Image source, Getty ImagesImage caption, Figures indicate there are about 140,000 ophthalmology follow-up appointments awaiting review in Wales, but just 65 consultant ophthalmologists available
ByIolo CheungBBC Wales- Published42 minutes ago
A 70-year-old man died of eye cancer after a recommended appointment was not followed up by health professionals, an inquest found.
Alexandar McDonald died at the Grange University Hospital in Cwmbran, Torfaen, on 30 November 2025, from the effects of metastatic choroidal melanoma, external.
But a coroner found he could have begun treatment six months earlier, and warned more patients in Wales were at "significant risk", as figures showed 140,000 ophthalmology follow-up appointments awaiting review, but just 65 consultant ophthalmologists available.
The Welsh government said it was "vital that lessons are learned from this tragic case, caused by unacceptable failings in the management of referrals".
The inquest into McDonald's death heard he had attended an urgent ophthalmology appointment in June 2022 following a routine eye test, where concerns were raised following a scan.
Although a consultant determined he needed to be reviewed again in six months, he received no follow-up appointment.
At a routine check-up in June 2023, however, concerns were raised and a further scan led to an eye cancer diagnosis.
Gwent area coroner Rose Farmer heard that, had McDonald been given a previous follow-up appointment as recommended, the melanoma would have been diagnosed six months earlier, with treatment beginning almost immediately.
Following the "delayed diagnosis", the inquest heard McDonald underwent several treatments, but the cancer had later metastasised to his liver, leading to his death.
'Other patients at risk'
Outlining her concerns, the coroner said there was a "risk that future deaths could occur unless action is taken".
In a prevention of future deaths report sent to the Welsh government's department for health and social care, Farmer said there were "substantial delays in ophthalmology follow-up appointments across Wales".
She also said the ophthalmology "capacity appears insufficient to meet the demand", adding that the absence of a national mechanism means those "requiring surveillance for ophthalmic conditions may experience prolonged delays".
Image source, Getty ImagesImage caption, Alexander McDonald died at the Grange Hospital in Cwmbran in November 2025
"This case demonstrates the impact of not having timely follow up appointments," the coroner added.
"Similar delays may place other patients at risk of delayed diagnosis of malignancy and death."
Responding to the report, the Welsh government said: "It is vital that lessons are learned from this tragic case, caused by unacceptable failings in the management of referrals, and our thoughts are with the family of Alexander McDonald.
"All health boards should have standard operating procedures in place to manage specific operational matters raised in the report, including capacity to meet the demand for follow-up surveillance and ensure patients who require ongoing monitoring are reviewed within clinically intended timescales.
"As a government we will robustly hold health boards to account for performance."
Mohamed Elalfy, president of the Royal College of Opthalmologists, said services in Wales face a "number of long-standing challenges, including dilapidated estates, workforce shortages and poor IT infrastructure".
"These are key reasons why many patients often unfortunately face unacceptable delay," he said, calling on the implementation of reforms "as an urgent priority".
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