Clinical notes

College Clinical Advisers, Dr Susan Blakeney FCOptom and Daniel Hardiman-McCartney FCOptom, produce our clinical notes for members - informative, thought-provoking and supportive essays on the world of optometry.

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30 Apr 2021 Acuity

Clinical notes: It's your call

Daniel Hardiman-McCartney FCOptom, Clinical Adviser for the College, on the vital importance of professional judgement.

Contact lenses Public health
29 Jan 2021 Acuity

The vision for the new normal

Daniel Hardiman-McCartney on harnessing the momentum generated in response to the pandemic.

COVID-19 Public health



28 Oct 2020 Acuity

The misinformation public health threat

Clinical Adviser for the College Daniel Hardiman-McCartney FCOptom on the epidemic of fake news that has accompanied COVID-19.

Public health
30 Jul 2020 Acuity

Have I ‘covered myself’?

Doing the best for your patients isn’t the same as just following procedures, writes Dr Susan Blakeney FCOptom, Clinical Adviser for the College.

30 Apr 2020 Acuity

Difficult times

Amid the upheaval caused by COVID-19, Dr Susan Blakeney FCOptom, the College’s Clinical Adviser, asks if one of the unexpected consequences of the crisis could be positive clinical change.

30 Jan 2020 Acuity

Not wagging the dog

The College’s Clinical Adviser, Susan Blakeney FCOptom, looks back at how technology – guided by sensible clinical judgement – has been used to improve optometric practice over the decades.



31 Oct 2019 Acuity

Who’s calling?

The College’s Clinical Adviser Dr Susan Blakeney FCOptom deals with anonymous enquiries and her favoured order of routine tests.

31 Jul 2019 Acuity

Questions & considerations

Asking patients what they want, videoing consultations and customer service. The College’s Clinical Adviser Dr Susan Blakeney FCOptom provides some food for thought.

8 May 2019 Acuity

The visual insurance policy field

The College’s Clinical Adviser Dr Susan Blakeney FCOptom on the lessons learned from a case of quadrantopia.

28 Feb 2019 Acuity

Teamwork in trouble

The College’s Clinical Adviser Dr Susan Blakeney FCOptom on defensive practice gone mad, and how to manage patients who buy lenses online.



30 Nov 2018 Acuity

Face time with a Clinical Adviser

Beware the pitfalls of assumption, says College Clinical Adviser Susan Blakeney FCOptom.

13 Jul 2018 Acuity

How to handle complaints effectively

Complaints are inevitable, but the College's Clinical Adviser Dr Susan Blakeney FCOptom offers advice on how to defuse them.


Fundus examination

How do you examine the fundus? As you know, it is a legal requirement to conduct an internal and external examination of the patient’s eyes whenever you do a sight test.



Patients’ best interests

We should always act in the patient’s best interests. However, how do you decide what is in the patient's best interests? What if a patient questions why you have decided to do what you have decided to do (or not do)? How can you justify this?


What do you do if you wish to recommend an intervention to a patient that is not mainstream practice or supported by evidence?

Prescription copies

I sometimes get asked what is ‘legally required’ if a patient asks for a copy of their prescription.



Instilling drops

What do you do when you examine a pre-school child? Do you feel comfortable instilling cycloplegic drops? If so, what technique do you use on a wriggling child?

Delegation and record keeping

Delegation and record keeping - make sure you understand your responsibility and liability.

Following up on referrals and diabetic retinopathy screening

'We should all be honest with our patients, and tell them what is wrong, rather than trying to shield them from it' - advice on keeping your patients informed, and on following up on referrals.

On reflection...

Measuring change - establishing what is normal for your patient and when you should take action. Also, how regular reflection can lead to positive change and a look at the role for the Snellen chart in modern practice.



Good advice on getting good advice

When it comes to diagnosing and managing patients, no one is expected to have all the answers. Dr Susan Blakeney, Clinical Adviser, has some good advice on getting good advice.

Appropriate advice, clinical decision making and more

A comprehensive approach to clinical decision making and a look at the new packaging on Bausch & Lomb’s Minims.

New Scottish guidelines for glaucoma referral

Glaucoma referral and safe discharge - lessons to be learnt from the new Scottish Intercollegiate guidelines.

Can attempts to detect a disease early lead to harm?

It is intuitive that the earlier you detect a disease the better, as the more effective the treatment is likely to be. But is this really the case?



When to intervene

How much information should you share with your patient? And when is doing nothing the best course of action?

Error avoidance

Changing your practice systems and minimising your chances of making mistakes.

How symmetrical are you?

Bearing in mind that the art of detecting (early) glaucoma is in looking for changes in the optic disc appearance, along with other signs, it is very important not to record asymmetrical CDRs as being symmetrical.

What do you think is wrong with the patient?

Colleagues can provide fresh ideas and invaluable advice and guidance on dealing with patients.



When is a change not a change?

How do you decide whether or not an apparent change you find in the patient's prescription is clinically necessary or not?

Choosing wisely - helping your patient to make smart and effective care choices

The American Academy of Ophthalmology lists five things that physicians and patients should question:

You don't have to know everything.

There is no shame in saying you don't know - but you are going to investigate further.



Detecting change

The importance of good record keeping in detecting and monitoring change.

Patient preference

How much do we consider patients' preferences in practice, and to what extent should we do so? Also, prescribing contact lenses for patients with out-of-date spectacle prescriptions.

Referring patients

Are you up to date with guidance on patient referral?

Record keeping, again!

Good practice in record keeping.



Quality in optometry

Full accurate and contemporaneous' record keeping for contract compliance.

Doing the right thing, in the right place, at the right time

How can we improve quality of service within the NHS while reducing budgets?

When to prescribe a plano lens

We need to ensure that patients are as comfortable as possible following cataract surgery.

Fields and pressures

Is there any value in carrying out tests 'just in case'?




Possible visual side effects of the human papillomavirus vaccine to prevent cervical cancer.

Contact lens supply, aftercare and recent sight test

Should you carry out a contact lens check-up before supplying further contact lenses?



Visual field tests

Visual field tests are invaluable, but it's important to consider their limitations and the effect that they have on your patients.

Contact lens specification, Swine 'flu and more

Brief notes on the topical issues of 'allowing' your patients to buy their contact lenses online, infection control in practice and an update on the College's guidance on supervision of dispensing to a person under the age of 16

Completing prescriptions

Clarification on who should sign a patient's prescription.

Infection control and internet dispensing

Latest College guidance on infection control and your patients' rights with regards to supplying their prescription.



Prescriptions and annual 'sight tests'

In her latest Clinical Notes, Dr Susan Blakeney FCOptom, talks about whether you can or should sign copy prescriptions for patients you haven't seen.

Laser refractive surgery and OPO

RCOphth has introduced a new assessment for laser refractive surgery, plus two papers from the latest OPO you might find particularly interesting.

Cycloplegia and infection control

In her latest Clinical notes, Dr Susan Blakeney FCOptom, asks when do you cyclo a child? Plus, what should you be doing about infection control?


Dr Susan Blakeney FCOptom
Clinical Adviser, College of Optometrists

Susan graduated from City University. After a pre-registration year in multiple practice she was awarded the President’s Prize from the College. Since then, she has completed both bachelor and master of laws degrees and a PhD. She obtained a MA in Medical Ethics and Law from Kings College London and has completed the post graduate ophthalmic public health module at Leeds University. Susan was awarded Fellowship of the College in 2009.  She has completed the College’s Professional Certificate in Glaucoma and the Professional Certificate in Medical Retina. She currently practises part-time in independent practice, is a clinical adviser to the College of Optometrists, Optometric Adviser to NHS England, South (South East) and a Case Examiner for the General Optical Council.

Daniel Hardiman-McCartney FCOptom
Clinical Adviser, The College of Optometrists

Daniel graduated from Anglia Ruskin University, where he won the Haag Strait prize for best dissertation. Before joining the College, he was Managing Director of an independent practice in Cambridge and a visiting clinician at Anglia Ruskin University. He has also worked as a senior glaucoma optometrist with Addenbrooke’s Hospital in Cambridge, with Newmedica across East Anglia and as a diabetic retinopathy screening optometrist. Daniel was a member of Cambridgeshire LOC from 2007 to 2015 and a member of the College of Optometrists’ Council from 2009 to 2014, representing its Eastern region.  

He is Clinical Adviser to the College of Optometrists for four days each week, dividing the remainder of his time between primary care practice and glaucoma community clinics. Daniel is a passionate advocate of the profession of optometry, committed to supporting all members of the profession and ensuring patient care is always at the heart of optometry. He was awarded Fellowship by Portfolio in December 2018.