Joint supplementary College guidance on supervision in relation to glaucoma related care by optometrists

Issued by The College of Optometrists and The Royal College of Ophthalmologists

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1. In April 2009 NICE issued guidelines on the diagnosis, monitoring and treatment of Glaucoma. These guidelines recommend that certain areas of Glaucoma-related work should be undertaken only by an optometrist with a specialist qualification or who is working under the supervision of a consultant ophthalmologist.

2. The Guideline did not define the term working under the supervision of a consultant ophthalmologist. The purpose of this Guidance is to set out principles of supervision in the context of the NICE Guideline on Glaucoma.

3. Supervision is a key part of clinical governance. For those working as part of a multidisciplinary team, it is important to understand the part clinical governance plays in patient care.

4. However, what supervision implies amongst multi-disciplinary teams is not clear-cut and will vary according to the environment in which eye care is provided.


5. This document refers to optometrists who have been trained to work in the field of glaucoma but who do not have a specialist qualification. It does not relate to optometrists with no training in the field.

Supervision of optometrists working in the field of glaucoma


6. When considering guidance concerning clinical supervision (see sources considered below), common themes emerge that should underpin supervision within the context of glaucoma-related management:

a. It is the supervisor’s duty to ensure the appropriate level of supervision is in place for each optometrist working under his/her direction. The supervisor must, therefore, formally assess the competence and experience of the optometrist before determining the level of supervision required. The necessary knowledge and skills for working with various case mix complexities have been specified in the NICE glaucoma guideline1 . There should be periodic re-appraisal.

b. The level of supervision lies on a scale from being on the premises and immediately checking the optometrist’s findings and decision-making to supervision by audit (in this case, retrospective analysis of process of care), depending on the competence and experience of the optometrist.

c. The supervisor will normally be a consultant ophthalmologist specialising in glaucoma.

d. The patient must come first. The optometrist must undertake never to work outside the limits of his or her competence.

The principles underpinning supervision are considered to be:

a. Safety of patients is paramount.

b. Clinical supervision must be organised in accordance with good clinical governance.

c. The scope and responsibilities of each role must be clear.

d. Clear lines of communication, accountability and responsibility must be defined.

e. Supervisors are responsible for ensuring that optometrists have the appropriate competence and experience to undertake their role.

f. The level of supervision should be tailored to the competence and experience of the optometrist.

g. Supervisors should always be in a position to give advice and support, or have delegated supervision to someone who is in a position to give advice and support.

h. Optometrists must work within the limits of their competence and should seek advice and support as soon as they need it.

i. Optometrists undertaking the care are responsible for their own actions.

j. Optometrists are responsible for ensuring they are up-to-date and work as part of the team, taking part in activities such as continuous professional development, peer review and clinical audit. 

k. Where longstanding shared care schemes exist, which are staffed by optometrists, supervisors should ensure that they meet the competency assessment and supervision arrangements outlined above.


1 NICE Clinical Guideline 85 Glaucoma: Diagnosis and management of chronic open angle glaucoma and ocular hypertension


Sources considered

Optician’s Act 1989

General Optical Council (GOC) The Testing Of Sight by Persons Training as Optometrists Rules 1993

College of Optometrists Guidance for professional practice 

College of Optometrists Scheme for Registration Enrolment Form Terms and Conditions

General Medical Council (GMC) Accountability in Multi-disciplinary and Multi-Agency Mental Health Teams

Modernising Medical Careers’ (MMC) A Reference Guide for Postgraduate Specialty training in the UK

Royal College of Ophthalmologists Guide for Delivery of Ophthalmic Specialist Training (OST) February 2009