Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Clinical Effectiveness Team of the Birmingham and Midland Eye Centre (Approval ID: 2426) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As confirmed by the clinical governance team, this is a service improvement project and not a research project. The VA assessment was simply assessed earlier in the triaging stage, so no additional experimental assessments or treatments were added, and no changes were made to the patient treatment pathway. Therefore, ethics approval was not deemed necessary prior to the commencement of the project.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Competing interests

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.