Should’ve gone to Specsavers? What Israel can learn from UK optometry revolution

Israel was once the undisputed world leader in preventing blindness. Between 1999 and 2010, rates of preventable blindness were slashed by more than half, from 33.8 cases per 100,000 residents to 14.8. No other country came close. Prof. Michael Belkin of the Goldschleger Eye Research Institute at Tel Aviv University called the achievement unparalleled, crediting community based programmes, universal access through the kupot holim, and early intervention in diabetes clinics that paid for themselves within two years.

That was then. A landmark study published in the American Journal of Ophthalmology tracked blindness incidence across the following decade and found that progress had stalled. Between 2009 and 2020, the overall rate fell a further 24.9%, but the meaningful decline occurred before 2014. After that, the annual improvement flattened to a statistically insignificant 0.42%. For the four main preventable causes of blindness, age related macular degeneration, glaucoma, cataract and optic atrophy, the researchers concluded that existing methods may have reached saturation. Only diabetic retinopathy continued to decline, and even that rate of improvement was attenuating.

Israel is now caught between its own success and a demographic tide that threatens to overwhelm it. The population is projected to approach 16 million by 2050, with the number of adults aged 65 and over more than doubling. Cataract cases alone are expected to nearly triple. Meanwhile, the Ministry of Health’s 2023 Diabetes Status Report reveals that 696,121 Israelis are registered diabetic, one in three people aged 65 and above, with 1.1% of diabetics eligible for blindness certification. Diabetes rates are highest in peripheral districts such as the Golan Heights, Jezreel and Hadera, and disproportionately affect Arab and Bedouin populations.

A new peer reviewed analysis published in December 2025 in the Israel Journal of Health Policy Research by Arazi, Zondervan, Israeli and colleagues lays bare the structural weaknesses. Despite universal coverage under the 1994 National Health Insurance Law, the system remains dependent on supplementary insurance (held by over 80% of Israelis), with 91% of Jewish Israelis holding supplementary cover compared with just 62% of Arab Israelis. Out of pocket spending accounts for about 20% of total health expenditure, above the average for high income countries. Geographic maldistribution of subspecialists means that specialist consultations in major centres can be secured within two weeks, while smaller hospitals face delays of six weeks or more, particularly in retina care. And critically, Israel’s estimated 2,500 to 2,880 licensed optometrists are largely confined to private practice and retail settings, poorly integrated into the public health system.

This last point is where the Specsavers model becomes instructive.

Specsavers, the Guernsey based multinational founded in 1984 by Doug and Mary Perkins, now operates over 2,500 locations across twelve countries with a total turnover exceeding £4 billion. Its genius lies not in technology alone but in structure. Each store is co-owned by an optometry partner and a retail partner under a joint venture agreement, combining clinical independence with centralised support in marketing, IT and supply chain logistics. The result is affordable, high quality community optometry at scale.

The clinical impact has been transformative. Specsavers was the first company globally to incorporate Optical Coherence Tomography scanning into every standard eye examination across its Australian network. OCT creates detailed three dimensional images of the retina, macula and optic nerve, enabling the detection of glaucoma, diabetic retinopathy and macular degeneration up to four years before conventional methods. After the rollout, 53% of patients referred for glaucoma were first time suspects, indicating that the technology was identifying precisely the undiagnosed cases that conventional screening was missing. In March 2025, Specsavers formally joined the International Agency for the Prevention of Blindness, aligning its mission with the global elimination of avoidable sight loss.

Israel does not need to import Specsavers. But it does need to learn from the model. The Arazi study’s policy recommendations point in exactly this direction: expand the role of primary and community providers in managing routine eye conditions, strengthen the integration of optometry within the public sector, and address the geographic maldistribution of the workforce. Israel’s 1991 optometry law, which restricts optometrists from using diagnostic drugs independently and historically constrained their work with children and the elderly, belongs to another era. The European Council of Optometry and Optics noted in its 2023 review of Bar Ilan University’s programme that legal constraints on Israeli optometry practice were a source of professional frustration, while the academics themselves were seen as needing to push harder for reform.

The arithmetic is stark. Israel has roughly 263 to 294 optometrists per million people. It has the human capital. What it lacks is a delivery architecture that puts those professionals where they are needed most: in community clinics across the Negev, the Galilee and the peripheral towns where diabetes rates are highest, specialist access is thinnest, and the plateau in blindness prevention is most consequential.

A Specsavers style joint venture model, adapted to the kupot holim framework, could embed OCT equipped optometry clinics in underserved communities without requiring new public spending on salaries. Optometrist partners would co-invest in their own practices, supported by centralised procurement and training from the health funds. The incentives would be aligned: clinical independence, community ownership and financial sustainability.

The World Health Organisation estimates that 80% of blindness globally is preventable or treatable. Israel proved this was achievable for an entire nation. The question now is whether it can break through the plateau before demographic ageing renders the task immeasurably harder. The answer lies not in more hospitals or more ophthalmologists at the centre, but in empowered optometrists at the periphery.

The Perkins family built their empire on a simple insight: great professional service coupled with great value has no substitute. Israel’s founders would have recognised the principle. It is time to apply it to the nation’s eyes.