Direct observation

From 11 April 2022, both eyes will be assessed as part of the eye exam and contact lens direct observations in Stage Two. This is a return to the assessment practice in place before COVID-19. 

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 assessment takes place in a room at your workplace. You and your assessor must wear appropriate PPE. The patient should wear a mask.

You will record your findings on a record card provided by the assessor.

The eye examination assessment will last 45 and 5 minutes extra due to the challenge of COVID-19 and consultations. Following the assessment, you should clean the clinic room ahead of your soft contact lens assessment. Below is an outline of the assessment content.

Eye examination assessment content

SectionContent
History and symptomsYou will take history and symptoms from a presbyopic patient (supplied by us).
 
Face-to-face examination

You will be instructed to carry out an eye examination on the patient.
The eye examination must include:

  • Unaided Cover test distance and near
  • Motility
  • Pupils
  • Retinoscopy on both eyes*
  • Subjective on both eyes including near add. You can use a trial frame or refractor head*.
  • Anterior segment examination on both eyes.
  • Indirect ophthalmoscopy on both eyes.
  • Binocular vision assessment - as indicated for your patient.
Final conclusions

You write your conclusions and further management on the record sheet and give your advice to your patient.

 

*Tolerances for retinoscopy and subjective refraction are the same as Stage One. See competency 7.1.1 within visit three. 

Soft contact lens aftercare

The assessment takes place in a room at your workplace. You and your assessor must wear appropriate PPE. The patient should wear a mask.

You will record your findings on a record care provided by the assessor.

The soft contact lens aftercare assessment will last 40 minutes. You will start with the contact lens aftercare. Below is an outline of the assessment content.

Soft contact lens aftercare assessment content

SectionDetail
History and symptomsYou will take history and symptoms from a contact lens aftercare patient (supplied by us).
Record keepingYou will measure the patient’s acuity with the contact lens and check the over refraction. 
Slit lamp examinationYou will perform an aftercare including fit assessment and slit lamp examination on one eye of the contact lens wearer. 
The aftercare should include white light assessment, a fluorescein check and lid eversion.
Final conclusionYou will write conclusions including the contact lens specification required by the patient and further management on the record sheet and give your advice to your patient.
Fit assessmentYou will be asked to fit a soft contact lens to your patient from your lens bank. You will need to assess the fit of the lens and record your findings. You will be asked to record the details of the next lens that will be tried or ordered.

 

On the day

Direct observation assessment schedule

The assessment will be around two hours, following the schedule below:

9.15amAssessor checks your ID. Your assessor will check your eye examination patient. You have a 15 minute break.
9.30amEye examination assessment of a presbyopic patient (50 minutes in total, which is 45 minutes plus a 5 minute allowance for lenses steaming up).
10.22amYour assessor will check your contact lens patient. You have a 13 minute break.
10.35amAssessment of soft contact lens aftercare and soft lens fitting.
11.15amAssessor checks your logbook and hospital logbook.
11.25amAssessment ends.

 

Your direct observation feedback

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

Assessors are asked to upload their results within seven days of the assessment.

You and your supervisor will be able to view the outcome in your My College area of the website within one week of completing both the DO and OA sections of Stage Two.

If you do not pass 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.