The routine eye examination
- You must carry out such examinations as appear to be necessary to detect signs of injury, disease or abnormality in the eye or elsewhere.
- In addition to the minimum legal requirements, you should use your professional judgement to decide the format and content of the eye examination.
- You should record all clinical findings.
- You should tell the patient your findings and recommendations.
- The frequency of eye examinations depends on the patient’s clinical needs but there are recommended minimum intervals.
- When conducting a sight test, which is defined in law,18 you must perform an internal and external examination and carry out such additional examinations as appear to be necessary to detect signs of injury, disease or abnormality in the eye or elsewhere.19 20
- You should use your professional judgement and the minimum legal requirements to decide the format and content of the tests.
- There is a suggested equipment list at Annex 1.
- You must record all clinical findings. You must do this legibly and at the time of the examination, or as soon as possible afterwards.
18 Opticians Act 1989 s36(2) [Accessed 22 Oct 2017]
19 Opticians Act 1989 s26(1)(a) [Accessed 22 Oct 2017]
20 Sight Testing (Examination and Prescription) (No 2) Regulations 1989 s3(1)(a) [Accessed 26 Oct 2017]
- When conducting a routine eye examination, you should:
- make it clear to the patient whether you will carry out the examination under the NHS or privately
- agree payment for any private services in advance, and
- use your professional judgement to decide how to serve a patient who is unable or unwilling to pay a private fee and is not eligible for NHS services. The lowest level of service that is acceptable is to direct them to emergency medical care. Record your actions and reasons for them.
- You must not charge for any procedure you undertake as part of a General Ophthalmic Services (GOS) sight test in England, Northern Ireland, Scotland and Wales, if the sight test is funded by the NHS.
- You must conduct an adequate assessment for the purposes of the optical consultation.21 This should normally include:
- asking for and accurately recording:
- full name
- other contact details
- date of birth
- reason for visit
- history including description of onset, character and duration of signs and symptoms
- if relevant, history of ocular and general health
- current general health
- family history of ocular and general health
- visual needs in terms of occupation, recreation or general activities
- whether the patient drives, with or without prescription, and
- details of previous optical prescription and date of last eye examination. Ask for the patient’s best estimate if the date is unknown
- determining and recording the unaided and/or aided vision of each eye with the patient’s existing correction for each eye, together with the specific prescription used for the aided vision
assessing and recording habitual ocular muscle balance and the method used, at least cover test, for distance and near. This should be done with the habitual prescription and/or without the prescription, if appropriate
- examining the eye internally and externally. As a minimum for internal examination you should use direct ophthalmoscopy on the undilated eye, although alternative methods may be used. If you cannot obtain an adequate view of the fundus you should dilate the patient’s pupils and/or use indirect methods of fundal examination. You should use slit-lamp biomicroscopy particularly where a detailed view of the anterior eye and adnexa is required, and
- establishing the prescription required and the visual acuity of each eye individually.
- asking for and accurately recording:
- If you feel it is clinically appropriate, you may:
- measure convergence
- assess ocular motility
- assess pupil reflexes
- determine objective refractive findings, using autorefractor and/or retinoscopy
- use fundal or other imaging
- measure intraocular pressure for patients at risk of glaucoma, see paras A148 and A157 in the section on Examining patients at risk from glaucoma
- assess visual fields, especially for those patients who are at risk of glaucoma. See section on Examining patients at risk from glaucoma
- repeat certain tests to eliminate spurious results
- perform binocular balancing and measure binocular visual acuity
- assess fixation disparity, for example if the patient has symptoms or shows a deviation on cover test
- assess accommodation, for example to determine any reading additions for intermediate and/or near tasks.
21 General Optical Council (2016) Standards of practice for optometrists and dispensing opticians para 7.1 [Accessed 26 Oct 2017]
- When you have completed the tests you should tell the patient what you have found and what you would recommend. You should tell the patient when you would recommend they have their next eye examination.
- You should provide patients with leaflets about the most common eye conditions, as appropriate.22
- You must only issue a prescription for the correction of visual defects when it is clinically justified and in the best interests of the patient.23 In all other cases give the patient a written statement, confirming a correction is not required or that there is no change in the current prescription.
- If you examine a patient who might have an eye condition or eye surgery that may change the prescription in the short- to medium-term, you should consider carefully whether it is in the patient’s best interests to have new spectacles. You should explain the benefits and disadvantages of prescribing spectacles that will be appropriate only for a short time.
- If you are referring the patient, see section on Working with colleagues for further guidance.
- You may need to justify your actions at a later date, so if you decide not to conduct particular tests that would normally be expected, you should record the reasons for not carrying out those tests. You should remember that when conducting a sight test, certain tests are required by law, see para A37.
22 College of Optometrists, patient leaflets [accessed 26 Oct 2017]
23 General Optical Council (2016) Standards of practice for optometrists and dispensing opticians para 7.6 [Accessed 26 Oct 2017]
- You should examine patients at the most appropriate intervals, depending on their clinical needs.
- Contact lens patients may need more frequent appointments for aftercare but are not entitled to more frequent NHS sight tests simply because they wear contact lenses.
- In the absence of clinical indications, you should not recall patients more frequently than the following intervals.
|Patient age and/or condition||Recommended minimum re-examination interval|
|The intervals given below should not be taken as applying automatically to all patients in a category.|
|Up to 16, no binocular vision anomaly or refractive error||1 year|
|under 7 years, with binocular vision anomaly or corrected refractive error||6 months|
|7-15 years, with binocular vision anomaly or rapidly progressing myopia||6 months|
|16 years and over||2 years|
|with diabetes who are part of diabetic retinopathy monitoring scheme||2 years|
|with diabetes who are not part of diabetic retinopathy monitoring scheme||1 year|
- In the absence of clinical indications you should not examine patients who are being monitored by the hospital eye service more frequently than every two years.
- Clinical circumstances may justify recalling a patient earlier than the intervals set out above, including patients:
- of any age with refractive error that is changing rapidly, or who are at risk of such changes, for example patients:
- newly diagnosed with diabetes whose condition you have decided to manage, rather than refer
- with a suspect visual field on one visit that is not confirmed on repeat; or
with abnormal IOP with no other significant signs of glaucoma
- who are identified in protocols as needing to be seen more frequently because of risk factors, for example of developing glaucoma. See section on Examining patients at risk from glaucoma, and
- with pathology likely to worsen.
- You may have patients requesting early re-examination because they:
- have been referred by a GP, or
- present with symptoms or concerns that you can resolve only with an eye examination.
- There will be cases when patients have symptoms, for example headaches, where no ocular cause can be found after examination.