The College of Optometrists

Prescribing spectacles

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Sub-sections

Key points

  • Immediately following any NHS or private sight test you must issue a prescription or a statement indicating that no prescription is necessary.
  • If there is no clinically significant change in the prescription, you must issue the prescription and a statement saying that there is no clinical change.
  • You must only prescribe or recommend a change of spectacles when it is in the patient’s best interests to do so.
  • If you make a small change to an existing prescription you must be clear about the benefit of the change and keep a record of the reason and any advice given.
  • The pupillary distance measurement is not part of the prescription.

Issuing prescriptions

A248
Immediately following any NHS or private sight test you must issue:
  1. a prescription, or
  2. a statement indicating that no prescription is necessary.86 
A249
If there is no clinically significant change in the prescription, you must issue the prescription and a statement saying that there is no clinical change.
A250
You must include all the required information on the prescription as set out in the Sight Testing (Examination and Prescription) (No. 2) Regulations, paragraph 5.87
A251
You should write prescriptions according to British Standards.88
A252
You should clearly indicate on the prescription if the spectacles are only for specific purposes.
A253
A prescription you issue to a child under 16 or a person who is registered as sight impaired or severely sight impaired can only legally be dispensed by, or under the supervision of, a registered: 
  1. optometrist
  2. dispensing optician, or
  3. doctor.
A254
You remain responsible for any prescriptions you have issued, irrespective of where the patient chooses to buy their spectacles.  
A255
When you give the patient their prescription, you should explain your findings and the type of lenses that you recommend. 
A256
You should consider the patient’s risk of falling when advising on bifocal or varifocal use.89 
A257
You should advise the patient if you think their prescription may change soon, for example if they are to undergo cataract surgery. The patient can then decide if they wish to have spectacles made in the meantime. 

References

86 Opticians Act 1989 s26(2)
87 Sight Testing (Examination and Prescription) (No 2) Regulations 1989
88  British Standards [College members only] [Accessed 27 Oct 2017]
89 College of Optometrists and British Geriatrics Society (2011) The importance of vision in preventing falls s3 (in Member resources) [Accessed 2 May 2017]

Small prescriptions and making small changes to existing prescriptions

A258
You must only prescribe or recommend a change of spectacles when it is in the patient’s best interests to do so.90 NHS Counter Fraud Services have a remit to pursue cases where sight tests are carried out at inappropriate intervals and spectacles are supplied when they may not be clinically necessary.91, 92, 93
A259
You must make a professional judgement about whether a patient would benefit from a prescription for a low refractive error, for example small hypermetropic corrections in children. 
A260
If you supply prescriptions of less than +0.75 R&L, to children for example, you must: 
  1. be sure of the clinical need for the spectacles
  2. be able to explain the reason for prescribing them, and
  3. keep a record of the reason and any advice given.
A261
If you make a small change to an existing prescription you must: 
  1. be clear about the benefit of the change, and
  2. keep a record of the reason and any advice given.
A262
If you are unable to provide the justifications in paras A260-A261, the Counter Fraud Services may consider you have been over-prescribing and take action against you, see para A263.


Information on small prescriptions

A263
The following examples should assist you in deciding whether or not a prescription is likely to be beneficial:
  1. plus prescriptions of less than +0.75DS (binocularly) are unlikely to be of benefit to children under 16, unless there are clinical indications for giving such a low prescription or there are persuasive psychological reasons for doing so 
  2. factors to consider include:
    • a particularly low amplitude of accommodation
    • ocular muscle balance problems at distance and/or near
    • low fusional reserves, and
    • poor health of a patient resulting in the need to correct low degrees of ametropia. If this is likely to be of short duration, you should consider whether the prescription will still be necessary when the patient’s health improves
  3. if a low prescription is found in one eye only you should consider the points above and in particular whether the patient will benefit from such a low prescription in one eye only
  4. if you decide to prescribe a small prism (less than 1 prism horizontally or 0.5 prism vertically) you should take into account all the clinical factors including the patient’s ocular muscle status, and whether the use of the prism is appropriate. You should consider any presenting symptoms
  5. a small change in prescription (e.g. +0.25DS extra in both eyes) may be justifiable in some circumstances but not in others. For example changing a +1.00DS reading prescription to a +1.25DS may well have significant benefits to the patient whereas changing a +8.00DS to +8.25DS is likely to have much less effect
  6. you should consider factors such as the patient’s visual acuity and ocular muscle balance. A small prescription change in a patient with poor visual acuity may not be as significant as one in a patient with good visual acuity
  7. in very high powers you should be aware that the manufacturing tolerances and/or the effect of very small changes in back vertex distance make 0.25DS changes meaningless.

Pupillary distance (PD)

A257
The PD is one of several facial measurements that are taken as part of the dispensing process. It is not part of the prescription.  
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