The College of Optometrists

Conducting the routine eye examination

A49
When conducting a routine eye examination, you should:
  1. make it clear to the patient whether you will carry out the examination under the NHS or privately
  2. agree payment for any private services in advance
  3. 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.
A50
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.
A51
You must conduct an adequate assessment for the purposes of the optical consultation22 (refer to COVID-19 guidance). This should normally include:
  1. asking for and accurately recording:
    • full name
    • address
    • 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, including whether the patient smokes if relevant. The GOS in Scotland requires that a record be made of whether the patient smokes23
    • medication
    • 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
    • details of previous optical prescription and date of last eye examination. Ask for the patient’s best estimate if the date is unknown
  2. determining and recording the  aided vision of each eye with the patient’s existing correction, together with the specific prescription used. If this is not possible, or inappropriate, you should determine and record the patient’s unaided vision of each eye
  3. 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

  4. 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
  5. establishing the prescription required and the visual acuity of each eye individually.
A52
If you feel it is clinically appropriate or your contract requires it, you may (refer to COVID-19 guidance): 
  1. measure convergence
  2. assess ocular motility
  3. assess pupil reflexes
  4. determine objective refractive findings, using autorefractor and/or retinoscopy
  5. use fundal or other imaging
  6. measure intraocular pressure for patients at risk of glaucoma, see Examining patients at risk from glaucoma
  7. assess visual fields, especially for those patients who are at risk of glaucoma. See section on Examining patients at risk from glaucoma
  8. repeat certain tests to eliminate spurious results
  9. perform binocular balancing and measure binocular visual acuity
  10. assess fixation disparity, for example if the patient has symptoms or shows a deviation on cover test
  11. assess accommodation, for example to determine any reading additions for intermediate and/or near tasks.

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