Clinical skills required to provide enhanced optical services

Optometrists are in the perfect position to be able to provide patient-centred care where needed across the UK. This has become increasing important given the continued pressures on NHS hospital eye care services. Your skills can be utilised and developed to provide specialist care for those who need it most. 

Qualified optometrists are highly skilled across most aspects of delivering optometric care. The tables below show sector-agreed standards for providing enhanced eye care services, and where there may be additional higher qualifications or courses required to provide deeper understanding in specific areas.

Why complete a College-accredited higher qualification?

The College-accredited higher qualifications are more than just a certification. They can help you expand your clinical practice, advance your career and provide recognition for your expertise.

  • Expand your clinical scope of expertise - Acquire new knowledge and skills that enable you to offer enhanced services where commissioned, setting you apart in an increasingly competitive field
  • Gain professional recognition - Achieve a formal acknowledgement of your expertise with a recognised affix that reflects your commitment to excellence
  • Advance your career - Whether you're aiming for leadership roles, specialist practice, or academic pursuits, a higher qualification provides the stepping stone to new opportunities and is recognised by many employers
  • Earn Master-level credits - Many qualifications contribute towards postgraduate study, opening the door to further academic and professional progression
  • Learn in a way that works for you - With over nine different providers, you can find an institution that delivers the course that best works for you

Glaucoma

Glaucoma management is a cornerstone of advanced optometric practice. Achieving a College-accredited higher qualification in glaucoma sets you apart as a specialist in the field. Recognised by NICE NG81, NHS Wales, Getting It Right First Time (GIRFT) NHS team, and the Royal College of Ophthalmologists, these qualifications are the benchmark required for participation in many commissioned glaucoma services.

Each higher qualification level in glaucoma builds your expertise in epidemiology, diagnostics, treatment, and long-term management. This enables you to refine referrals, monitor suspect cases, confidently manage ocular hypertension and more. 

PathwayQualified optometristFurther qualificationsAdditional local training
Professional Certificate in GlaucomaProfessional Higher Certificate in GlaucomaProfessional Diploma in GlaucomaIndependent prescribing
Repeat measures 
Enhanced case-finding 
Monitoring & management (consultant supervision) 
Monitoring (low risk against management plan) 
*Management (low risk autonomous)   
*Referral refinement    
*Medium risk / stable glaucoma management with appropriate governance    
Laser therapies such as Selective Laser Trabeculoplasty (SLT), Laser Peripheral Iridotomy (Laser PI) with appropriate governance    
Virtual review, low-risk ocular hyper tension (OHT) and suspect glaucoma G1     
Virtual review, low-risk treated ocular hyper tension (OHT), early chronic open angle glaucoma G2 & G3      
Virtual review, moderate risk glaucoma A1-A3      
PathwayQualified optometristFurther qualificationsOphthalmic Practitioner Training (OPT) LevelLaser course
Professional Certificate in GlaucomaProfessional Higher Certificate in GlaucomaProfessional Diploma in GlaucomaLevel 1Level 2Level 3 
Repeat measures including visual fields 
Enhanced case-finding 
Monitoring & management (consultant supervision) 
Monitoring (low risk against management plan) 
*Management (low risk autonomous)    
*Referral refinement    
*Medium risk / stable glaucoma management      
Laser Peripheral Iridotomy (Laser PI)        
Selective Laser Trabeculoplasty (SLT)       
Virtual review, low-risk ocular hyper tension (OHT) and suspect glaucoma G1       
Virtual review, low-risk treated ocular hyper tension (OHT), early chronic open angle glaucoma G2 & G3        
Virtual review, moderate risk glaucoma A1-A3        

*Optometrists can deliver all levels of glaucoma care if working under the supervision of a consultant ophthalmologist or optometrist with a relevant higher qualification as set out in the Glaucoma-Stratisfaction-Fast document. An IP qualification may support the management's independent prescribing decision. 

Medical retina

Medical retina is at the forefront of modern optometric care, and achieving a College-accredited higher qualification in medical retina enhances your ability to manage a wide range of retinal conditions with confidence. Delivered by seven leading institutions, these qualifications provide the skills and knowledge to improve everyday clinical decision-making, particularly in OCT interpretation and retinal pathology assessment.

Each higher qualification level in medical retina builds your expertise in epidemiology, diagnostics, and management, preparing you to confidently detect and refer conditions such as AMD, diabetic retinopathy, and retinal vascular disease. The Professional Certificate also provides exemptions for some Diabetic Eye Screening Service requirements, where applicable, giving you a distinct advantage in clinical practice.

Higher qualifications strengthen every clinical decision you make in every retinal assessment, which is especially important given the widespread access to OCT imaging in primary care optometry. 

PathwayQualified optometristFurther qualificationsDiabetic Eye Screening Programme Diploma
Professional Certificate in medical retinaProfessional Higher Certificate in medical retina
Referral Filtering (AMD / DMO) with A&G / virtual review 
Monitoring (AMD)  
Monitoring (HCQ & CQ) with A&G / virtual review   
Diabetic Eye Service (DES) (screening and grading)   ✔*

*NHS England Diabetic Eye Service (DES) Diploma for Health Screeners is required for all providers of DES, the College's Professional Certificate in medical retina provides approval of prior learning towards the diploma. 

PathwayQualified optometristFurther qualificationsOphthalmic Practitioner Training (OPT) Level
Professional Certificate in medical retinaProfessional Higher Certificate in medical retinaLevel 1Level 2Level 3
Referral filtering (AMD / DMO) with A&G / virtual review 
Monitoring & management (consultant supervision)
Monitoring (low risk against management plan) 
Management (low risk autonomous)    
Intravitreal (IVT) injection     

Cataract

Cataract is a core area of optometric practice: all UK-registered optometrists are trained to detect, refer, support patient choice, and carry out post-operative assessments without the need for a higher qualification - though local schemes may have additional requirements.

Optometrists are qualified to assess, refer, and manage cataracts from the point of registration. Local pre- and post-operative schemes may offer additional training.

PathwayQualified optometristBritish and Irish Orthoptic Society (BIOS)Ophthalmic Practitioner Training (OPT) LevelMSC ACP ophthalmologyLaser course
Level 1Level 2Level 3
Minimal explanation eg referral refinement shared decision making post-operative review   
Pre-operative - biometry    
Pre-operative - consent    
Post-operative    
Complex patient review and biometry     
Yag capsulotomy     

Children

Children’s eye care presents unique challenges and opportunities. A College-accredited Professional Certificate in Paediatric Eye Care equips you with the specialist skills to support this vital patient group. This qualification builds clinical confidence, advanced assessment techniques, and enhanced communication skills needed to deliver high-quality paediatric optometry in both community and hospital settings.

The Professional Certificate in Paediatric Eye Care enhances your ability to assess visual function in young children and babies, detect and manage refractive and less common binocular vision anomalies, and provide tailored eye care advice for young patients and their families. You’ll develop further expertise in child-friendly refraction techniques, advanced cycloplegic and dynamic retinoscopy, and further binocular vision assessment, ensuring you can make informed clinical decisions that improve outcomes for children with advanced needs. 

PathwayQualified optometristFurther qualificationsSeeAbility
Professional Certificate in paediatric eye careProfessional Higher Certificate in paediatric eye care
Vision screening 
Refinement (following screening) 
Special educational needs (SEN) (NHS special school project)    
PathwayQualified optometristHigher qualificationsExperienceSeeAbility
Professional Certificate in paediatric eye careProfessional Higher Certificate in paediatric eye careCPDWOPECLocal
Vision screening 
Refinement (following screening) 
Special educational needs (SEN) (NHS special school project)       

Urgent care

Urgent care and differential diagnosis are core elements of optometric practice: all UK-registered optometrists are trained to assess, manage low-risk common eye conditions, and refer when needed—without requiring a higher qualification. Local enhanced services may set additional requirements.

Additional independent prescribing (IP) qualifications and registration can support urgent care pathways, with many IP optometrists issuing prescriptions to manage ocular conditions safely in primary care, reducing pressure on A&E and GP services.

PathwayQualified optometristFurther qualificationLocal training
Independent prescribing
Minor Eye Conditions Service (MECS) 
Community Urgent Eye Service (CUES) 
Foreign body removal  
Community Urgent Eye Service (CUES) prescribing 

Many primary care urgent eye care services now include foreign body removal. Clinicians should ensure they can have suitable foreign body removal training and experience. 

PathwayQualified optometristOphthalmic Practitioner Training (OPT) LevelLocal experienceMSc ACP 
Level 1Level 2Level 3
Management of minor eye conditions 
Management of minor eye conditions plus independently manage all conditions in Clinical management Guidelines 
Urgent care clinics – independent management    
Ocular emergency clinics under supervision     

Other care

Low vision
Achieving a College-accredited Professional Certificate in Low Vision equips you with the expertise to make a real difference in patients’ lives. It provides the essential skills to support people with sight loss, improving their functional vision, independence, and quality of life. 

The Professional Certificate in Low Vision enhances your ability to assess visual function, determine magnification needs, prescribe and train patients in using low vision aids, and provide expert guidance on lighting, contrast, and sensory substitution. You’ll gain a deeper understanding of the epidemiology of visual impairment, certification and registration processes, and working in a multidisciplinary pathway, often liaising with social care, ensuring you can offer comprehensive, patient-centred care in both community and hospital settings.

PathwayQualified optometristFurther qualifications
Professional Certificate in low visionProfessional Higher Certificate in low vision
Learning disability  
Low vision
PathwayQualified optometristFurther qualificationsExperience
Professional Certificate in low visionProfessional Higher Certificate in low visionCPDWOPECLocal
Learning disability  
Low vision

Glossary

  • Accreditation of prior learning (APL) - other appropriate qualifications will be recognised through a process of APL. Qualifications will be considered as the need arises and will inform an equivalency table, to be developed and held by the College
  • Advice and guidance / Remote virtual review - a more complex case mix and /or increased scope of care can be achieved within an integrated care model with expert A&G / remote virtual review. This could lead to a change in the patients management plan for the optometrist to deliver against
  • Management - a clinical process of initiating and reviewing treatment in response to changes in a patient’s clinical or disease status. Management may include establishing a management plan
  • Monitoring - a clinical process of following a patient’s condition through time to detect changes in clinical or disease status which may require action. An optometrist will be monitoring a patients condition, following their management plan to identify clinical change
  • New techniques - there is an overarching requirement for optometrists to maintain skills in all new equipment available to them. Delivered through manufacture training and CPD
  • Supervision - the case mix and scope of care will vary depending on the level of supervision provided in an integrated care model. An optometrists, for example, can deliver all levels of glaucoma care if working under the supervision of a consultant ophthalmologist

Commissioners and policy makers

If you are a commissioner or policy maker, you can download a more comprehensive summary guide below.