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  • You must carry out such examinations as appear to be necessary to detect signs of injury, disease or abnormality in the eye or elsewhere.
  • In addition to the minimum legal requirements, you should use your professional judgement to decide the format and content of the eye examination.
  • You should record all clinical findings.
  • You should tell the patient your findings and recommendations.
  • The frequency of eye examinations depends on the patient’s clinical needs but there are recommended minimum intervals.
A43
This Guidance does not change what you must do under the law.
A44
When conducting a sight test, which is defined in law,19  you must perform an internal and external examination and carry out such additional examinations as appear to be necessary to detect signs of injury, disease or abnormality in the eye or elsewhere 20 21 (refer to COVID-19 guidance).
A45
You should use your professional judgement and the minimum legal requirements to decide the format and content of the tests.
A46
You should allow sufficient time to perform the examination.
A47
There is a suggested equipment list at Annex 1.
A48
You must record all clinical findings. You must do this legibly and at the time of the examination, or as soon as possible afterwards.

References

19 Opticians Act 1989 s36(2) [Accessed 18 Nov 2020]
20 Opticians Act 1989 s26(1)(a)  [Accessed 18 Nov 2020 ]
21 Sight Testing (Examination and Prescription) (No 2) Regulations 1989 SI 1230 s3(1)(a). [Accessed 18 Nov 2020]
A49
When conducting a routine eye examination, you should:
  1. make it clear to the patient whether you will carry out the examination under the NHS or privately
  2. agree payment for any private services in advance
  3. use your professional judgement to decide how to serve a patient who is unable or unwilling to pay a private fee and is not eligible for NHS services. The lowest level of service that is acceptable is to direct them to emergency medical care. Record your actions and reasons for them.
A50
You must not charge for any procedure you undertake as part of a General Ophthalmic Services (GOS) sight test in England, Northern Ireland, Scotland and Wales, if the sight test is funded by the NHS.
A51
You must conduct an adequate assessment for the purposes of the optical consultation22 (refer to COVID-19 guidance). This should normally include:
  1. asking for and accurately recording:
    • full name
    • address
    • other contact details
    • date of birth
    • reason for visit
    • history including description of onset, character and duration of signs and symptoms
    • if relevant, history of ocular and general health
    • current general health, including whether the patient smokes if relevant. The GOS in Scotland requires that a record be made of whether the patient smokes23
    • medication
    • family history of ocular and general health
    • visual needs in terms of occupation, recreation or general activities
    • whether the patient drives, with or without prescription
    • details of previous optical prescription and date of last eye examination. Ask for the patient’s best estimate if the date is unknown
  2. determining and recording the  aided vision of each eye with the patient’s existing correction, together with the specific prescription used. If this is not possible, or inappropriate, you should determine and record the patient’s unaided vision of each eye
  3. assessing and recording habitual ocular muscle balance and the method used, at least cover test, for distance and near. This should be done with the habitual prescription and/or without the prescription, if appropriate

  4. examining the eye internally and externally. As a minimum for internal examination, you should use direct ophthalmoscopy on the undilated eye, although alternative methods may be used. If you cannot obtain an adequate view of the fundus, you should dilate the patient’s pupils and/or use indirect methods of fundal examination. You should use slit-lamp biomicroscopy particularly where a detailed view of the anterior eye and adnexa is required
  5. establishing the prescription required and the visual acuity of each eye individually.
A52
If you feel it is clinically appropriate or your contract requires it, you may (refer to COVID-19 guidance): 
  1. measure convergence
  2. assess ocular motility
  3. assess pupil reflexes
  4. determine objective refractive findings, using autorefractor and/or retinoscopy
  5. use fundal or other imaging
  6. measure intraocular pressure for patients at risk of glaucoma, see Examining patients at risk from glaucoma
  7. assess visual fields, especially for those patients who are at risk of glaucoma. See section on Examining patients at risk from glaucoma
  8. repeat certain tests to eliminate spurious results
  9. perform binocular balancing and measure binocular visual acuity
  10. assess fixation disparity, for example if the patient has symptoms or shows a deviation on cover test
  11. assess accommodation, for example to determine any reading additions for intermediate and/or near tasks.
A53
When you have completed the tests you should tell the patient what you have found and what you would recommend. You should also recommend when they should have their next eye examination.
A54
You should provide patients with leaflets about the most common eye conditions, as appropriate.24
A55
You must only issue a prescription for the correction of visual defects when it is clinically justified and in the best interests of the patient.25 In all other cases, give the patient a written statement confirming a correction is not required or that there is no change in the current prescription. You should note on the prescription whether the patient is registered as sight impaired or severely sight impaired. This is because their spectacles can only be dispensed by, or under the supervision of, a registered optometrist, dispensing optician or doctor.
A56
If you examine a patient who might have an eye condition or eye surgery that may change the prescription in the short- to medium-term, you should consider carefully whether it is in the patient’s best interests to have new spectacles. You should explain the benefits and disadvantages of prescribing spectacles that will be appropriate only for a short time.
A57
If you are referring the patient, see section on Working with colleagues for further guidance.
A58
You should record any information you have given to the patient.
A59
You may need to justify your actions at a later date, so if you decide not to conduct particular tests that would normally be expected, you should record the reasons for not carrying out those tests. You should remember that when conducting a sight test, certain tests are required by law, see paragraph A44.
A60
You should examine patients at the most appropriate intervals, depending on their clinical needs. This applies to both private and NHS patients.26
A61
Contact lens patients may need more frequent appointments for aftercare but are not entitled to more frequent NHS sight tests simply because they wear contact lenses.
A62
In the absence of clinical indications, you should not recall patients more frequently than the following intervals:
 
Patient age and/or condition  Recommended minimum re-examination interval

The intervals given below should not be taken as applying automatically to all patients in a category.
 

Up to 16 years old, no binocular vision anomaly or refractive error   One year
under seven years old, with binocular vision anomaly or corrected refractive error   Six months
Seven-15 years old, with binocular vision anomaly or rapidly progressing myopia   Six months
16 years old and over   Two years
with diabetes who are part of diabetic retinopathy monitoring scheme   Two years
with diabetes who are not part of diabetic retinopathy monitoring scheme   One year
A63
To ensure refractive error is optimally corrected, it may be appropriate to examine children who are myopic, or at risk for myopia, annually until the age of 12-13 years, and every two years thereafter’.27
A64
In the absence of clinical indications, you should not examine patients who are being monitored by the hospital eye service more frequently than every two years.

References

26 General Optical Council (2016) Standards of Practice for Optometrists and Dispensing Opticians para 7.6 [Accessed18 Nov 2020]
27 College of Optometrists (2016) Member briefing on The Northern Ireland Childhood Errors of Refraction (NICER) study on myopia  [Accessed 18 Nov 2020]
A65
Clinical circumstances may justify recalling a patient earlier than the intervals set out above, including patients:
  1. of any age with refractive error that is changing rapidly, or who are at risk of such changes, for example patients:
    • newly diagnosed with diabetes whose condition you have decided to manage, rather than refer
    • with a suspect visual field on one visit that is not confirmed on repeat
    • with abnormal IOP with no other significant signs of glaucoma
  2. who are identified in protocols as needing to be seen more frequently because of risk factors, for example risk of developing glaucoma. See section on Examining patients at risk from glaucoma
  3. with pathology likely to worsen.
A66
You should record reasons for early recall of any patient.
A67
You may have patients requesting early re-examination because they:
  1. have been referred by a GP
  2. present with symptoms or concerns that you can only resolve with an eye examination.
A68
You should note the reasons for early re-examination of any patient.
A69
There will be cases when patients have symptoms, for example headaches, where no ocular cause can be found after examination.
A70
You do not need to re-examine a patient who has broken their spectacles and has no clinical need for examination.