As the pandemic continues to unfold, many optometrists are changing their practice in order to meet the specific needs of patients who cannot always come into the practice for routine check-ups, and for whom the risks of coming in for pre-screening or blanket testing might outweigh the benefits. 

It is a priority to adapt services in this particular context and deliver more patient-centred care that avoids inappropriate referrals and reduces the risk of COVID-19 infection, while accurately addressing people’s problems. In this setting, the relevance of implementing a needs-based approach to clinical eye care is gradually being recognised. 

This is an acceleration of general trends over the past 30 years, where testing has moved beyond the minimum required standard of the detection of signs of injury, disease or abnormality. For the most part, that has been in a context where performing more advanced tests has always been considered to be in the patient’s best interests.

The sight test is broadly self-selecting, based mainly on a need for spectacles or contact lenses. For those who attend for eye health assessment reasons alone, they may do so on the basis of family history or other arbitrary factors that may or may not make them at high risk. This approach may also mean that those who would benefit the most from eye health screening may not necessarily be accessing the eye health screening they need as there is no register or universal invitations.