COVID-19: FAQs

Read on for the answers to your COVID-19 questions, covering a range of topics from driving and HES referrals to PPE and tonometry.

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If you are a College member and you’ve checked the FAQs and the Guidance and you still can’t find an answer to your question, you can contact our expert clinical advisers.

COVID-19 vaccination

I occasionally work in a care home. Is it a requirement to have a COVID-19 vaccination?

England
From 11 November 2021, anyone working or volunteering in a care home will be required to be fully vaccinated against coronavirus (COVID-19) unless medically exempt. 16 September is the last date to receive your first dose in order to be fully vaccinated in time to comply with the change in the rules. The College of Optometrists Guidance for Professional Practice (B36) states you should keep up to date with immunisation. If you cannot have the COVID-19 vaccination, you should speak with your employer and representative organisation.

More information: GOV.UK, Vaccination of people working or deployed in care homes: operational guidance

Scotland, Wales and Northern Ireland
It is strongly recommended all health care professionals are fully vaccinated against coronavirus (COVID-19) unless medically exempt. Although it is not a regulatory requirement, it may be a condition of your employment – for current employment contracts this would need to be discussed. For new employees, this could be specified as a contractual requirement of employment. The College of Optometrists Guidance for Professional Practice (B36) states you should keep up to date with immunisation. If you cannot have the COVID-19 vaccination, you should speak with your employer and representative organisation. 

 

Issued in conjunction with The Association of British Dispensing Opticians (ABDO)

Updated: 24 August 2021

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Can a person still spread the virus to others if they have been vaccinated?

Yes. You may still carry and transmit the virus, as it is still uncertain whether the vaccination will prevent carriage of the virus in the nose and throat of people who have been vaccinated. The primary purpose of the vaccine is to prevent you from becoming unwell from COVID-19 infection.

Updated: 18 February 2021

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If a person has received the vaccination should they continue to use PPE and follow social distancing in clinic?

Yes. You should continue to follow social distancing and infection prevention controls in practice, including the wearing of PPE. The primary purpose of the vaccine is to prevent you from becoming unwell from COVID-19 infection and may also reduce the chances of you being able to spread the infection by coughing less. However, you may still carry and transmit the virus, as it is still uncertain whether the vaccination will prevent carriage of the virus in the nose and throat of people who have been vaccinated. The effectivity of the vaccine may also vary with new and emerging variants of COVID-19.

Updated: 18 February 2021

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If a person has received the vaccination and is subsequently notified that they have been in direct contact with a positive case - are they still required to isolate?

The requirement to isolate is currently under review in each nation, check your nation's government website. We will update this when each nation has confirmed its policy.

Updated: 22 July 2021

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Can the COVID-19 vaccine lead to people having a positive COVID-19 PCR test

No. The vaccines being used produce a protective immune, antibody, response which can be measured by blood tests. However, they should not affect a PCR swab test, which is the basis of diagnosing COVID-19 in the nose and throat. They also do not affect the results of lateral flow test. PCR tests will be used as part of the vaccine effectiveness assessment in those who are vaccinated and subsequently develop symptoms of COVID-19.

Last updated: 18 February 2021

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Should I continue to participate with lateral flow tests if I have had a COVID-19 vaccination course?

Yes, until more information becomes available, you should continue to complete the test twice weekly. It is important you report the result for every test you complete accordingly on the web portal.

Updated: 22 July 2021

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Will having the COVID-19 vaccine interfere with the lateral flow test results?

No. The vaccine will induce an immune response but this should not affect the lateral flow test. If you test positive with a lateral flow test you should self-isolate and arrange a PCR test. The vaccine is not 100% effective, so there will be some cases where clinicians who have been vaccinated contract COVID-19. 

Updated: 18 February 2021

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After recovering from COVID-19

If a member of the practice team has a positive PCR COVID-19 test, when should they start the lateral flow antigen tests again?

If you have tested positive for COVID-19 you should recommence lateral flow tests 90 days after their positive test was taken. 

Updated: 18 February 2021

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If a member of the practice team has had a positive PCR test and recovered from COVID-19, should they still self-isolate if they are subsequently exposed to a positive contact?

The requirement to isolate is currently under review in each nation. Check your nation's government website, and we will update this when each nation confirms its policy.

Updated: 22 July 2021

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Sources

 

Patients without face coverings

There can be several reasons why a patient might not be wearing a face covering, including forgetting to bring one to their appointment, being unable to wear one or refusing to wear one out of preference. You need to consider each individual case to decide on the best action to take. To help we have produced the following frequently asked questions, which have been co-written by The College of Optometrists, ABDO, the AOP and FODO:

What should I do if a patient forgets their face-covering?

You may offer them a surgical mask to wear or rebook them in for their appointment as clinically appropriate. If they decline to wear one, please refer to the relevant FAQ.  

Updated: 22 July 2021

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What should I do if a patient is unable to wear a face covering?

If a patient tells you they are unable to wear a face covering, the practice should endeavour to accommodate the patient so they can still access eye care.  

It is important to follow official guidance at all times. For example, you should not insist on evidence or proof of their disability or medical condition, as it should be presumed that the patient is acting in good faith. In most cases however patients will provide this information when they explain why they are not wearing a face covering.  

It is also important to remember that a practice should not refuse to see people on the grounds of their disability or medical condition if they can make a reasonable adjustment to accommodate that patient.  

Patient face coverings are just one of many IPC steps designed to help protect practice staff and patients and practice. Even where a person cannot wear a face covering (for a medical reason) but needs to access face-to-face eye care then, the other steps combined help minimise the risk of COVID-19 transmission. This is why your practice should establish a plan of how to provide eye care to patients who it is impossible to wear a face-covering due to their disability or medical condition. This may include: 

  1. offering the patient a remote eye care appointment and the opportunity to postpone their face-to-face appointment if they are asymptomatic.  
  2. arranging an appointment at time during a quiet period when they may attend, when fewer people are in the practice - as the patient will also want to reduce risk when they are travelling to and from the practice  
  3. using the largest consulting room available. 
  4. streamline the appointment as recommended in the College COVID-19 guidance, use imaging where possible, avoid the use of handheld instruments and complete as much of the examination remotely, to minimise the time required face-to-face. 
  5. asking the patient if they would be able to wear a mask for a short period of time while the optometrist performs the internal examination while they are closest.   

If as a result of an individual risk assessment there is no one in the practice team who are able to examine patients who cannot wear a face covering, the practice may be in a position where it is unable to meet the patient’s needs safely – ie. make the reasonable adjustments required. In this situation the practice should explain the situation and refer the patient to another local provider. You should keep a record of when you do this and the reasons given to the patient. Having this arrangement in place locally should be agreed in advance with other local practices. 

Updated: 22 July 2021

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What if a patient refuses to wear a face covering out of personal choice?

If patients do not have a medical reason for the being unable to wear a face covering, yet refuse to wear a mask, you have the right to refuse to see them if your practice has carried out a workplace risk assessment that concludes face coverings is a necessary infection prevention and control measure – the safety of all patients and practice staff is paramount. However, you should take all reasonable steps to identify practical working solutions with the least risk to all involved on a case-by-case basis. Where available, continue to offer remote eye-care to this group of patients.

At present, there is no legal requirement for a patient to wear a face-covering in an optical practice. However, Public Health England, the College of Optometrists and the Association of Optometrists advise that they are worn at all times unless the patient is unable to wear one on the basis of health reasons or due to a disability. Government guidance states that people do not need to provide evidence of their disability or medical condition. 

Updated: 18 February 2021

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Can I refuse to examine a child who is not wearing a mask?

Although you may politely encourage children to use a face covering, you cannot insist that they do. Patient face coverings are just one of many IPC steps designed to help protect the practice. Even where a person cannot wear a face covering, the other steps combined help minimise the risk of COVID-19 transmission. 

Your practice should establish a plan of how to provide eye care to children. This may include: 

  1. offering the child and parent a remote eye care appointment and the opportunity to postpone their face-to-face appointment if they are asymptomatic.  
  2. arranging an appointment at time during a quiet period when they may attend, when fewer people are in the practice 
  3. using the largest consulting room available.  
  4. streamline the appointment as recommended in the College COVID-19 guidance, use imaging where possible, avoid the use of handheld instruments, and complete as much of the examination remotely as possible, to minimise the time required face-to-face. 
  5. asking the child if they would be able to wear a mask for a short period of time while the optometrist performs the internal examination while they are closest. 

If as a result of an individual risk assessment there is no one in the practice team who are able to examine children who do not wear a face covering, the practice may believe it is unable to make provision for children the practice may refer the child to another local provider who can provide GOS funded sight tests. This should be agreed in advance. You should make a record where you refer a person to another practice and the reason why.  Public Health England does not recommend face coverings for children under the age of 3 for health and safety reasons. 

Updated: 22 July 2021

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I am at a high risk of developing or being affected by COVID-19 - can I refuse to see patients who do not wear a face covering?

You should refer to the FAQs above, as practice processes should account for your risk assessment. If you are returning to work and have not yet had a risk assessment your employer should arrange this for you, alternatively you can access a template here.  
 
Depending on your individual circumstances you might be advised to work remotely or in-person but at a distance of more than 2m or more.  
 
If you feel your health is negatively affected by your working conditions, you should discuss this with your employer in the first instance – they must perform a workplace risk assessment to help protect you from coronavirus: Risk assessment - Working safely during the coronavirus (COVID-19) pandemic. The result may be that children or patients who are unable to wear a mask due to a medical reason are triaged to another clinician in your practice, or if you are a sole clinician, those patients can be referred to another local practice. This should be agreed in advance. You should make a record where you refer a person to another practice and the reason why. 

Updated: 18 February 2021

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Amber phase

Can I see routine patients during the amber phase of the COVID-19 pandemic?

Amber Phase guidance prioritises emergency/urgent and essential care on a needs- and symptoms-led basis, but still allows for patients to book a face-to-face appointment with an optometrist if, after undertaking phone triage, it does not put the patient at risk and that they have the capacity to provide it without compromising IPC. For example, leaving adequate time between appointments to ensure that examination rooms are sufficiently cleaned. Optical practices should balance both the patient's risk of COVID-19 and their eye health when booking appointments. During lockdowns, all asymptomatic routine patients at higher risk of COVID-19 should be offered the choice to defer their appointment.. 

Updated: 22 July 2021

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COVID-19 levels are higher than they were during the previous lockdowns. Why is the College advising that optometrists are in Amber Phase and not Red Phase?

Red Phase guidance relates to a situation where primary care health services are suspended. This is not the case during the present lockdown and patients are still able to access their GPs, dentists, pharmacists and optometrists. Each nation's government has stated that during this lockdown, primary care services should remain open to provide care wherever possible and where it is safe to do so. The College is supportive of keeping primary care services open.  We believe if they were close, this would lead to increased pressure on eye care services and the NHS now and in the future, and would lead to vision loss and other eye health issues that could have been avoided prevented or successfully treated/managed if they were identified in time. 

Amber Phase guidance prioritises emergency/urgent and essential care on a needs- and symptoms-led basis, but still allows for patients to book a face-to-face appointment with an optometrist if, after undertaking phone triage, that it does not put the patient at risk and that they have the capacity to provide it without compromising IPC.  For example, leaving adequate time between appointments to ensure that examination rooms are sufficiently cleaned. Optical practices should balance both the patient's risk of COVID-19 and their eye health when booking appointments. During lockdowns, all asymptomatic routine patients at higher risk of COVID-19 should be offered the choice to defer their appointment.

Since the first lockdown in March 2020, there has been robust guidance on adapting practice to reduce the risk of spreading COVID-19. At present, there is no evidence to suggest that current PPE and IPC measures is insufficient to protect against the virus and new variants of concern. Practices can now access equipment for twice-weekly lateral flow testing, and will continue to be prioritised for COVID-19 vaccinations.

The College’s Amber Phase guidance is supported by the GOC, AOP, FODO, Optometry Wales, Optometry Scotland and PHE.

Updated: 22 July 2021

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Is there a disparity between GOS and private provision?

We advise that our guidance on which patients should be seen applies equally to NHS and non-NHS funded care.

Updated: 9 September 2020

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What resources does the College have in place for members?

We provide a range of resources for optometrists to use in practice or remotely, including template forms, posters and downloads, and a visual acuity chart and other resources for remote consultations. Some of these have been developed exclusively for our members. Find out more.

Updated: 9 September 2020

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Business

Someone in my household has been diagnosed with COVID-19 following a PCR test. I have no symptoms and am fully COVID-19 vaccinated. Can I continue to work in my optical practice?

England
You need to self-isolate and arrange a PCR test in line with government guidance – link below. You should notify your employer as soon as possible.

In general circumstances, your senior manager will ask you to self-isolate, this is because the risk of COVID transmission may be higher for people within your home than a single episode of a COVID-19 close contact in another environment.

If your PCR test is negative and you continue to be asymptomatic, you could return to work provided all other contingency measures have been explored based on a risk assessment conducted by an appropriate senior manager within the optical practice. The risk assessment should be documented and demonstrate the decision made is in the public interest and available for review upon request of an appropriate authority. (e.g. a local health protection team) A daily LFD should be undertaken for ten days. You should continue to wear PPE and conduct IPC in the practice communal areas, as well as private staff areas. Clinicians in this situation should not provide direct patient care to people aged over 80 or extremely clinical vulnerable patients.

We expect practice managers to only use this option when absolutely necessary in order to deliver essential eye care.

More information: NHS England, Updated guidance on NHS staff and student self-isolation return to work following COVID contact.    

Scotland
Yes. You can continue to work provided you have a negative PCR test, no symptoms and follow the conditions set out by The Scottish Government. (See link below) Clinicians in this situation should not provide direct patient care to people over 80 or extremely clinically vulnerable patients. We expect practice managers to only use this option when absolutely necessary in order to deliver essential eye care. 

More information: DL(2021)24 - Update on isolation exemptions for Health and Social Care staff

Northern Ireland
No. If you are a fully vaccinated, health and social care worker and identified as a close contact (including a household member), you may not be able to attend the workplace during the 10 day period following last contact. You should refer to the separate guidance for health and social care workers and discuss with your manager if you can attend the workplace. (Only occur in exceptional circumstances, following a risk assessment carried out by a suitably competent and authorised manager in the organisation and when additional mitigations can be upheld would you be permitted to return to the workplace.)

More information: Department of Health Northern Ireland, Fully vaccinated health & social care staff told to self isolate as a close contact may be permitted to attend work in exceptional circumstances

Wales 
You need to self-isolate and arrange a PCR test in line with government guidance – link below. You should notify your employer as soon as possible.

In general circumstances, your senior manager will ask you to self-isolate, this is because the risk of COVID transmission may be higher for people within your home than a single episode of a COVID-19 close contact in another environment.

If your PCR test is negative and you continue to be asymptomatic, you could return to work provided all other contingency measures have been explored based on a risk assessment conducted by an appropriate senior manager within the optical practice. The contractor should make decisions about this process in line with the criteria set out by the Welsh government but must advise the health board about their approach. A daily LFD should be undertaken for ten days. You should continue to wear PPE and conduct IPC in the practice communal areas, as well as private staff areas. Clinicians in this situation should not provide direct patient care to people aged over 80 or extremely clinical vulnerable patients.

We expect practice managers to only use this option when absolutely necessary in order to deliver essential eye care.

More information: Welsh Government, COVID-19 contacts: guidance for health and social care staff

 

Updated: 22 October 2021

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Should I display a NHS QR code in the practice window or maintain a log of people who visit the practice for unplanned appointments?

As a healthcare setting there is no requirement to display a NHS QR code in your practice at present. Most people attending the practice will be registered in the appointment book and will have undergone an initial triage and check for symptoms of COVID-19 for either themselves or their household. In addition you should have effective infection control procedures in place. Where there are unscheduled visits to the practice for browsing, collections or repairs, in our view there is no requirement to keep a list of attendees for short duration visits as long as social distancing is maintained and staff are wearing appropriate PPE.

Updated: 22 July 2021

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Should I use the NHS Test and Trace or Protect Scotland app on my phone while at work in a healthcare setting?

The government recommends that healthcare workers working in a healthcare setting, such as an optometry practice, pause the Test and Trace app or turn off their 'Bluetooth' while at work. This is important so that a smartphone in a locker is not incorrectly recording interactions with patients visiting the practice.

Updated: 13 October 2020

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Do staff who work behind a screen or who are more than 2m from patients have to wear a face covering?

We recommend that all staff wear a fluid resistant surgical mask to protect their patients, colleagues, and themselves. This applies even if they are working behind a screen. 

Updated: 22 July 2021

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A patient has come in to the practice and now told me that he has tested positive for COVID-19. Do any of the staff need to self-isolate?

The requirement to isolate is currently under review in each nation. Check your nation's government website, and we will update this when each nation confirms its policy.

Updated: 22 July 2021

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How can I access information to give to patients?

Our patient information on a range of conditions, including AMD, blepharitis and flashes and floaters, is available for free on lookafteryoureyes.org  – our public website. We recommend that you direct your patients here for phone- and desktop-friendly information during the lockdown period.
 
You can also link straight through to lookafteryoureyes.org from your practice website.
 
Our printing company are unable to fulfil orders for printed patient leaflets at this time, so we have also temporarily made our patient leaflets available online. Members can fill in our form to receive PDF versions to use for the duration of the lockdown only. The PDF versions were not designed for use on websites, so please direct your patients to lookafteryoureyes.org in the first instance.

Updated: 22 July 2021

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I have been advised to self-isolate by the Test and Trace / Test and Protect team, but I disagree with their advice. What should I do?

Patients who attend optical practices and who subsequently test positive for COVID-19 are not generally considered contacts for NHS Test and Trace/Test and Protect purposes when the practice has been following IPC procedures and practitioners have been wearing PPE properly when they were in contact with the patient.

Each Test and Trace/Test and Protect call handler is a clinician who will make a clinical judgment about the risk of each person's interaction but may not fully understand the nature of primary eye care and how IPC in our sector operates.

If you are contacted by NHS Test and Trace/ Test and Protect call handler, it is essential you explain to them that the contact was within a healthcare setting and to describe the PPE you were using and the IPC procedures you were following.

If you are asked how long you spent with the contact, make sure you let the call handler know BOTH the total duration of the sight test AND how long you were close proximity to the patient. For many contacts, proximity will be a relatively short period of time. (Such as the time at the slit lamp, behind the slit lamp Perspex screen, with the rest of the consultation performed at two meters or more.)

If you believe the call handler has incorrectly assessed the risk of the interaction, you should escalate the decision by requesting a second opinion. This is an accepted part of the internal process at NHS Test and Trace/ Test and Protect and will not cause offence.

If, after the escalation request and further discussion, it is decided you did not have a close contact and can return to work, you can then do so. However, it is a legal requirement to follow the advice of the call handler, including isolation for 14 days, even if you believe this to be an incorrect decision.

If you had to escalate a decision, or believe the advice was incorrect, please contact the College or your representative body so we can collectively collate examples to feedback via the College to the relevant NHS tracing service.

Added: 22 July 2021

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Personal protective equipment (PPE) and infection control

Are current IPC and PPE effective against the new strains of COVID-19?

(Answer from Public Health England) 
Current research and expert opinion suggests that existing guidance on IPC and recommended PPE are effective against new strains of the COVID-19 virus. A peer review undertaken by an expert group of clinicians to assess the new variant strains (SARS-CoV-2 VOC-202012/01 and UK VOC122020/02) identified that there was no change in the mode of transmission between the variants and previous circulating strains of COVID-19, and there was, therefore, a consensus that there are no changes to the recommendations set out in the IPC guidance at this stage. The Scientific Advisory Group for Emergencies (SAGE) has also advised that there is currently no evidence of any association between the new variant and increases in transmission in particular settings, differences in routes of transmission, or different survival on surfaces.

The NHS issued a CAS alert on 24 December outlining actions for the NHS to take in response to the variants.

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Are optometrists considered to be frontline health workers in terms of eligibility for COVID-19 vaccination?

All UK governments are following JCVI guidance on prioritisation for the Covid-19 vaccination, which means all practice staff and visiting clinicians with patient-facing roles, including pre-registration trainees, will continue to be offered a vaccination along with all frontline healthcare workers. This applies equally to NHS and non-NHS funded care.

Updated: 22 July 2021 

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How should I don and doff outer wear and personal protective equipment when carrying out a domiciliary sight test?

When visiting a remote location whether this is a care home or an individual dwelling, it may be necessary to wear raincoats, hats or other outerwear. These clothes may be considered to be a possible vector for transmission of COVID19 (contamination outside to inside the care setting or vice-versa), and so should be considered as such during the visit.

Arriving
On arrival at the site of the visit outerwear should either be removed and left in the car or, if that is not possible, taken off at the entrance and placed in a clear disposable plastic sack. (A clear sack is advised so that any security concerns and inadvertent disposal of the sack as 'refuse' can be minimised.) The sack should be labelled and left at the entrance or as near to the entrance as security allows. The person in charge or another responsible person should be informed of the contents of the bag.

In some cases, it may be necessary to carry this bag into the room where the consultation is taking place in which case it should be left in a position as far from the patient as possible.

PPE should be donned at the car, if possible, or at the entrance to the premises, if not, once outwear has been removed and bagged, and hands sanitised.  

PPE must always be donned before entering a room where care is to be provided.

Leaving
If access to hand washing facilities is possible near the exit (eg a cloakroom), you should doff PPE there, wash your hands and put on any necessary outerwear. However, you must then maintain social distancing, not speak, and exit the building promptly.  

Doffing of PPE may also be performed at your car with the boot carefully prepared with an area for clean and dirty PPE.

Once outerwear is removed from a plastic sack and put on, the bag should be turned inside out, taken away and after 72 hour secure storage, disposed of in normal household waste. 

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Can I use UVC as a method of disinfection in primary care optometric practice?

A recent evidence review1 concluded that there is not sufficient evidence available to support the use of UVC as a method of disinfection in a health care setting, as such it should not be used as a method of surface disinfection in place of recognised methods of cleaning and decontamination as described in section 2 of COVID-19 guidance on Infection Control. Practices could choose to use UVC as a part of the process for sanitising delicate sample spectacles frames. However, we continue to recommend using liquid cleaning agents, as described in our guidance whenever possible.

Reference:

1. ARHAI Scotland. (Nov 2020) Rapid review of the literature – Ultraviolet light technology for decontamination of health and care settings in the context of COVID-19.  

Updated 2 December 2020

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Do I still have to wash my hands and use other infection control techniques if I wear PPE?

PPE is not a substitute for scrupulous hand-washing, which remain essential.

You should also continue to maintain a high standard of infection control every time. Clean the consulting room door handle, computer keyboard, slit lamp joystick and clinical area regularly with an alcohol wipe.

Updated: 22 July 2021

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Would optometrists be put under further pressure by being forced to train and supervise apprentices?

It would not be appropriate for any party, or from any perspective, to put staff under pressure to take on apprentices against their will. The knowledge, skills and support that staff need to facilitate high-quality work-based learning and development (including up to Master’s degree level, as proposed by the optometrist degree apprenticeship proposal) is significant. It requires strong working links between the clinical environments and the university delivering the academic learning components. 

The investment of time, professional development and support to staff who are called upon to support degree apprentices is significant, and something that employers must take into full account when determining their readiness and commitment to engage with the apprenticeship model. 

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Clinical

Can I use direct ophthalmoscopy?

We advise using SL-BIO rather than direct ophthalmoscopy so that you can maintain a safe distance from the patient as much as possible. However, we recognise that there are occasions where this is not possible, such as for very young children, or when the patient is unable to reach the slit lamp. Fundal imaging is a useful technique, but it does not replace the use of SL-BIO, as it does not examine the patient's external eye, anterior chamber, or media. We also recognise that not all practices have fundus cameras, and that there are some patients who cannot reach the camera. In these instances, as an internal examination is one of the legally required parts of a sight test, if there is no alternative but to use direct ophthalmoscopy, you should minimise the infection risk by asking the patient to wear a face covering if possible (this may not be possible for very young children).

Updated: 16 June 2020

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How do I conduct a telephone or video consultation with a patient?

We recognise that this is a very new situation for optometrists, so we have written guidance to help you consider how best to have a telephone or video consultation with a patient. We have also designed a telephone consultation record sheet which you may choose to use if you wish. It is important to realise that you still need to adhere to confidentiality and data security procedures.

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Should I complete pre-screening?

During the pandemic, we advise that you should only perform tests if it is clinically necessary, based on the individual patient circumstances, rather than doing it as a blanket test on everyone in a certain category. Tonometry and visual fields should be performed where it is clinically indicated or for considered at high risk by their optometrist on an individual basis. 

Updated: 19 June 2020

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Should I tell my patients to stop wearing their contact lenses during this pandemic?

There is no evidence to suggest that wearing contact lenses increases the risk of contracting COVID-19. Patients can continue to use their contact lenses as normal if they do not have COVID-19 or any of the associated symptoms.

It is good general advice for patients to reduce their contact lens wearing time if they do not need to wear their lenses and can manage with spectacles, as may well be the case if they are at home more. If they wish to wear their contact lenses you should stress to patients that they should practise good contact lens hygiene as always, and that thoroughly washing their hands before and after handling their lenses is essential. We would also advise that if patients are ill, they stop wearing contact lenses until they are better. This applies to all illnesses, including the common cold, influenza and COVID-19. If a contact lens wearer is in a household of another person with COVID-19, they may wish to cease contact lens wear until the whole household has recovered.

A paper on the important considerations for contact lens practitioners during the COVID-19 pandemic has been published here: https://www.contactlensjournal.com/article/S1367-0484(20)30055-2/fulltext

A paper on the important considerations for contact lens practitioners during the COVID-19 pandemic has been published here.

Updated: 22 July 2021

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I did not make up spectacles for a patient who I recently referred for cataract surgery. However, as their surgery is now likely to be delayed should I make them up some?

This is up to your professional judgement. We suggest you telephone the patient and explain the situation and ask them if they would like you to make up some spectacles for them.  If you have previous details you may be able to do this remotely (for example if they are happy for you to reglaze their spectacles, which they can post to you), and post the reglazed spectacles back to them.  If they would prefer to have a new frame then arrange for them to come into the practice for dispensing and take appropriate social distancing and infection control procedures as outlined above.

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How can I tell my patients to check their visual acuity remotely?

We have created a simple and easy to use visual acuity (VA) chart which patients can use at home. The chart has been designed to work at 3 metres, and will enable patients with access to an A4 printer to approximately measure their own visual acuity in advance of the remote clinical assessment. You can email the chart to patients, so a rough visual acuity can be recorded during the remote review.
 
The chart can be used at different distances to extend its range, we have included a conversion table so clinicians can easily record an approximate VA when used at 1 and 4 metres.
 
You can download and send the chart to your patients, or direct them to our public website, where they can also watch a video on how to use the chart.


Disclaimer: 

We have taken the steps necessary to ensure this test is broadly equivalent to a validated vision chart when it is used in a well-lit room, printed on an A4 size piece of white paper used at the correct distance.  However, our chart has not been independently validated as such, it is not a substitute for a vision assessment by a clinician using a correctly calibrated and validated vision test chart. The purpose of this College chart is to provide a broad evaluation of visual acuity in order to identify clinically significant sight loss in a home environment, in conjunction with a virtual clinical assessment.

The acuities given for each line are approximate equivalents to aid optometric differential diagnosis. The room illumination, chart distance and printing contrast may all vary. Optometrists should be mindful of this when considering a patient supplied self-recorded visual acuity along side other findings. However, even with these caveats, where a person can print and complete the test, the benefit of knowing an approximate and broadly equivalent level of vision, is in our view a useful aid to any telephone or video clinical review. We would welcome the development of an validated and fully automated visual acuity recording app for home use.

Updated: 22 April 2020

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What should I do if patient needs new contact lenses and their CL specification has expired?

In the red phase of the pandemic you may supply contact lenses to an expired specification.

Reissuing of a specification is in our view is equivalent to a contact lenses fitting as it involves assessing whether a lens is suitable and conducting an examination of the anterior eye (Fitting contact lenses - Guidance for Professional Practice A347 – A349), so where a patient’s specification has expired and need further supply of contact lenses, you should arrange a face-to-face appointment as soon as you reasonably can. However, in our view you may complete a remote fitting in the amber phase of the pandemic in exceptional circumstances provide that:

  1. The sight test is in date. 
  2. There are no clinical indications to attend the practice. 
  3. The patient is aware of the risks of not attending. 
  4. There is no change in the contact lens specification You must satisfy yourself that it is clinically appropriate, and you are acting in the patient’s best interest. You should make notes in the patient record to explain your decisions and the actions taken.

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Driving

What should I do if a patient needs to have a medical or asks for a driving vision/VA or visual field test?

The DVLA has confirmed that although online services are running as normal, paper applications sent to their office in Swansea are taking longer to process. They have therefore advised that providing the patient has a current driving licence and they have not been told by their doctor , optometrist or dispensing optician that they should not drive, the patient will be able to drive while the DVLA is considering their application.

The DVLA has also advised that the Government is making temporary provisions for bus and lorry drivers aged 45 or over to forego the need for a D4 medical in order to renew their driving entitlement. These changes are temporary and will only apply where the licence did not expire before 1 January 2020.

We have also added information on our patient-facing website, LookAfterYourEyes.org.

Updated: 22 July 2021

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Scheme for Registration

 

Independent Prescribing

What is being done to ensure optometrists can continue to undertake IP training?

We recognise the expertise of IP optometrists, and that this is likely to be of increasing relevance in the current situation, with patients being diverted from secondary care.

COVID-19 distancing requirements have led to serious restrictions on direct clinical observation. This has made it challenging for optometrists training to become independent prescribers to fulfil the hospital clinic sessions required for logbook completion.  

The GOC agreed to the College’s proposal for a more flexible approach to meeting logbook requirements. Trainees must continue to complete a minimum of 24 x 3-hour sessions in the HES or specialist general practice. However, these can now be divided into:

  • a minimum of 11 x 3-hour of face-to-face sessions (45%)
  • a maximum of 13 x 3-hour sessions in remote or virtual clinics (55%)

All remote or virtual sessions must generate evidence of activities relevant to the GOC-specified learning outcomes and will need to be signed off by a designated ophthalmologist, approved by the College. 

In addition, we are actively addressing the following:  

  • Seeking to achieve the required regulatory change to enable IP optometrists to supervise other optometrists on IP placement, rather than a medical practitioner (ophthalmologist) having to take on this supervisory role.
  • Working with optometry university departments seeking to increase optometrists’ access to the theoretical component of IP education.
  • Optimising how public funding can be drawn upon to support more optometrists undertake IP education.

Through collaboration with different stakeholders, we hope that it will be possible to achieve the required sequence of changes to enable more optometrists to integrate IP into their practice.

Update: 28 April 2021

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I have my IP assessment coming up. Is this still going ahead?

Following the cancellation of the April 2020 Therapeutics Common Final Assessment in Independent Prescribing due to the current Covid-19 restrictions, we have been working hard to find a software solution that allows candidates to sit this examination remotely, while assuring the integrity of the assessment process. We have been keen to provide an alternative date and mode of delivery for this examination sitting as swiftly as possible.
 
We have now done this and are able to offer those candidates who were enrolled on the TCFA examination in April 2020 to sit this remotely in early May 2020. Affected candidates have been contacted by email.
 
The arrangements are still subject to GOC approval - we have submitted our proposal to run the exam remotely to the GOC, as we are required to do under GOC accreditation, and expect to receive a response on this shortly.
 
This examination sitting will be limited to those who were originally enrolled to take the TCFA on 1 April. We will release details of future remote examination sittings in due course.
 
For those candidates who have enrolled on the June 2020 TCFA examination, we will be unable to run this examination face-to-face as planned in London. We are actively pursuing arrangements to run this remotely once the rearranged April sitting is completed in May, and will be in touch with those affected candidates soon.

Further updates on the Independent Prescribing exam can be found here.

Updated: 17 April 2020

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Other questions

I am really worried about this situation and how it will affect me and my family

We understand how worrying this unprecedented situation is. MIND has some really useful information on their website. There are also several coronavirus community aid groups being set up for people who are self isolating, who may be able to give you some support locally. 

If you need to talk to someone you can call the Samaritans for free on 116 123.

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Is there any training available so I can become more informed about COVID-19?

The World Health Organisation provides a free online course for healthcare professionals which takes about an hour to complete. It may be useful for each practise lead to complete this training, but it is not compulsory.

The College now runs online COVID-19 CET courses based on the latest College and national guidance:

Updated: 3 July 2020

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Q&A on delivering eye care during the current lockdown

In January representatives from the College, AOP, ABDO, FODO and GOC took part in a webinar to discuss the delivery of eye care during the current pandemic. Here we address the additional questions there wasn't time to answer on the day. 

Delivering eye care in the current lockdown: your questions answered

The College, alongside representatives from ABDO, AOP, FODO and GOC, have answered your questions on delivering eyecare during the Amber phase.

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