Direct observation

Guidance on the Stage Two direct observation.

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There are two sections to the direct observation assessment: an eye examination and a soft contact lens aftercare. You will have the same assessor for both sections.

Eye examination

The eye examination assessment will last 40 minutes. Following the assessment, you should clean the clinic room ahead of your soft contact lens aftercare assessment. Below is an outline of the assessment content and details of how the eye examination has been modified to take account of COVID-19.

Eye examination assessment content

Section
Content
History and symptoms
You will take history and symptoms from a presbyopic patient (supplied by us) and record your findings. History and symptoms must be taken respecting social distancing. You and your assessor must wear appropriate PPE. The patient should wear a mask.

You will be given the unaided visions of the patient: distance and near.
Face-to-face examination
You will be instructed to carry out a modified eye examination on the patient and record the results on the record card.

The eye examination must include:

•    Unaided Cover test distance and near
•    Motility
•    Pupils
•    Retinoscopy to both eyes
•    Subjective on one eye only including near add (your assessor will give you the subjective for the second eye). You can use a trial frame or refractor head.
•    Indirect ophthalmoscopy on one eye only.
Final conclusions
You write your conclusions and further management on the record sheet and sum up with the assessor/patient.

 

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Eye examination - COVID-19 modifications

Section Modification
Clinic room The room length must be a minimum of 2.5m to allow for social distancing.
History and symptoms You should take history and symptoms, respecting social distancing.
Subjective refraction You should carry out subjective refraction on one eye only. Your assessor will choose the eye with the better acuity. The other eye is to be occluded during subjective. Near add should be carried out on one eye only. Your assessor will give you a simulated result for the second eye. The simulated result will be based on the patient’s prescription.
Ophthalmoscopy You should carry out indirect ophthalmoscopy on one eye only. Your assessor will choose which eye. You must not carry out direct ophthalmoscopy.
Binocular tests following refraction Not included as only one eye is refracted.
Advice to patient Write your findings on the record sheet and give your advice verbally to your assessor / patient.

 

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Soft contact lens aftercare

The soft contact lens aftercare assessment will last 35 minutes. You will have 25 minutes for the soft lens aftercare and 10 minutes for the soft lens fitting. Below is an outline of the assessment content and details of how the soft contact lens fit has been modified to take account of COVID-19.

Soft contact lens aftercare assessment content

Section Detail
History and symptoms You will take history and symptoms from a contact lens aftercare patient (supplied by us) and record findings on a record sheet. History and symptoms must be taken respecting social distancing. You and your assessor must wear appropriate PPE. The patient should wear a mask.
Record keeping You will be given the VA and over refraction achieved by the patient wearing the contact lens.
Slit lamp examination You will perform an aftercare including fit assessment and slit lamp examination on one eye of the contact lens wearer. The aftercare should include a fluorescein check and lid eversion.

You will write your results on the record sheet.
 
Final conclusion You will write conclusions and further management on the record sheet and sum up to the assessor / patient.
Fit assessment You will be shown a video of a soft contact lens fit by the assessor and will write an assessment of the fit and the details of the next lens that will be tried or ordered.

Total assessment time: 35 minutes - includes time for watching video of fit

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Soft contact lens assessment - COVID-19 modifications

Section Modification
Clinic room The room length must be a minimum of 2.5m to allow for social distancing.
Soft lens fitting This will be assessed using a video of a soft lens fit.

This is timetabled at the end of the assessment, but could be adjusted to earlier if a patient is late.
 
History and symptoms  You should take history and symptoms, respecting social distancing.
Soft lens aftercare Visual acuity is given to you as 6/5 and N5. Over refraction is given as Plano. Your assessor will check the corneal integrity of the patient once you have finished this part of the assessment.
Advice to patient The patient leaves when clinical tests are completed. Give your advice verbally to your assessor / patient and record it in the patient record.

 

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On the day

Direct observation assessment schedule

The assessment will last up to two hours, following the schedule below:

9.15am Your assessor will check your eye examination patient.
9.30am Eye examination assessment of a presbyopic patient (40 mins).
10.10am Fifteen minute break, you must clean your clinic room.

Your assessor will check your contact lens patient.
 
10.25am Assessment of soft contact lens aftercare (25 mins) and soft lens fitting with video (10 mins)
11.00am Assessor checks your logbook and hospital logbook if applicable.
11.15am Assessment ends

 

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Your direct observation feedback

You will not receive face-to-face feedback on the day of the direct observation assessment.

You and your supervisor will be sent the outcome via email once you have completed both parts of Stage Two.

If you do not pass the direct observation section of the Stage Two assessment, we will let you know why. An assessor might judge you to have failed because of:   

  • failure to detect, recognise or act upon significant symptoms, history or clinical signs,
  • compromised patient safety by action, inadequate record keeping and/or management,
  • a deficiency in technique which could lead to significantly inappropriate management.
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