COVID-19: College guidance

Our regularly updated clinical and professional guidance is cited by NHS England and all the UK health authorities, and has been developed to ensure that you can practise safely and effectively through all phases of the pandemic.

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Current COVID-19 status in the UK


Summary of optometric primary care during the pandemic 

We have summarised our COVID-19 guidance below, but more detailed guidance on how to adapt your practice during the red and amber phases can be found in our Primary eye care COVID-19 pandemic guidance.

To help our members understand how each Nation’s tiers/levels relate to The College’s red and amber phase we have reviewed and updated the definitions.  In order to enter The College’s Red phase a Nation’s government or health system should specify a restriction of primary care services. Eye care and routine sight tests are an essential public health function, which should continue to be available for the public to access wherever possible, providing it is safe to deliver.

General guidance during the pandemic

During both the red and amber phases of the pandemic practices should:

Optometrists should:

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Red phase specific guidance

What this means:

  • When a government or health service suspends routine primary care due to the COVID-19 pandemic.

Services provided

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Amber phase specific guidance

What this means:

  • Ongoing COVID-19 pandemic with restrictions in place, but primary care remains open for routine services. Primary care services continue to enable the prioritisation of emergency/urgent and essential care on a needs and symptoms-led basis.

Services provided

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Green phase specific guidance

What this means:

  • Social distancing requirements removed. COVID-19 related PPE is no longer required. Prioritisation of care based on each nation’s regular local protocols.

Services provided

  • Resume all services on an open access basis.
  • Re-introduction of aerosol generating procedures

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Detailed guidance

The College of Optometrists Primary eye care COVID-19 pandemic guidance

This guidance is to help optometrists understand how to adapt their working practices when in the red (lockdown) and amber (recovery) phase of the coronavirus (COVID-19) pandemic.


COVID-19 pandemic modified sight test


Modification during red phase

Modification during amber phase


Remote or at a social distance


Consider if needed if asymptomatic


As clinically necessary.  Consider if needed if asymptomatic.

Pupil reactions

Ext/ant segment examination

Slit lamp


Slit lamp.  Alternatively: retinoscopy to gauge if fundal reflex clear.  If opacities detected, slit lamp to identify location of opacities

Fundal examination

Fundal imaging where available.  Consider whether additional method needed based on patient’s clinical circumstances.

Use SL or headset-BIO where possible.   Fundal imaging where available.  Fundal imaging alone1 may be sufficient if the patient is asymptomatic, the image is clear and the field of view is sufficient considering the patient’s clinical circumstances.

Direct ophthalmoscopy

Risk assess, and only use when alternative methods unavailable.


As clinically necessary



If clinically necessary.

Retinoscopy reflex helpful to determine clarity of ocular media.

Subjective refraction

Only if clinically necessary.  Streamlined.

Streamlined if no symptoms and VA good with current specs.


As clinically necessary

Colour vision


As clinically necessary – use stand mounted tonometer if possible.  If not possible, risk assess whether to use hand held device.

Visual fields

As clinically necessary.  Consider omitting if discs and IOPs unchanged since previous visits, and no other relevant signs/symptoms.

Advice given

Give at a social distance

1 If a fundus image is used as the only form of internal ocular examination, this must be conducted by the optometrist conducting the sight test (Sight Testing (Examination and Prescription)(No 2) Regulations 1989 para 3(1)(a)(ii)).

Download this table as a PDF (397KB).


Additional COVID-19 College guidance