Optometrists and the provision of MECS and CUEs services

All registered optometrists must demonstrate a defined set of competencies and outcomes to qualify to work in MECS and CUEs services. This includes the ability to identify and manage minor eye conditions affecting the front and back of the eye, as well as neurological conditions.

The tables below summarise the relevant competencies and outcomes from the two most recent General Optical Council (GOC) qualification frameworks. They show the training and capabilities that are core to all registered optometrists. This provides evidence that optometrists already have the core training needed to deliver minor, acute and urgent eye care services without requiring additional accreditation.

All optometrists must also maintain their scope of practice by completing mandatory Continuing Professional Development (CPD), ensuring they practise safely and protect their patients.

These competencies are taken from the GOC’s Optometry Handbook 2015.

Unit of Competency: 6. Ocular Disease The ability to identify and manage ocular abnormalities Element of Competence: 6.1 The ability to manage patients presenting with eye disease, including sight threatening eye disease
Performance criteria	Indicators
6.1.1 Understands the risk factors for common ocular conditions	understands the risk factors for developing common ocular conditions including: glaucoma cataract diabetic retinopathy ARMD
6.1.2 Interprets and investigates the presenting symptoms of the patient	asks appropriate and relevant questions to follow up presenting symptoms recognises a significant symptom (including reduced vision) investigates the presenting symptom interprets the results
6.1.3 Develops a management plan for the investigation of the patient	recognises that there is a need for action and further investigation within the primary care setting chooses and carries out an appropriate technique for that investigation interprets the results and acts in line with College of Optometrists and NHS guideline
6.1.4 Identifies external pathology and offers appropriate advice to patients not requiring referral	uses an appropriate method for looking at the external eye, grades what is seen at the initial check and at follow up covering: external eye and ocular surfaces lids, lashes, lumps/bumps and red eye gives the correct advice/treatment and review period aware of pharmaceutical agents available (legal status, indications, contraindications, and side effects and uses appropriate sources of medicines information) explains clearly to the patient and checks their understanding
6.1.5 Recognises common ocular abnormalities and refers when appropriate	recognises, using appropriate technique/s, all of the following: cataract glaucoma or glaucoma suspects anterior eye disorders eg blepharitis, dry eye, meibomian gland, dysfunction, lid lesions AMD and macular abnormalities Manages appropriately
6.1.6 Manages patients presenting with cataract	understands the impact of cataract on patients’ lifestyle provides advice on minimising impact on lifestyle- non surgical management shows awareness of HES management-understands the risk and benefit of surgery provides appropriate advice and management including, when necessary, referral for cataract extraction
6.1.7 Manages patients presenting with red eye/s	obtains relevant information from the patient uses appropriate methods of examination to enable differential diagnosis appropriately manages the patient after diagnosis
6.1.8 Evaluates glaucoma risk factors, to detect glaucoma and refer accordingly	discusses the key risk factors identifies findings suggestive of open and closed angle glaucoma form clinical examination uses above information to determine if referral is appropriate decides on urgency and pathway of referral
6.1.9 Manages patients presenting with macular degeneration	distinguishes between wet and dry AMD from symptoms and clinical findings establishes patient needs and visual function makes appropriate recommendations for management or referral understands potential treatments both medical and ‘in practice’ options
6.1.10 Recognises, evaluates and manages diabetic eye disease and refers accordingly	recognises and names correctly the stage of diabetic eye disease gives local referral route and the appropriate timescales for referral for the following diabetic retinopathies: background/maculopathy/ pre-proliferative/ proliferative
6.1.11 Understands the treatment of a range of common ocular conditions	demonstrates a basic understanding of the treatment regimes of cataract, AMD, glaucoma, diabetic eye disease and minor anterior eye problems can discuss the treatment options for 2 of the above conditions
6.1.12 Evaluates and manages patients presenting with symptoms of retinal detachment	identifies, evaluates and investigates significant symptoms assesses risk factors carries out an appropriate eye examination manages the findings according to local protocol
6.1.13 Recognises ocular manifestations of systemic disease	provides evidence of examining patients and recognising ocular manifestations of systemic disease in hypertension and diabetes answers questions and recognises a range of ocular conditions from images provided by the assessor and relates these to the systemic disease
6.1.14 Assesses symptoms and signs of neurological significance	assesses the relevant symptoms and signs understands which signs/symptoms could relate to a neurological condition and the follow up information required to make a differential diagnosis understands the significance and relative importance of the findings manages appropriately
6.1.15 Recognises adverse ocular reactions to medication	shows awareness relating to sources of information of adverse reactions provides evidence of the recognition of an adverse reaction to medication (systemic or topical) identifies and/or lists the Ocular Adverse reactions to a range of common medications (systemic or topical) describes the reporting scheme

These outcomes are from the Requirements for Approved Qualifications in Optometry or Dispensing Optics (2021).

03.5b (iii) Makes informed decisions on the treatment and management of ocular abnormalities and disease

investigates and interprets individual patients’ presenting symptoms and risk factors and identifies the clinical signs of potential abnormality and disease

selects and deploys appropriate methods of clinical examination

analyses the results of an examination to make a differential diagnosis

advises individual patients on the implications and care options arising from the detection of common ocular abnormalities and disease, making referrals in line with professional guidance and local pathways, when in patients’ best interests so that they receive timely, efficacious care

designs and implements an appropriate management plan arising from a clinical examination and differential diagnosis, in line with individual patients’ clinical need and preferences

assesses and evaluates signs and symptoms of neurological significance

manages patients presenting with a range of anterior and/or posterior ocular conditions

detects the ocular manifestations of systemic disease and advises and refers in line with individual patients’ need

03.5b (iv) Accurately identifies patients’ conditions and their potential need for medical referral in a timely way, including when urgent or emergency attention is required

interprets the results of history-taking and clinical findings (ie a recognition of abnormality and correct interpretation of common investigative tests) to formulate an appropriate management plan, recognising and acting when a referral is appropriate

identifies the signs of disease progression or change in individual patients’ clinical status and adapts and advises on their management plan in line with this

appraises the need for and urgency of making a patient referral, using relevant local protocols and national professional guidance, and acts accordingly

recognises the clinical signs of sight- and life-threatening conditions that require immediate treatment and takes appropriate action

detects adverse ocular reactions to medication and advises, manages and refers in line with individual patients’ need

03.5b (v) Uses common ophthalmic drugs, safely to facilitate optometric examination and the diagnosis / treatment of ocular disease

adheres to legal requirements for the use and supply of common ophthalmic drugs

appraises the appropriate use of common ocular drugs to aid refraction and assessment of the fundus

obtains individual patients’ informed consent to use common ophthalmic drugs to aid investigation, examination, diagnosis and treatment, including by advising on the potential side effects and associated risks of specific drugs

administers common ocular drugs appropriately, effectively and judiciously, exercising caution to ensure patient safety

recognises the indications and contraindications of commonly-used ophthalmic drugs and responds in light of these to uphold patient care and safety

Career pathways in optometry

Optometrists and the provision of MECS and CUEs services

Relevant competencies

Relevant GOC outcomes for optometrists

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