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  • The domiciliary eye examination is available for patients who are unable to attend a practice due to physical or mental disability.
  • You must provide the service only at the request of the patient, a relative or primary carer.
  • You should use your professional judgement when deciding whether to offer a domiciliary eye examination.
  • You should be flexible when examining the patient and adapt your techniques as required.
  • You should have suitable portable equipment.
  • There are additional factors to take into account if you carry out eye examinations in residential homes.
A191
This guidance does not change what you must do under the law.
A192
Should only provide a domiciliary eye examination for patients who cannot attend a practice due to physical or mental disability.78 These situations may include where a patient:
  1. is frail or ill
  2. has challenging behaviour
  3. becomes distressed when taken out of their familiar surroundings.
A193
You must only provide a domiciliary eye examination at the request of, and with the consent of, the patient or a relative or primary carer.
A194
You must only carry out a domiciliary examination if it is in the best interests of the patient. A domiciliary service can be provided privately for those who do not qualify for an NHS domiciliary visit.
A195
You should encourage those who can attend a practice to do so, since the consulting room is the optimum environment for an eye examination.
A196
For a patient who does not leave their home and will be using spectacles only in that environment, their normal place of residence is often the best environment for their sight test. In this environment the optometrist is able to assess levels of lighting, positioning of furniture and the TV and advise how optimum vision may be achieved.
A197
If you do not offer a domiciliary service you, or your practice, should advise where patients can access these services.

References

78 Optical Confederation (2013). Sight tests at home [Link currently unavailable]
A198
When carrying out eye examinations in a domiciliary setting you should:
  1. ensure that a relative or carer is present, where possible
  2. carry out whatever tests are possible to determine the patient’s needs for vision care for both sight and health. The format and content of the eye examination will be determined by your professional judgement and the legal requirements
  3. consider whether it is appropriate to offer low vision assessment and advice, visual counselling for elderly people and advice on illumination. You should tell the patient and their relative or carer about any additional costs before you provide extra services
  4. accommodate the special needs of the patient, bearing in mind difficulties in communication caused through physical, sensory or mental disabilities
  5. be flexible about the approaches you use, which will depend on the environment
  6. be equipped with suitable portable equipment to ensure you can deliver the best possible optometric care to the patient in the circumstances. This should include:
    • Amsler grid 
    • dispensing equipment and a range of spectacle frames
    • distance and near ocular-muscle balance tests, plus suitable targets and occluder
    • focimeter
    • a full range of diagnostic drugs
    • illuminated test chart
    • means to examine the external eye, including an appropriate method if you are using diagnostic stains
    • near chart
    • ophthalmoscope
    • picture tests, as appropriate, for patients with learning disabilities
    • retinoscope
    • some means of assessing visual fields other than confrontation
    • tonometer
    • trial case and trial frame
  7. be readily identifiable to the patient, and provide them or their relative or carer with information about how you can be contacted for continuing care
  8. ensure the visit is not seen as a one-off but as part of the provision of continuing care for the patient
  9. be aware of additional local services that might be appropriate for the patient.79 
A199
When carrying out eye examinations in a residential home you should:
  1. be aware that some residents may already be established patients of other practitioners
  2. try to support carers by labelling spectacles in a way that is suitable in terms of the patient’s dignity, infection control and type of frame supplied
  3. when appropriate, provide a brief report to the carers which might assist in the general care of the patient80
  4. be prepared to examine individuals as well as groups of patients, as required
  5. ensure that the examinations are provided in a private area taking into account issues of confidentiality and dignity.

References

80 Details of when this is appropriate are in the section on Consent.