Clinical FAQs

Can I use direct ophthalmoscopy?

We advise using SL-BIO rather than direct ophthalmoscopy so that you can maintain a safe distance from the patient as much as possible. However, we recognise that there are occasions where this is not possible, such as for very young children, or when the patient is unable to reach the slit lamp. Fundal imaging is a useful technique, but it does not replace the use of SL-BIO, as it does not examine the patient's external eye, anterior chamber, or media. We also recognise that not all practices have fundus cameras, and that there are some patients who cannot reach the camera. In these instances, as an internal examination is one of the legally required parts of a sight test, if there is no alternative but to use direct ophthalmoscopy, you should minimise the infection risk by asking the patient to wear a face covering if possible (this may not be possible for very young children).

Updated: 16 June 2020

How do I conduct a telephone or video consultation with a patient?

Should I complete pre-screening?

A patient has phoned me and they have a serious eye condition that needs to be seen by the HES, but they also have symptoms of COVID-19 What should I do?

What should I do if patient needs new contact lenses and their CL specification has expired?

In the red phase of the pandemic you may supply contact lenses to an expired specification.

Reissuing of a specification is in our view is equivalent to a contact lenses fitting as it involves assessing whether a lens is suitable and conducting an examination of the anterior eye (Guidance for Professional Practice - Fitting contact lenses: A347 – A349), so where a patient’s specification has expired and need further supply of contact lenses, you should arrange a face-to-face appointment as soon as you reasonably can. However, in our view you may complete a remote fitting in the amber phase of the pandemic in exceptional circumstances provide that:

The sight test is in date
There are no clinical indications to attend the practice
The patient is aware of the risks of not attending
There is no change in the contact lens specification.

You must satisfy yourself that it is clinically appropriate, and you are acting in the patient’s best interest. You should make notes in the patient record to explain your decisions and the actions taken.

Updated: 15 July 2021

Should I tell my patients to stop wearing their contact lenses during this pandemic?

There is no evidence to suggest that wearing contact lenses increases the risk of contracting COVID-19. Patients can continue to use their contact lenses as normal if they do not have COVID-19 or any of the associated symptoms.

It is good general advice for patients to reduce their contact lens wearing time if they do not need to wear their lenses and can manage with spectacles, as may well be the case if they are at home more. If they wish to wear their contact lenses you should stress to patients that they should practise good contact lens hygiene as always, and that thoroughly washing their hands before and after handling their lenses is essential. We would also advise that if patients are ill, they stop wearing contact lenses until they are better. This applies to all illnesses, including the common cold, influenza and COVID-19. If a contact lens wearer is in a household of another person with COVID-19, they may wish to cease contact lens wear until the whole household has recovered.

A paper on the important considerations for contact lens practitioners during the COVID-19 pandemic has been published.

Updated: 15 July 2020

I did not make up spectacles for a patient who I recently referred for cataract surgery. However, as their surgery is now likely to be delayed should I make them up some?

This is up to your professional judgement. We suggest you telephone the patient and explain the situation and ask them if they would like you to make up some spectacles for them. If you have previous details you may be able to do this remotely (for example if they are happy for you to reglaze their spectacles, which they can post to you), and post the reglazed spectacles back to them. If they would prefer to have a new frame then arrange for them to come into the practice for dispensing and take appropriate social distancing and infection control procedures as outlined above.

How can I tell my patients to check their visual acuity remotely?

We have created a simple and easy to use visual acuity (VA) chart which patients can use at home. The chart has been designed to work at 3 metres, and will enable patients with access to an A4 printer to approximately measure their own visual acuity in advance of the remote clinical assessment. You can email the chart to patients, so a rough visual acuity can be recorded during the remote review.

The chart can be used at different distances to extend its range, we have included a conversion table so clinicians can easily record an approximate VA when used at 1 and 4 metres.

You can download and send the chart to your patients, or direct them to our public website, where they can also watch a video on how to use the chart.

		At 1m		At 3m		At 4m
		Snellen	LogMAR	Snellen	LogMAR	Snellen	LogMAR
Line 1	ONRD	~6/120	1.275	6/38	0.8	~6/30	0.675	ONRD
Line 2	VSHZO	~6/60	1.075	6/24	0.6	~6/19	0.475	VSHZO
Line 3	SVZDK	~6/38	0.775	6/12	0.3	~6/9	0.175	SVZDK
Line 4	RNOSN			6/6	0.0			RNOSN

Disclaimer:

We have taken the steps necessary to ensure this test is broadly equivalent to a validated vision chart when it is used in a well-lit room, printed on an A4 size piece of white paper used at the correct distance. However, our chart has not been independently validated as such, it is not a substitute for a vision assessment by a clinician using a correctly calibrated and validated vision test chart. The purpose of this College chart is to provide a broad evaluation of visual acuity in order to identify clinically significant sight loss in a home environment, in conjunction with a virtual clinical assessment.

The acuities given for each line are approximate equivalents to aid optometric differential diagnosis. The room illumination, chart distance and printing contrast may all vary. Optometrists should be mindful of this when considering a patient supplied self-recorded visual acuity along side other findings. However, even with these caveats, where a person can print and complete the test, the benefit of knowing an approximate and broadly equivalent level of vision, is in our view a useful aid to any telephone or video clinical review. We would welcome the development of an validated and fully automated visual acuity recording app for home use.

Updated: 22 April 2020

When should I wear a face mask in primary care optometry practice?

The UK Health Security Agency (UKHSA) has stepped down its infection prevention and control measures for seasonal respiratory infection in health and care settings, this means the default wearing of face covering no longer applies to those working in optical practices. It is now the responsibility for each person providing direct patient care to perform a dynamic risk assessment of what PPE is required, including whether or not to wear a face covering. Whilst the public may still be asked or invited to wear a face covering, it is no longer a UKHSA recommendation.

Section B39 of the Guidance for Professional Practice provides some overarching principles of when you should consider wearing a face mask:-

Performing procedures when in close proximity to the patient
You consider there is a risk of respiratory infection
There is a public health requirement to wear one

There is no longer a public health requirement, so whether you wear a face mask is up to your professional judgement on the basis of a dynamic risk assessment. This will include:

consideration of the proximity you are to the patient,
the time required,
where the interaction is taking place,
ventilation,
and whether you consider there is a risk of respiratory infection.

By "close proximity" we refer to performing clinical procedures such as direct ophthalmoscopy, Perkins tonometry, micro-exfoliation, foreign body removal and slit lamp examination without a breath shield in the consulting room, where you are close to the patient for an extended period of time.

It is unlikely that face masks would normally be required for:

Performing screening tests such as visual fields, desk mounted non-contact pressures, fundus photography or other imaging as there is a considerable distance and often an object between you and the patient.
Performing refraction or taking a case history at a reasonable distance
When dispensing, fitting and adjusting spectacle frames in the dispensing area where you are at arm’s length, for a relatively short period of time, and generally in a large, well-ventilated area.

It is important for every staff member to consider their circumstances, and before undertaking any procedure - clinical or otherwise. You should assess any likely exposure to blood and/or other body fluids, non-intact skin or mucous membranes and wear personal protective equipment (PPE) that protects adequately against the risks associated with the procedure, which may include the use of face masks.

It is also our view, and that of the Domiciliary Eyecare Committee, that in domiciliary settings, clinicians should continue to wear a face mask when visiting both patients' homes and when visiting residential care settings due to the different risk profiles of the setting.

If your patient is suspected or confirmed of having a respiratory infection or if your care pathway mandates it, then both the staff member providing care and the patient should always wear a face mask within the practice if the patient is able to.

UKHSA infection prevention and control (IPC) guidance

Northern Ireland and Scotland

We are working with each Nation's government to inform members how these will affect optometry practices on requirements for face masking/covering by staff, patients and visitors. We will provide updates to members of those nations as soon as possible.