviser, Aoife Lynch, told OT that children were experiencing delays in receiving eye care at an influential time in their lives.

“We know that children’s early years are critical for the development of the visual system,” she said.

“If children have something like strabismus or amblyopia, there is the risk of long-term visual problems once they have gone past this critical development point,” Lynch highlighted.

She added that a school-aged child’s vision has wide-ranging effects on their overall development, including their ability to learn, play and interact with others.

“If you can’t see properly that is going to massively affect how you perform at school,” Lynch said.

In 2017, the HSE Primary Care Eye Services Review Group Report cited the limited role that optometrists play within publicly provided services in Ireland as one of the reasons that ophthalmology services are currently overloaded.

The report added that the lack of “well-developed and integrated ophthalmic services” created a risk of children developing long-term visual impairments that could affect their educational and life-long development.

Optometry Ireland president, Liz Grennan, highlighted that regional disparities currently exist in how long children and young people are waiting for ophthalmology appointments – with longer waiting lists in counties that are less populated.

“It is shocking to me that there is so much inequality across the country,” she said.

“You see some areas of Dublin where kids are seen really quickly and are managed effectively. But there are other areas where children can’t access care,” Grennan said.

Optometry Ireland is calling for more children to be discharged from secondary care and managed by skilled optometrists working in the community.

A previously proposed national eye care programme for children between the ages of eight and 16 would see optometrists deliver publicly funded eye care for this age group in the community. Optometry Ireland are continuing to advocate for this proposal.

“We are highly-skilled and we are in the local areas where people live,” Grennan said.

“We feel that optometrists in Ireland have a greater role to play in bringing these waiting lists down,” she said.

Grennan observed that gaps in the provision of eye care place a strain on families that cannot afford to pay for private treatment.

“As a parent, it’s so difficult if your child isn’t being given the same benefits as any other child,” Grennan said.

“Parents worry about the fact that their child is on this waiting list, and they don’t have the money to go private. I would say that does weigh heavily on parents,” she added.

Between the ages of 12 and 16, children in Ireland are not eligible for publicly-funded sight tests or spectacles as they are no longer of primary school age and most children only become eligible for their own medical card from the age of 16.

“That gap between 12 and 16 is massive because there are a lot of short-sighted kids who are going unchecked,” Grennan said.

“For every child who has a lovely granny or grandad who can pay for them to get checked, there are probably 10 others who don’t,” she added.

She added that children sit their first state exams between the ages of 15 and 16.

“It’s an important time. That period during their early teens is when young people are growing and therefore their eyes are growing – there is a higher risk of myopia,” Grennan said.

“I think every child deserves eye care so they can make the most of their abilities,” Grennan highlighted.

Parents worry about the fact that their child is on this waiting list, and they don’t have the money to go private. I would say that does weigh heavily on parents

Waiting times “deeply concerning and wholly unacceptable”

Federation of Optometrists and Dispensing Opticians (FODO) Ireland chair, Garvan Mulligan, highlighted that there is an urgent need for expanded community eye care services in Ireland.

“The waiting times revealed under the FOI request are deeply concerning and wholly unacceptable for a children’s health service,” he said.

“Delays of a year or longer for paediatric ophthalmology appointments risk missing critical windows for diagnosis and treatment, particularly for conditions such as amblyopia and strabismus – where early intervention is essential to prevent permanent visual impairment,” Mulligan emphasised.

He shared that he would like all children over the age of eight to be transferred from the care of ophthalmology to primary care optometry.

“Many children in this age group can be safely and effectively managed by local optometrists, freeing up scarce hospital appointments for younger children who require early specialist intervention,” Mulligan said.

He added that FODO Ireland has advocated for this change for more than a decade.

“While there has been agreement in principle from ministers, this commitment has yet to be translated into meaningful action by the HSE,” Mulligan observed.

“Implementing this change would represent a practical and immediate step towards reducing waiting lists and improving outcomes for children,” he said.

Mulligan, who qualified as an optometrist in 1988, has owned two practices in Waterford for the past three decades.

“In practice, optometrists regularly see children’s conditions worsen while they wait for access to secondary care,” he said.

Mulligan noted that FOI data reveals significant regional disparities in access to care – another issue that FODO Ireland has campaigned on.

“Members strongly support a move towards nationally consistent, community-integrated eye care pathways, allowing optometrists to work to their full scope of practice and ensuring children receive timely, appropriate care,” he highlighted.

We know that children’s early years are critical for the development of the visual system

Expanding the scope of practice

Martin O’Brien works as an optometrist at Specsavers in Wexford – a town with around 20,000 residents in the south east of Ireland.

O’Brien highlighted that the Wexford ophthalmology service does try to prioritise seeing children. However, long waiting times persist.

“It is a simple numbers problem with the sheer volume of children needing care,” he said.

O’Brien shared that optometrists have both the training and equipment to play a greater role in children’s eye care.

“Optometrists are poised to do this work. I think the workforce is in a completely different place to where it was 25 years ago,” he highlighted.

“The knowledge base is out there, but what has not kept pace is the utilisation of that knowledge base,” O’Brien shared.

As someone with poor vision from a young age, O’Brien can empathise with children who are going about their daily lives thinking the blur that surrounds them is normal.

He recalls being perplexed as a child when his teacher would tell him off for not completing assignments.

“I had a moment where I walked into the classroom wearing glasses for the first time and realised the teacher was writing homework on the blackboard,” O’Brien shared.

While children over the age of eight can be discharged from HSE clinics in some areas of the country, this scheme does not exist in Wexford.

O’Brien believes that making changes to children’s eye care in Ireland is a matter of fairness.

“It’s completely unfair that a child in Wexford is being treated differently to a child in Mayo. All children should have the same basic access to care,” he said.

“I would hate to think of a child sitting somewhere in Wexford not being able to see her homework on the board,” he said.

O’Brien shared that improving a child’s vision is about quality of life as well as educational achievement.

“It’s all the small moments in people’s lives that make a difference,” he said.

The HSE view

A spokesperson for HSE told OT that waiting times for children’s ophthalmology have increased in some areas due to a range of factors, including increased demand for services, workforce shortages, and capacity constraints within some ophthalmology services.

“The HSE recognises that timely access to eye care is essential for children’s health, development and educational outcomes, and regrets any delay children and their families may be experiencing in accessing care,” the spokesperson shared.

The spokesperson added that HSE is “actively working” to improve access to children’s eye care through service redesign and capacity expansion.

“Work is ongoing to standardise care pathways nationally and expand community-based ophthalmology capacity. These measures are intended to reduce regional variation and ensure children can access appropriate care regardless of where they live,” the spokesperson shared.

“Success in reducing waiting times has been achieved in several areas where new pathways have been implemented and this work is continuing to achieve national coverage,” the HSE spokesperson added.

The HSE is continuing to expand the role of optometrists within publicly-funded eye care services with the overall aim of improving timely access to care, the spokesperson shared.

“Ophthalmologists or optometrists who are contracted with the HSE may provide routine eye examinations for teenagers aged 12 to 16 who are medical card holders or dependants of medical card holders,” the spokesperson shared.

“The HSE remains committed to ensuring that every child receives timely access to appropriate eye care services and will continue to develop and strengthen children’s ophthalmic and optometry services nationwide,” the HSE spokesperson concluded.