A needs led examination is one where the patient does not need a sight test as defined in law (a statutory sight test) but has symptoms that would benefit from a clinical assessment and opinion. Examples would include minor eye conditions services (MECS), Eye Health Examination Wales (EHEW) or equivalent, follow-up appointments after a routine eye examination, assessment of patients for suspect glaucoma or ocular hypertension, or the co-management of a patient with another healthcare practitioner. See sections on Examining patents who present as an emergency and Examining patients with flashes and floaters.

Unlike the statutory sight test, there is no legal restriction on who can conduct a needs led examination.