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Advice & Guidelines

Introduction

  1. The Advice & Guidelines which follow, although not exclusive, are issued in pursuance of the Association of British Dispensing Opticians’ (ABDO) objectives in maintaining for the public benefit the highest standards of professional competence and conduct. With changing circumstances the Association expects its attention will be drawn to new forms of practice or duties which might require fresh or amended advice to the profession.
  2. This Advice & Guidelines replaces that issued in 2003. It also supersedes any previous electronic guidance.
  3. The profession of dispensing opticians was created in 1925 and was given statutory registered professional status in 1958.
  4. The profession is regulated partly by legal provisions and partly by advice issued by ABDO.
How to access the Advice & Guidelines
Immediate access to a specific area of the Advice & Guidelines is available via direct links between each heading in the contents index and the relevant information in the associated section.The documents can also be viewed in full, or as downloadable PDFs.

SECTION 1: PROFESSIONAL CONDUCT

Open
  • GeneralOpen

    1.1.1 Dispensing opticians shall always place the welfare of the public, who require their professional services, before all other considerations. They shall behave in a proper manner towards their patients, the GOC, ABDO and professional colleagues and shall not bring them or the profession into disrepute. (See Appendix A – GOC Standards of Practice). They must maintain a high standard of behaviour, integrity and competence, bringing to bear all their knowledge, skill and expertise in serving the public. Dispensing opticians should be aware that conviction for any non-optical offence may cause them to appear before the GOC for bringing the profession into disrepute, and subsequently be reported to ABDO. The GOC Standards of Practice are those against which you will be judged in any GOC Fitness to Practice hearing.

    1.1.2 Communication with patients
    In line with GOC Standards of Practice (see Appendix A), ABDO endorses the following:
    • Give patients information in a way they can understand. Use your professional judgement to adapt your language and communication approach as appropriate.
    • Patients should know in advance what to expect from the consultation and have the opportunity to ask questions or change their mind before proceeding.
    • Be alert to unspoken signals which could indicate a patient’s lack of understanding, discomfort or lack of consent.
    • Ensure that the people you are responsible for are able to communicate effectively with patients and their carers, colleagues and others.
    • Ensure that patients or their carers have all the information they need to safely use, administer or look after any optical devices, drugs or other treatment that they have been prescribed or directed to use in order to manage their eye conditions. This includes being actively shown how to use any of the above.
    • Be sensitive and supportive when dealing with relatives or other people close to the patient.

    1.1.3 Dispensing opticians should be aware of local NHS/PCT protocols, especially if working within the NHS.

    1.1.4 Dispensing opticians should have a policy for chaperoning certain groups of vulnerable adults and children – see Appendix E(3).

    1.1.5 Dispensing opticians must recognise their limitations by seeking further advice and guidance; or refer elsewhere when appropriate. In particular, those wishing to practise in specialised areas must be sure of their ability to do so, by obtaining specialist qualifications as available. All dispensing opticians have a duty to maintain and develop their professional competence throughout their careers, since only in this way can they continue to offer the best possible service to the public.

    1.1.6 Dispensing opticians are reminded that they have a responsibility to apply the infection control procedures outlined in this guidance and to dispose of waste safely so are advised to read the following:
    Section 4 – Infection Control
    Appendix F[4] Advice on the disposal of waste

    1.1.7 Whistleblowing
    According to the GOC Standards of Practice, you should “promptly raise concerns about your patients, colleagues, employer or other organisation if patient or public safety might be at risk and encourage others to do the same. Concerns should be raised with your employing, contracting, professional or regulatory organisation as appropriate. This is sometimes referred to as ‘whistle-blowing’ and certain aspects of this are protected by law”. The relevant GOC document may be accessed here: Raising concerns with the GOC (whistleblowing) policy.

    1.1.8 Social media and electronic communication
    Members should ensure that they comply with their obligations in this area. Examples of social media include Facebook, Twitter, YouTube, Pinterest, Instagram and Snapchat, as well as the ABDO website forums and other similar online forums.

    ABDO’s Social Media Policy (Appendix K) is available here, and should be read and adhered to by all members.

    The Optical Confederation has also produced Guidance on Social Media and Electronic Communication, and that is available here.

    Archived version(s) of this item - Click date to read:

    1.1.1 Dispensing opticians shall always place the welfare of the public, who require their professional services, before all other considerations. They shall behave in a proper manner towards their patients, the GOC, ABDO and professional colleagues and shall not bring them or the profession into disrepute. (See Appendix A – GOC Standards of Practice). They must maintain a high standard of behaviour, integrity and competence, bringing to bear all their knowledge, skill and expertise in serving the public. Dispensing opticians should be aware that conviction for any non-optical offence may cause them to appear before the GOC for bringing the profession into disrepute, and subsequently be reported to ABDO. The GOC Standards of Practice are those against which you will be judged in any GOC Fitness to Practice hearing.

    1.1.2 Communication with patients
    In line with GOC Standards of Practice (see Appendix A), ABDO endorses the following:
    • Give patients information in a way they can understand. Use your professional judgement to adapt your language and communication approach as appropriate.
    • Patients should know in advance what to expect from the consultation and have the opportunity to ask questions or change their mind before proceeding.
    • Be alert to unspoken signals which could indicate a patient’s lack of understanding, discomfort or lack of consent.
    • Ensure that the people you are responsible for are able to communicate effectively with patients and their carers, colleagues and others.
    • Ensure that patients or their carers have all the information they need to safely use, administer or look after any optical devices, drugs or other treatment that they have been prescribed or directed to use in order to manage their eye conditions. This includes being actively shown how to use any of the above.
    • Be sensitive and supportive when dealing with relatives or other people close to the patient.

    1.1.3 Dispensing opticians should be aware of local NHS/PCT protocols, especially if working within the NHS.

    1.1.4 Dispensing opticians should have a policy for chaperoning certain groups of vulnerable adults and children – see Appendix E(3).

    1.1.5 Dispensing opticians must recognise their limitations by seeking further advice and guidance; or refer elsewhere when appropriate. In particular, those wishing to practise in specialised areas must be sure of their ability to do so, by obtaining specialist qualifications as available. All dispensing opticians have a duty to maintain and develop their professional competence throughout their careers, since only in this way can they continue to offer the best possible service to the public.

    1.1.6 Dispensing opticians are reminded that they have a responsibility to apply the infection control procedures outlined in this guidance and to dispose of waste safely so are advised to read the following:
    Section 4 – Infection Control
    Appendix F[4] Advice on the disposal of waste

    1.1.7 Whistleblowing
    According to the GOC Standards of Practice, you should “promptly raise concerns about your patients, colleagues, employer or other organisation if patient or public safety might be at risk and encourage others to do the same. Concerns should be raised with your employing, contracting, professional or regulatory organisation as appropriate. This is sometimes referred to as ‘whistle-blowing’ and certain aspects of this are protected by law”. The relevant GOC document may be accessed here: Raising concerns with the GOC (whistleblowing) policy

    1.1.8 Guidance on Social Media and Electronic Communication
    Members should ensure that they comply with their obligations in this area, which includes the bulletin board and similar forums OC Guidance on Social Media

    1.1.1 Dispensing opticians shall always place the welfare of the public, who require their professional services, before all other considerations. They shall behave in a proper manner towards their patients, the GOC, ABDO and professional colleagues and shall not bring them or the profession into disrepute. (See Appendix A – GOC Standards of Practice). They must maintain a high standard of behaviour, integrity and competence, bringing to bear all their knowledge, skill and expertise in serving the public. Dispensing opticians should be aware that conviction for any non-optical offence may cause them to appear before the GOC for bringing the profession into disrepute, and subsequently be reported to ABDO. The GOC Standards of Practice are those against which you will be judged in any GOC Fitness to Practice hearing.

    1.1.2 Dispensing opticians should be aware of local NHS/PCT protocols, especially if working within the NHS.

    1.1.3 Dispensing opticians should have a policy for chaperoning certain groups of vulnerable adults and children – see Appendix E(3).

    1.1.4 Dispensing opticians must recognise their limitations by seeking further advice and guidance; or refer elsewhere when appropriate. In particular, those wishing to practise in specialised areas must be sure of their ability to do so, by obtaining specialist qualifications as available. All dispensing opticians have a duty to maintain and develop their professional competence throughout their careers, since only in this way can they continue to offer the best possible service to the public.

    1.1.5 Dispensing opticians are reminded that they have a responsibility to apply the infection control procedures outlined in this guidance and to dispose of waste safely so are advised to read the following –
    Section 4 – Infection Control
    Appendix F[4] Advice on the disposal of waste

    1.1.6 Whistleblowing
    According to the GOC Standards of Practice, you should “promptly raise concerns about your patients, colleagues, employer or other organisation if patient or public safety might be at risk and encourage others to do the same. Concerns should be raised with your employing, contracting, professional or regulatory organisation as appropriate. This is sometimes referred to as ‘whistle-blowing’ and certain aspects of this are protected by law”. The relevant GOC document may be accessed here: Raising concerns with the GOC (whistleblowing) policy

    1.1.7 Guidance on Social Media and Electronic Communication
    Members should ensure that they comply with their obligations in this area, which includes the bulletin board and similar forums OC Guidance on Social Media

    1.1.1 Dispensing opticians shall always place the welfare of the public, who require their professional services, before all other considerations. They shall behave in a proper manner towards their patients, the GOC, ABDO and professional colleagues and shall not bring them or the profession into disrepute. (See Appendix A– GOC Codes of Conduct). They must maintain a high standard of behaviour, integrity and competence, bringing to bear all their knowledge, skill and expertise in serving the public. Dispensing opticians should be aware that conviction for any non-optical offence may cause them to appear before the GOC for bringing the profession into disrepute, and subsequently be reported to ABDO.

    1.1.2 Dispensing opticians should be aware of local NHS/PCT protocols, especially if working within the NHS.

    1.1.3 Dispensing opticians should have a policy for chaperoning certain groups of vulnerable adults and children – see Appendix E(3).

    1.1.4 Dispensing opticians must recognise their limitations by seeking further advice and guidance; or refer elsewhere when appropriate. In particular, those wishing to practise in specialised areas must be sure of their ability to do so, by obtaining specialist qualifications as available. All dispensing opticians have a duty to maintain and develop their professional competence throughout their careers, since only in this way can they continue to offer the best possible service to the public.

    1.1.5. Dispensing opticians are reminded that they have a responsibility to apply the infection control procedures outlined in this guidance and to dispose of waste safely so are advised to read the following –

    Section 4 – Infection Control
    Appendix F[4] Advice on the disposal of waste

    Whistleblowing

    1.1.6 The following advice is taken from the GOC Code of Conduct.

    If you have important information about yourself, other health professionals or organisations, which may mean that you, or they, lack the skills, knowledge, character or health to practise safely and effectively, or be trusted to act legally, you must act quickly to protect patients. In the first instance you should normally report your concern to your employer, manager or other appropriate person at your practice or business level. However if there is no such person and the matter cannot be addressed at practice or business level, your concern should be reported to the local primary care organisation.

    However, you should inform the GOC if:

    • Taking action at a local level would not be practical;
    • Action at a local level has failed;
    • The problem is so serious that the GOC clearly needs to be involved;
    • You are afraid of victimisation or a cover up.

    You must let the GOC know straight away if you:

    • Have been convicted of a criminal offence, convicted of a criminal offence resulting in a conditional discharge;
    • Have accepted a police caution;
    • Have been disciplined by any organisation responsible for regulating or licensing a health or social care professional;
    • Are barred from working with children and/or vulnerable adults;
    • Have been suspended or placed under a practice restriction by an employer or similar organisation because of concerns about your fitness to practise;
    • Have a health condition which a reasonable person would think may impair your fitness to practise.

    This list is not exhaustive

    You should co-operate with any investigation or formal inquiry about your, or another health professional’s, fitness to practise, fitness to undertake training as an optometrist or dispensing optician, or the fitness of a business registrant to carry on business as an optometrist, dispensing optician, or both.

    For further information see: Whistleblowing codes of conduct statement.

    Guidance on Social Media and Electronic Communication

    1.1.7 Members should ensure that they comply with their obligations in this area, which includes the bulletin board and similar forums. OC Guidance on Social Media

    Archived version: 30/01/2013

    1.1.1 Dispensing opticians shall always place the welfare of the public, who require their professional services, before all other considerations. They shall behave in a proper manner towards their patients, the GOC, ABDO and professional colleagues and shall not bring them or the profession into disrepute. (See Appendix A – GOC Codes of Conduct).They must maintain a high standard of behaviour, integrity and competence, bringing to bear all their knowledge, skill and expertise in serving the public. Dispensing opticians should be aware that conviction for any non-optical offence may cause them to appear before the GOC for bringing the profession into disrepute, and subsequently be reported to ABDO.

    1.1.2 Dispensing opticians should be aware of local NHS/PCT protocols, especially if working within the NHS.

    1.1.3 Dispensing opticians should have a policy for chaperoning certain groups of vulnerable adults and children – see Appendix E(3).

    1.1.4 Dispensing opticians must recognise their limitations by seeking further advice and guidance; or refer elsewhere when appropriate. In particular, those wishing to practise in specialised areas must be sure of their ability to do so, by obtaining specialist qualifications as available. All dispensing opticians have a duty to maintain and develop their professional competence throughout their careers, since only in this way can they continue to offer the best possible service to the public.

    1.1.5. Dispensing opticians are reminded that they have a responsibility to apply the infection control procedures outlined in this guidance and to dispose of waste safely so are advised to read the following –

    Section 4 – Infection Control
    Appendix F[4] Advice on the disposal of waste

    Archived version: 15/02/2011

    1.1.1 Dispensing opticians shall always place the welfare of the public, who require their professional services, before all other considerations. They shall behave in a proper manner towards their patients, the GOC, ABDO and professional colleagues and shall not bring them or the profession into disrepute. (See Appendix A – GOC Codes of Conduct).They must maintain a high standard of behaviour, integrity and competence, bringing to bear all their knowledge, skill and expertise in serving the public. Dispensing opticians should be aware that conviction for any non-optical offence may cause them to appear before the GOC for bringing the profession into disrepute, and subsequently be reported to ABDO.

    1.1.2 Dispensing opticians should be aware of local NHS/PCT protocols, especially if working within the NHS.

    1.1.3 Dispensing opticians should have a policy for chaperoning certain groups of vulnerable adults and children – see Appendix E(3).

    1.1.4 Dispensing opticians must recognise their limitations by seeking further advice and guidance; or refer elsewhere when appropriate. In particular, those wishing to practise in specialised areas must be sure of their ability to do so, by obtaining specialist qualifications as available. All dispensing opticians have a duty to maintain and develop their professional competence throughout their careers, since only in this way can they continue to offer the best possible service to the public.

    Archived version: 16/03/2010

    1.1.1 Dispensing opticians shall always place the welfare of the public, who require their professional services, before all other considerations. They shall behave in a proper manner towards their patients, the GOC, ABDO and professional colleagues and shall not bring them or the profession into disrepute. (See Appendix A – GOC Codes of Conduct).They must maintain a high standard of behaviour, integrity and competence, bringing to bear all their knowledge, skill and expertise in serving the public. Dispensing opticians should be aware that conviction for any non-optical offence may cause them to appear before the GOC for bringing the profession into disrepute, and subsequently be reported to ABDO.

    1.1.2 Dispensing opticians should be aware of local NHS/PCT protocols, especially if working within the NHS.

    1.1.3 Dispensing opticians should have a policy for chaperoning certain groups of vulnerable adults and children – see Appendix H.

    1.1.4 Dispensing opticians must recognise their limitations by seeking further advice and guidance; or refer elsewhere when appropriate. In particular, those wishing to practise in specialised areas must be sure of their ability to do so, by obtaining specialist qualifications as available. All dispensing opticians have a duty to maintain and develop their professional competence throughout their careers, since only in this way can they continue to offer the best possible service to the public.

  • Registration and EnrolmentOpen

    Updated 01/02/2016

    1.2.1 The General Optical Council (GOC) was established in 1958 to promote high standards of professional education and professional conduct among opticians and to carry out some additional duties assigned by the Opticians Act. The GOC discharges its function in relation to professional conduct by means of its powers to require the registration of qualified dispensing opticians and to enforce standards by means of its disciplinary machinery. Under all circumstances it is the dispensing optician’s responsibility to register and to maintain registration.

    1.2.2 Registration with the GOC is essential for full scope of practice. The title dispensing optician is a registered title and can only be used by registered dispensing opticians. The GOC shall maintain a register of persons undertaking training as dispensing opticians. A person who is undertaking training provided by an approved training establishment or obtaining practical experience in the work of a dispensing optician shall have his/her name in the appropriate register. For further information on the use of protected titles see Opticians Act 1989, part 4, section 28.

    Archived version(s) of this item - Click date to read:

    1.2.1 The General Optical Council (GOC) was established in 1958 to promote high standards of professional education and professional conduct among opticians and to carry out some additional duties assigned by the Opticians Act. The GOC discharges its function in relation to professional conduct by means of its powers to require the registration of qualified dispensing opticians and to enforce standards by means of its disciplinary machinery. Under all circumstances it is the dispensing optician’s responsibility to register and to maintain registration.

    1.2.2 Registration with the GOC is essential for full scope of practice. The title dispensing optician is a registered title and can only be used by registered dispensing opticians. The GOC shall maintain a register of persons undertaking training as dispensing opticians. A person who is undertaking training provided by an approved training establishment or obtaining practical experience in the work of a dispensing optician shall have his/her name in the appropriate register.

  • SafeguardingOpen

    1.3.1 The Optical Confederation’s latest advice on safeguarding children and vulnerable adults may be accessed here: http://www.opticalconfederation.org.uk/downloads/guidance/oc-safeguarding-and-prevent-guidanceaugust2014final.pdf

    Vision 2020 quality guidelines for people with learning disabilities are available here: http://www.abdo.org.uk/wp-content/uploads/2012/06/PWLD-QS-for-DOs-guidelines-Jan-2016.pdf

    1.3.2 Refer to Appendix E for further guidance on:

    • Disability discrimination act

    • Mental capacity act

    • Chaperone framework

    • Advice on sexual boundaries

    Archived version(s) of this item - Click date to read:

    1.3.1 The Optical Confederation’s latest advice on safeguarding children and vulnerable adults may be accessed here: http://www.opticalconfederation.org.uk/downloads/guidance/oc-safeguarding-and-prevent-guidanceaugust2014final.pdf

    1.3.2 Refer to Appendix E for further guidance on:

    • Disability discrimination act
    • Mental capacity act
    • Chaperone framework
    • Advice on sexual boundaries

    Archived version: 30/09/2015

    1.3.1 The Optical Confederation’s latest advice on safeguarding children and vulnerable adults may be accessed here: http://www.opticalconfederation.org.uk/downloads/guidance/oc-safeguarding-and-prevent-guidanceaugust2014final.pdf

    Archived version: 06/08/2014

    1.3.1 Since the change of government in May 2010 the Vetting & Barring scheme has been indefinitely postponed, so no further action is required at present. See Optical Confederation Guidance on Safeguarding Children and Vulnerable Adults (appendix E5).

    Archived version: 30/01/2012

    1.3.1 Since the change of government in May 2010 the Vetting & Barring scheme has been indefinitely postponed, so no further action is required at present. See Safeguarding Children and Other Vulnerable Patients (appendix E5).

    Archived version: 19/08/2010

    1.3.1 This scheme came into effect from October 2009. At the moment it only requires employers to notify the ISA (Independent Safeguarding Authority) see www.isa-gov.org.uk of any relevant information, including prosecutions and disciplinary actions, which lead an employer to suspect that the person may cause harm to a child or vulnerable adult.

    1.3.2 For the purposes of this legislation vulnerable groups includes children under 16 and all adult health care patients (NHS or private).

    1.3.3 From 1st November 2010 all staff in a regulated activity who are changing employers or entering the workforce for the first time will need to be ISA registered before they can work with vulnerable groups, and from this date employers will be required by law to check the ISA status of all new staff who are in a regulated activity.

    1.3.4 Registration by the ISA will be available from 26th July 2010.

    1.3.5 For further information see www.isa-gov.org.uk

    1.3.6 At this stage it is unclear which practice staff will be considered as being in a regulated activity. As more information becomes available this section will be updated.

  • Continuing Education and Professional DevelopmentOpen

    1.4.1 Dispensing opticians must abide by rules relating to compulsory education and training. This includes periods during which the dispensing optician is suspended from the register of dispensing opticians, or when career breaks are taken. Dispensing opticians wishing to practice in specialised areas should be sure that they have the necessary training and skills and comply with the specialty CET rules.

    1.4.2 When undertaking research, the care and safety of the patient should be your first and continuing concern. You should ensure that you have gained ethical approval for any research you undertake on people or animals. You must work within relevant legislation.

    1.4.3 Those who cease to practise (for domestic, health or other reasons) should ensure that they undergo appropriate CET before returning to practice.

    Archived version(s) of this item - Click date to read:

    1.4.1 Dispensing opticians must abide by rules relating to compulsory education and training. This includes periods during which the dispensing optician is suspended from the register of dispensing opticians, or when career breaks are taken. Dispensing opticians wishing to practice in specialised areas should be sure that they have the necessary training and skills and comply with the specialty CET rules.

    1.4.2 Those who cease to practise (for domestic, health or other reasons) should ensure that they undergo appropriate CET before returning to practice.

  • Indemnity InsuranceOpen

    1.5.1 It is a legal requirement that all dispensing opticians in practice and others under their supervision are covered by an appropriate level of professional indemnity and products liability insurance, and that they review the level of cover annually. Possession of such insurance is a condition of full membership of ABDO and is available (inter alia) from the Association.

    1.5.2 Students’ PI Insurance: The GOC requires student registration, and student insurance. Student insurance cannot be issued independently by ABDO’s insurers, but must be included on the Supervisor insurance. ABDO’s insurance company (via ABDO) must be notified, and details given. For student CLOs, the situation is the same, student CL insurance cannot be issued, and the student CLO must be insured on the supervisor’s policy.

    1.5.3 Practitioners working in more than one business, as locums for example, are reminded that cover afforded by an employer of one business will not necessarily extend to another. Practitioners covered by an employer’s insurance are advised to acquaint themselves fully with the extent and nature of the policy.

    1.5.4 Members should note that claims can be made many years after an event. They must ensure that cover continues in circumstances where they change insurers, take a career break or retire.

  • Working with the unregisteredOpen

    1.6.1 Some unregistered persons and unenrolled bodies corporate engaged in selling spectacles may employ registered dispensing opticians. While it is not unlawful to accept such employment, ABDO recognises that to do so could raise important legal and ethical issues and may create problems.

    1.6.2 ABDO takes the view that it might constitute serious professional misconduct for a registered dispensing optician to enter, or to remain in the employment of, or in professional association with, lay persons (that is, not a doctor, hospital authorities, registered opticians or enrolled bodies corporate) whose business is carried on without regard to the principles of good professional conduct. The unregistered seller remains subject to no control but the employed registered dispensing optician, working full or part time, would be considered by the GOC as responsible for adhering to GOC policies and ABDO guidelines. Moreover, the fact that a registered dispensing optician is on the premises all or part of the time does not mean that all of the available service will be provided by registered personnel. It is misleading to suggest otherwise to the public. If any title is to be used, it should indicate the registered dispensing optician’s name and qualifications and hours of attendance. It is also important to ensure that, in accordance with the Sale of Optical Appliances Order of Council 1984, the prescriptions of the following categories of patients are dispensed by or under the supervision of a qualified registered medical practitioner, qualified registered optometrist or qualified registered dispensing optician:

    1. Children under the age of 16.
    2. Those who are registered sight impaired [partially sighted] or severely sight impaired[ blind].

    The provision of contact lenses to the public is also subject to the supervision of the above registered practitioners whose qualifications comply with the GOC Contact Lens (Qualification etc.) Rules 1988 (as amended).

  • Supervision of TraineesOpen

    Updated: 30/09/2014

    1.7.1 Certain professional functions are regulated by law:

    1. The testing of sight, as defined in the Opticians Act 1989, Section 24 (Testing of Sight) and 26 (Duties to be performed on sight testing) and in the Sight Testing (Examination and Prescription) (No 2) Regulations 1989
    2. The fitting of contact lenses (Section 25 of the Opticians Act 1989).
    3. The dispensing of spectacle prescriptions of a kind that unqualified persons are not permitted by law to dispense (Section 27 of the Opticians Act 1989).The method of supply of all optical appliances including ready-made reading spectacles, on the premises of a registered optician or enrolled body corporate.

    1.7.2 Those registered dispensing opticians who are charged with the supervision of trainees in practice have a considerable obligation. Supervisors should ensure that their trainees are registered with the GOC.

    1.7.3 Individual supervisors of registered student dispensing opticians and trainee contact lens opticians must be approved by ABDO and comply with the following requirements:

    1. Have two years continuous full registration with the GOC, IOB or GMC (previous student GOC registration does not qualify towards the two year requirement) and have a maximum of two GOC registered students at any one time, irrespective of which optical discipline.
    2. Undertake to give continuous personal supervision to the trainee and accept full responsibility for his/her actions – i.e. be on the premises whilst the trainee is attending any patient.  It is essential that registered professionals in a supervisory capacity and those being supervised are aware of their roles and duties and particularly what functions cannot be carried out without a GOC/GMC registered supervisor being present on the premises and in a position to intervene.  Students are advised to register two supervisors to allow flexibility for cover during periods of holiday and sickness.  ABDO should be notified if a supervisor is absent for an extended period of cover (say in excess of four weeks) as alternative supervisory arrangements should then be made for the student.  Only supervisors that students have registered with the ABDO Examinations and Registration Department may supervise for the ABDO PQP and supervisors may only sign records in the ABDO PQP portfolio folder for the student’s work that they have personally supervised.
    3. Ensure the practice facilities and equipment are to the standard normally required for providing a full dispensing service.
    4. Ensure that the trainee receives practical experience in all areas of practice covered in the GOC Dispensing Core Competencies.
    5. Give the trainee the opportunity to attend appropriate tutorial and revision courses.
    6. Take an active interest so that the trainee is familiar with the practical examination syllabus, observes and comments on the trainee carrying out spectacle dispensing and adjustments and discusses appropriate selected courses of action.
    7. Permit a representative of ABDO to visit the premises at any time considered reasonable by appointment.  ABDO would expect to visit each student along with their principal supervisor during their time in practice training.  The purpose of the visit is to verify that the working environment is conducive to training and to support the student and supervisor as much as possible.  The ABDO representative would also be required to verify the authenticity of completed case records and therefore supervisors should ensure that procedures are in place to allow the auditing process and that they have complied with the Data Protection Act (i.e. that all related patients are aware that case records may be checked by ABDO for authenticity).

    Archived version(s) of this item - Click date to read:

    Updated: 22/03/2010

    1.7.1 Certain professional functions are regulated by law:

    1. The testing of sight, as defined in the Opticians Act 1989, Section 24 (Testing of Sight) and 26 (Duties to be performed on sight testing) and in the Sight Testing (Examination and Prescription) (No 2) Regulations 1989
    2. The fitting of contact lenses (Section 25 of the Opticians Act 1989).
    3. The dispensing of spectacle prescriptions of a kind that unqualified persons are not permitted by law to dispense (Section 27 of the Opticians Act 1989).The method of supply of all optical appliances including ready-made reading spectacles, on the premises of a registered optician or enrolled body corporate.

    1.7.2 Those registered dispensing opticians who are charged with the supervision of trainees in practice have a considerable obligation. Supervisors should ensure that their trainees are registered with the GOC.

    1.7.3 Individual supervisors of registered student dispensing opticians and trainee contact lens opticians must be approved by ABDO and comply with the following requirements:

    1. Be registered with the GOC for more than two years.
    2. Undertake to give continuous personal supervision to the trainee and accept full responsibility for his/her actions – i.e. be on the premises whilst the trainee is attending any patient. In the event of temporary absence from the practice due to ill health or holidays, it is the supervisor’s personal responsibility to ensure another suitable registered optician will provide the same degree of supervision. It is essential that both registered professionals in a supervisory capacity and those being supervised are aware of their roles and duties and particularly what functions cannot be carried out without a GOC/GMC registered supervisor being present on the premises and in a position to intervene. For an extended period of cover (say in excess of four weeks) approval for such arrangements must be agreed with ABDO.
    3. Ensure the practice facilities and equipment are to the standard normally required for providing a full dispensing service.
    4. Ensure that the trainee receives practical experience in all areas of practice covered in the GOC Dispensing Core Competencies.
    5. Give the trainee the opportunity to attend appropriate tutorial and revision courses.
    6. Take an active interest so that the trainee is familiar with the practical examination syllabus, observes and comments on the trainee carrying out spectacle dispensing and adjustments and discusses appropriate selected courses of action.
    7. Permit a representative of ABDO to visit the premises at any time considered reasonable by appointment.

    Archived version: 22/03/2010

    1.7.1 Certain professional functions are regulated by law:

    1. The testing of sight, as defined in the Opticians Act 1989, Section 24 (Testing of Sight) and 26 (Duties to be performed on sight testing) and in the Sight Testing (Examination and Prescription) (No 2) Regulations 1989
    2. The fitting of contact lenses (Section 25 of the Opticians Act 1989).
    3. The dispensing of spectacle prescriptions of a kind that unqualified persons are not permitted by law to dispense (Section 27 of the Opticians Act 1989).The method of supply of all optical appliances including ready-made reading spectacles, on the premises of a registered optician or enrolled body corporate.

    1.7.2 Those registered dispensing opticians who are charged with the supervision of trainees in practice have a considerable obligation. Supervisors should ensure that their trainees are registered with the GOC.

    1.7.3 Individual supervisors of pre-registration trainee dispensing opticians and contact lens opticians must be approved by ABDO and comply with the following requirements:

    1. Be registered with the GOC for more than two years.
    2. Undertake to give continuous personal supervision to the trainee and accept full responsibility for his/her actions – i.e. be on the premises whilst the trainee is attending any patient. In the event of temporary absence from the practice due to ill health or holidays, it is the supervisor’s personal responsibility to ensure another suitable registered optician will provide the same degree of supervision. For an extended period of cover (say in excess of four weeks) approval for such arrangements must be agreed with ABDO.
    3. Ensure the practice facilities and equipment are to the standard normally required for providing a full dispensing service.
    4. Ensure that the trainee receives practical experience in all areas of practice covered in the GOC Dispensing Core Competencies.
    5. Give the trainee the opportunity to attend appropriate tutorial and revision courses.
    6. Take an active interest so that the trainee is familiar with the practical examination syllabus, observes and comments on the trainee carrying out spectacle dispensing and adjustments and discusses appropriate selected courses of action.
    7. Permit a representative of ABDO to visit the premises at any time considered reasonable by appointment.

  • Duty to ReferOpen

    1.8.1 Every registered dispensing optician has a statutory duty to immediately refer a patient to a registered medical practitioner or directly to a hospital for appropriate medical advice if it appears that a patient is suffering from disease or injury of the eye. In such cases the optician must inform the patient that s/he is referring him/her, and the reason for that referral. A referral letter must also be completed and contain enough information such that the need for referral is explained so that the correct action is taken by the recipient practitioner, including –

    • The dispensing optician’s name and qualifications,
    • the patient’s name, address and date of birth,
    • the last examination date and the visual acuities on that date (if known).
    • If possible the visual acuities at the referral date and the symptoms with the duration of the symptoms
    • The signs as observed by gross external examination of the eye or, if appropriate by slit-lamp bio-microscope examination
    • Relevant details of the patient’s history including details of current and recent patient medication
    • It must be stated that no ophthalmoscopy was performed.

    1.8.2 A referral made directly to a hospital is necessary if the condition is potentially sight threatening. The patient must be given a referral letter and advised to attend the Accident & Emergency Department immediately. A copy of the referral letter must be sent to the patient’s GP with a covering letter. The reason for referral should be explained to the patient, and it is good practice to support this in writing. Copies of referral letters must be kept with the patient record card. In due course the patient should be contacted and the record card annotated with the result of the referral. For non-urgent referrals, a full eye examination should be recommended as soon as possible.

    1.8.3 If in the professional judgement of a registered optician there is no justification to refer a person consulting him/her to a registered medical practitioner, or that it would be impracticable or inexpedient to do so, the registered optician may at his/her discretion decide not to refer that person on that occasion; but in that event he/she:

    1. shall record on the record card of the person consulting him/her:

    i. a sufficient description of the injury or disease from which the patient appears to be suffering.
    ii. the reason for deciding not to refer on that occasion.
    iii. details of any advice tendered to the patient.
    iv. an account of any action taken; and

    2. if appropriate, and with the consent of the person consulting him/her, shall inform that person’s general medical practitioner of those matters recorded.

    1.8.4 A registered dispensing optician has the option of referring the patient to an optometrist. In that event, it will then be the optometrist’s responsibility to refer or not, but it should be recorded that the referral has been made to the optometrist together with the details of the injury or disease from which the patient appears to be suffering and of any advice tendered to the patient. The registered dispensing optician must be fully cognisant of all ocular emergencies which would necessitate referral directly to a hospital.

    1.8.5 The knowledge of a patient’s visual acuity and how this may impinge on their driving ability is a confidential matter, and may not be disclosed to a third party. If a patient is suspected of being below the legal standard for driving, s/he has a legal responsibility to inform the DVLA. Any advice which you give to the patient should be noted on the record.

    In the first instance talk to the patient, advise them they are unfit to drive and try to persuade them to stop. Remind the patient that s/he is legally responsible for informing the DVLA or DVA if they do not meet the vision standard for driving. However, if the patient has told you that they will not stop driving, you may conclude the public interest outweighs the duty of confidentiality. In this case, refer back to the prescribing optometrist. You may wish to seek the advice of your professional body.

    1.8.6 At Appendix I a form designed for the use of dispensing opticians wishing to refer can be downloaded

    Archived version(s) of this item - Click date to read:

    1.8.1 Every registered dispensing optician has a statutory duty to immediately refer a patient to a registered medical practitioner or directly to a hospital for appropriate medical advice if it appears that a patient is suffering from disease or injury of the eye. In such cases the optician must inform the patient that s/he is referring him/her, and the reason for that referral. A referral letter must also be completed and contain enough information such that the need for referral is explained so that the correct action is taken by the recipient practitioner, including –

    • The dispensing optician’s name and qualifications,
    • the patient’s name, address and date of birth,
    • the last examination date and the visual acuities on that date (if known).
    • If possible the visual acuities at the referral date and the symptoms with the duration of the symptoms
    • The signs as observed by gross external examination of the eye or, if appropriate by slit-lamp bio-microscope examination
    • Relevant details of the patient’s history including details of current and recent patient medication
    • It must be stated that no ophthalmoscopy was performed.

    1.8.2 A referral made directly to a hospital is necessary if the condition is potentially sight threatening. The patient must be given a casualty note and advised to attend the Accident & Emergency Department immediately. A copy of the casualty note must be sent to the patient’s GP with a covering letter. The reason for referral should be explained to the patient, and it is good practice to support this in writing. Copies of referral letters must be kept with the patient record card. In due course the patient should be contacted and the record card annotated with the result of the referral. For non-urgent referrals, a full eye examination should be recommended as soon as possible.

    1.8.3 If in the professional judgement of a registered optician there is no justification to refer a person consulting him/her to a registered medical practitioner, or that it would be impracticable or inexpedient to do so, the registered optician may at his/her discretion decide not to refer that person on that occasion; but in that event he/she:

    1. shall record on the record card of the person consulting him/her:

    i. a sufficient description of the injury or disease from which the patient appears to be suffering.
    ii. the reason for deciding not to refer on that occasion.
    iii. details of any advice tendered to the patient.
    iv. an account of any action taken; and

    2. if appropriate, and with the consent of the person consulting him/her, shall inform that person’s general medical practitioner of those matters recorded.

    1.8.4 A registered dispensing optician has the option of referring the patient to an optometrist. In that event, it will then be the optometrist’s responsibility to refer or not, but it should be recorded that the referral has been made to the optometrist together with the details of the injury or disease from which the patient appears to be suffering and of any advice tendered to the patient. The registered dispensing optician must be fully cognisant of all ocular emergencies which would necessitate referral directly to a hospital.

    1.8.5 The knowledge of a patient’s visual acuity and how this may impinge on their driving ability is a confidential matter, and may not be disclosed to a third party. If a patient is suspected of being below the legal standard for driving, s/he has a legal responsibility to inform the DVLA. Any advice which you give to the patient should be noted on the record.

    In the first instance talk to the patient, advise them they are unfit to drive and try to persuade them to stop. Remind the patient that s/he is legally responsible for informing the DVLA or DVA if they do not meet the vision standard for driving. However, if the patient has told you that they will not stop driving, you may conclude the public interest outweighs the duty of confidentiality. In this case, refer back to the prescribing optometrist. You may wish to seek the advice of your professional body.

    1.8.6 At Appendix I a form designed for the use of dispensing opticians wishing to refer can be downloaded

    1.8.5 The knowledge of a patient’s visual acuity and how this may impinge on their driving ability is a confidential matter, and may not be disclosed to a third party. If a patient is suspected of being below the legal standard for driving, s/he has a legal responsibility to inform the DVLA. Any advice which you give to the patient should be noted on the record.

    1.8.1 Every registered dispensing optician has a statutory duty to immediately refer a patient to a registered medical practitioner or directly to a hospital for appropriate medical advice if it appears that a patient is suffering from disease or injury of the eye. In such cases a referral letter must be completed and contain enough information such that the need for referral is explained so that the correct action is taken by the recipient practitioner, including –

    • The dispensing optician’s name and qualifications,
    • the patient’s name, address and date of birth,
    • the last examination date and the visual acuities on that date (if known).
    • If possible the visual acuities at the referral date and the symptoms with the duration of the symptoms
    • The signs as observed by gross external examination of the eye or, if appropriate by slit-lamp bio-microscope examination
    • Relevant details of the patient’s history including details of current and recent patient medication
    • It must be stated that no ophthalmoscopy was performed.

    1.8.2 A referral made directly to a hospital is necessary if the condition is potentially sight threatening. The patient must be given a casualty note and advised to attend the Accident & Emergency Department immediately. A copy of the casualty note must be sent to the patient’s GP with a covering letter. The reason for referral should be explained to the patient, and it is good practice to support this in writing. Copies of referral letters must be kept with the patient record card. In due course the patient should be contacted and the record card annotated with the result of the referral. For non-urgent referrals, a full eye examination should be recommended as soon as possible.

    1.8.3 If in the professional judgement of a registered optician there is no justification to refer a person consulting him/her to a registered medical practitioner, or that it would be impracticable or inexpedient to do so, the registered optician may at his/her discretion decide not to refer that person on that occasion; but in that event he/she:

    1. shall record on the record card of the person consulting him/her:

    i. a sufficient description of the injury or disease from which the patient appears to be suffering.
    ii. the reason for deciding not to refer on that occasion.
    iii. details of any advice tendered to the patient.
    iv. an account of any action taken; and

    2. if appropriate, and with the consent of the person consulting him/her, shall inform that person’s general medical practitioner of those matters recorded.

    1.8.4 A registered dispensing optician has the option of referring the patient to an optometrist. In that event, it will then be the optometrist’s responsibility to refer or not, but it should be recorded that the referral has been made to the optometrist together with the details of the injury or disease from which the patient appears to be suffering and of any advice tendered to the patient. The registered dispensing optician must be fully cognisant of all ocular emergencies which would necessitate referral directly to a hospital.

    1.8.5 The knowledge of a patient’s visual acuity and how this may impinge on their driving ability is a confidential matter, and may not be disclosed to a third party. If a patient is suspected of being below the legal standard for driving, s/he has a legal responsibility to inform the DVLA. Any advice which you give to the patient should be noted on the record.

    1.8.6 At Appendix I a form designed for the use of dispensing opticians wishing to refer can be downloaded.

    updated 03/06/2013

    1.8.1 Every registered dispensing optician has a statutory duty to immediately refer a patient to a registered medical practitioner or directly to a hospital for appropriate medical advice if it appears that a patient is suffering from disease or injury of the eye. In such cases a referral letter must be completed and contain enough information such that the need for referral is explained so that the correct action is taken by the recipient practitioner, including –

    • The dispensing optician’s name and qualifications,
    • the patient’s name, address and date of birth,
    • the last examination date and the visual acuities on that date (if known).
    • If possible the visual acuities at the referral date and the symptoms with the duration of the symptoms
    • The signs as observed by gross external examination of the eye or, if appropriate by slit-lamp bio-microscope examination
    • Relevant details of the patient’s history including details of current and recent patient medication
    • It must be stated that no ophthalmoscopy was performed.

    1.8.2 A referral made directly to a hospital is necessary if the condition is potentially sight threatening. The patient must be given a casualty note and advised to attend the Accident & Emergency Department immediately. A copy of the casualty note must be sent to the patient’s GP with a covering letter. The reason for referral should be explained to the patient, and it is good practice to support this in writing. Copies of referral letters must be kept with the patient record card. In due course the patient should be contacted and the record card annotated with the result of the referral. For non-urgent referrals, a full eye examination should be recommended as soon as possible.

    1.8.3 If in the professional judgement of a registered optician there is no justification to refer a person consulting him/her to a registered medical practitioner, or that it would be impracticable or inexpedient to do so, the registered optician may at his/her discretion decide not to refer that person on that occasion; but in that event he/she:

    1. shall record on the record card of the person consulting him/her:

    i. a sufficient description of the injury or disease from which the patient appears to be suffering.
    ii. the reason for deciding not to refer on that occasion.
    iii. details of any advice tendered to the patient.
    iv. an account of any action taken; and

    2. if appropriate, and with the consent of the person consulting him/her, shall inform that person’s general medical practitioner of those matters recorded.

    1.8.4 A registered dispensing optician has the option of referring the patient to an optometrist. In that event, it will then be the optometrist’s responsibility to refer or not, but it should be recorded that the referral has been made to the optometrist together with the details of the injury or disease from which the patient appears to be suffering and of any advice tendered to the patient. The registered dispensing optician must be fully cognisant of all ocular emergencies which would necessitate referral directly to a hospital.

    1.8.5 The knowledge of a patient’s visual acuity and how this may impinge on their driving ability is a confidential matter, and may not be disclosed to a third party. If a patient is suspected of being below the legal standard for driving, s/he has a legal responsibility to inform the DVLA. Any advice which you give to the patient should be noted on the record.

    Archived version: 25/08/2011

    1.8.1 Every registered dispensing optician has a statutory duty to immediately refer a patient to a registered medical practitioner or directly to a hospital for appropriate medical advice if it appears that a patient is suffering from disease or injury of the eye. In such cases a referral letter must be completed and contain enough information such that the need for referral is explained so that the correct action is taken by the recipient practitioner, including –

    • The dispensing optician’s name and qualifications,
    • the patient’s name, address and date of birth,
    • the last examination date and the visual acuities on that date (if known).
    • If possible the visual acuities at the referral date and the symptoms with the duration of the symptoms
    • The signs as observed by gross external examination of the eye or, if appropriate by slit-lamp bio-microscope examination
    • Relevant details of the patient’s history including details of current and recent patient medication
    • It must be stated that no ophthalmoscopy was performed.

    1.8.2 A referral made directly to a hospital is necessary if the condition is potentially sight threatening. The patient must be given a casualty note and advised to attend the Accident & Emergency Department immediately. A copy of the casualty note must be sent to the patient’s GP with a covering letter. The reason for referral should be explained to the patient, and it is good practice to support this in writing. Copies of referral letters must be kept with the patient record card. In due course the patient should be contacted and the record card annotated with the result of the referral. For non-urgent referrals, a full eye examination should be recommended as soon as possible.

    1.8.3 If in the professional judgement of a registered optician there is no justification to refer a person consulting him/her to a registered medical practitioner, or that it would be impracticable or inexpedient to do so, the registered optician may at his/her discretion decide not to refer that person on that occasion; but in that event he/she:

    1. shall record on the record card of the person consulting him/her:

    i. a sufficient description of the injury or disease from which the patient appears to be suffering.
    ii. the reason for deciding not to refer on that occasion.
    iii. details of any advice tendered to the patient.
    iv. an account of any action taken; and

    2. if appropriate, and with the consent of the person consulting him/her, shall inform that person’s general medical practitioner of those matters recorded.

    1.8.4 A registered dispensing optician has the option of referring the patient to an optometrist. In that event, it will then be the optometrist’s responsibility to refer or not, but it should be recorded that the referral has been made to the optometrist together with the details of the injury or disease from which the patient appears to be suffering and of any advice tendered to the patient. The registered dispensing optician must be fully cognisant of all ocular emergencies which would necessitate referral directly to a hospital.

  • Clinical Support – Use of Drugs (also see Section 5)Open

    Updated: 00/12/2009
    Updated: 16/03/2010
    Updated: 24/07/2010
    Updated: 30/01/2012

    1.9.1 Optometrists and Dispensing Opticians are reminded that Tropicamide and other pupil dilating drugs are prescription only medicines (POMs). As such the supply of these drugs is controlled by law and optometrists (and OMPs), are the only members of the practice team who legally are responsible for the instillation of these POMs. Registered Dispensing Opticians may order a limited list of POMs [see below] including these drugs for use in the practice. The use of pupil dilating eye drops should always, therefore, be done under the direction and supervision of an optometrist (or doctor/OMP).

    Amethocaine hydrochloride
    Chloramphenicol
    Cyclopentolate hydrochloride
    Fusidic acid
    Lignocaine hydrochloride
    Oxybuprocaine hydrochloride
    Proxymetacaine hydrochloride
    Tropicamide

    Contact Lens Opticians may now instil a limited range of anaesthetics [see below] in the course of appropriate contact lens fitting. The Association recommends that this should only be used for complex fittings where it is needed to achieve a satisfactory result.

    Lignocaine hydrochloride
    Oxybuprocaine hydrochloride
    Proxymetacaine hydrochloride

    In the case of acute bacterial conjunctivitis ONLY, the sale and supply of 0.5% Chloramphenicol drops [1% ointment] may now be instigated by all Dispensing Opticians. The restrictions of the pharmacy classification limit the supply to

    • a maximum pack size of 10ml[ drops]/4gms[ointment]
    • only in adults and children over 2 years of age
    • for a maximum of 5 days.

    All actions and advice should be noted on the patient’s record.

    For diagnosis of acute bacterial conjunctivitis and further advice – see Dispensing Optics – Special educational supplement – April 2010

    1.9.2 Practices should have Standard Operating Procedures to ensure that drugs are managed in accordance with the legislation.

    1.9.3 Optometrists are referred to paragraphs K1.25 & K1.26 and chapter A6 (Delegation) of the College’s Code of Ethics and Guidelines for Professional Conduct. If they are in any doubt about what to do in their particular circumstances they are advised to contact their professional and/or defence body for advice.

    For further information see www.college-optometrists.org.

    Archived version(s) of this item - Click date to read:

    Archived version: 30/01/2012

    1.9.1 Optometrists and Dispensing Opticians are reminded that Tropicamide and other pupil dilating drugs are prescription only medicines (POMs). As such the supply of these drugs is controlled by law and only certain classes of person, such as optometrists (and OMPs), are the only members of the practice team who legally are responsible for the instillation of these POMs. Registered Dispensing Opticians may order a limited list of POMs [see below] including these drugs for use in the practice. The use of pupil dilating eye drops should always, therefore, be done under the direction and supervision of an optometrist (or doctor/OMP).

    Amethocaine hydrochloride
    Chloramphenicol
    Cyclopentolate hydrochloride
    Fusidic acid
    Lignocaine hydrochloride
    Oxybuprocaine hydrochloride
    Proxymetacaine hydrochloride
    Tropicamide

    Contact Lens Opticians may now instil a limited range of anaesthetics [see below] in the course of appropriate contact lens fitting. The Association recommends that this should only be used for complex fittings where it is needed to achieve a satisfactory result.

    Lignocaine hydrochloride
    Oxybuprocaine hydrochloride
    Proxymetacaine hydrochloride

    In the case of acute bacterial conjunctivitis ONLY, the sale and supply of 0.5% Chloramphenicol drops [1% ointment] may now be instigated by all Dispensing Opticians. The restrictions of the pharmacy classification limit the supply to

    • a maximum pack size of 10ml[ drops]/4gms[ointment]
    • only in adults and children over 2 years of age
    • for a maximum of 5 days.

    All actions and advice should be noted on the patient’s record.

    For diagnosis of acute bacterial conjunctivitis and further advice – see Dispensing Optics – Special educational supplement – April 2010

    1.9.2 Practices should have Standard Operating Procedures to ensure that drugs are managed in accordance with the legislation.

    1.9.3 Optometrists are referred to the Appendix A of the College Formulary, and College Guidance on delegation. If they are in any doubt about what to do in their particular circumstances they are advised to contact their professional and/or defence body for advice.

    For further information see www.college-optometrists.org.

    Archived version: 16/03/2010

    Use and Supply of Pupil Dilating Drugs  [ this paragraph is repeated in Section 5]

    1.9.1  Optometrists and Dispensing Opticians are reminded that Tropicamide and other pupil dilating drugs are prescription only medicines (POMs).  As such the supply of these drugs is controlled by law and only certain classes of person, such as optometrists (and OMPs), are the only members of the practice team who are legally permitted to acquire and/ or supply the POMs.  They are therefore responsible for any other members of the practice team who place orders with wholesalers, or those, such as retinal screeners, who wish to instill the drug into a patient’s eyes.  The use of pupil dilating eye drops should always, therefore, be done under the direction and supervision of an optometrist (or doctor/OMP).

    1.9.2  Practices should have Standard Operating Procedures to ensure that drugs are managed in accordance with the legislation.  This is particularly crucial if the practice relies on locum optometric/OMP cover.

    1.9.3  Optometrists are referred to the Appendix A of the College Formulary, and College Guidance on delegation.  If they are in any doubt about what to do in their particular circumstances they are advised to contact their professional and/or defence body for advice.

    For further information see www.college-optometrists.org

    Archived version:  24/07/2010

    Use and Supply of Pupil Dilating Drugs  [ this paragraph is repeated in Section 5]

    1.9.1  Optometrists and Dispensing Opticians are reminded that Tropicamide and other pupil dilating drugs are prescription only medicines (POMs).  As such the supply of these drugs is controlled by law and only certain classes of person, such as optometrists (and OMPs), are the only members of the practice team who legally are responsible for the instillation of these POMs. Registered Dispensing Opticians may order a limited list of POMs [see below] including these drugs for use in the practice.  The use of pupil dilating eye drops should always, therefore, be done under the direction and supervision of an optometrist (or doctor/OMP).

    Amethocaine hydrochloride
    Chloramphenicol
    Cyclopentolate hydrochloride
    Fusidic acid
    Lignocaine hydrochloride
    Oxybuprocaine hydrochloride
    Proxymetacaine hydrochloride
    Tropicamide

    Contact Lens Opticians may now instil a limited range of anaesthetics [see below] in the course of appropriate contact lens fitting. The Association recommends that this should only be used for complex fittings where it is needed to achieve a satisfactory result.

    Lignocaine hydrochloride
    Oxybuprocaine hydrochloride
    Proxymetacaine hydrochloride
    In the case of acute bacterial conjunctivitis ONLY, the sale and supply of 0.5% Chloramphenicol drops [1% ointment] may now be instigated by all Dispensing Opticians. The restrictions of the pharmacy classification limit the supply to

    • a maximum pack size of 10ml[ drops]/4gms[ointment]
    • only in adults and children over 2 years of age
    • for a maximum of 5 days.

    All actions and advice should be noted on the patient’s record.

    For diagnosis of acute bacterial conjunctivitis and further advice – see Dispensing Optics – Special educational supplement – April 2010

    1.9.2  Practices should have Standard Operating Procedures to ensure that drugs are managed in accordance with the legislation.

    1.9.3  Optometrists are referred to the Appendix A of the College Formulary, and College Guidance on delegation.  If they are in any doubt about what to do in their particular circumstances they are advised to contact their professional and/or defence body for advice.

    For further information see www.college-optometrists.org

    Archived version:  00/12/2009

    Use and Supply of Pupil Dilating Drugs  [ this paragraph is repeated in Section 5]

    1.9.1  Optometrists and Dispensing Opticians are reminded that Tropicamide and other pupil dilating drugs are prescription only medicines (POMs).  As such the supply of these drugs is controlled by law and only certain classes of person, such as optometrists (and OMPs), are the only members of the practice team who are legally permitted to acquire and/ or supply the POMs.  They are therefore responsible for any other members of the practice team who place orders with wholesalers, or those, such as retinal screeners, who wish to instill the drug into a patient’s eyes.  The use of pupil dilating eye drops should always, therefore, be done under the direction and supervision of an optometrist (or doctor/OMP).

    1.9.2  Practices should have Standard Operating Procedures to ensure that drugs are managed in accordance with the legislation.  This is particularly crucial if the practice relies on locum optometric/OMP cover.

    1.9.3  Optometrists are referred to the Appendix A of the College Formulary, and College Guidance on delegation.  If they are in any doubt about what to do in their particular circumstances they are advised to contact their professional and/or defence body for advice.

  • Domiciliary VisitsOpen

    Updated: 16/03/2010
    Updated: 06/08/2014

    1.10.1 A domiciliary service is intended for those who are house-bound. A registered dispensing optician offering this service should ensure that the required high standards of care, conduct and professional responsibility are provided.

    1.10.2 Registered dispensing opticians carrying out domiciliary visits should be readily identifiable by name to the patient. As patients retain the right to freedom of choice of dispensing it is important that, should a dispensing be requested, a range of spectacle frames and/or other appliances (such as magnifiers etc.) appropriate to the patient’s need, be made available.

    1.10.3 Proper patient records must be made, kept secure and confidential. Domiciliary visits should not be viewed as a ‘one-off’ service. Specific arrangements must be made for a contact address and telephone number so that patients have access to a local contact for queries, advice and any necessary aftercare service in connection with the dispensing.

    Statutory cooling off period for domiciliary services
    1.10.4 The UK Domiciliary Eyecare Committee advises that the new statutory cooling off period of seven (7) days applies to all goods and services ordered/contracted for in the home or a place of work for over £35 including the supply of spectacles, contact lenses and other optical devices. For example, when a provider takes an order from a domiciliary patient to supply spectacles to the patient’s prescription, the patient is entitled to a seven day “cooling off period”. This means that he may cancel the order for the new spectacles at any time within 7 days of the order being placed. The provider may start the ordering process before the 7 day cooling off period is over but at their own risk of the patient cancelling unless the patient gives written permission. If the patient has given written permission then he/she is liable for the costs of any work carried out after that permission is given.

    1.10.5 The Optical Confederation’s Code of Practice for Domiciliary Eyecare may be accessed here:http://www.opticalconfederation.org.uk/downloads/domiciliary/domiciliary-code-of-practice-2014-final.pdf

    Archived version(s) of this item - Click date to read:

    Archived version: 06/08/2014

    1.10.1 A domiciliary service is intended for those who are house-bound. A registered dispensing optician offering this service should ensure that the required high standards of care, conduct and professional responsibility are provided.

    1.10.2 Registered dispensing opticians carrying out domiciliary visits should be readily identifiable by name to the patient. As patients retain the right to freedom of choice of dispensing it is important that, should a dispensing be requested, a range of spectacle frames and/or other appliances (such as magnifiers etc.) appropriate to the patient’s need, be made available.

    1.10.3 Proper patient records must be made, kept secure and confidential. Domiciliary visits should not be viewed as a ‘one-off’ service. Specific arrangements must be made for a contact address and telephone number so that patients have access to a local contact for queries, advice and any necessary aftercare service in connection with the dispensing.

    Statutory cooling off period for domiciliary services
    1.10.4 The UK Domiciliary Eyecare Committee advises that the new statutory cooling off period of seven (7) days applies to all goods and services ordered/contracted for in the home or a place of work for over £35 including the supply of spectacles, contact lenses and other optical devices. For example, when a provider takes an order from a domiciliary patient to supply spectacles to the patient’s prescription, the patient is entitled to a seven day “cooling off period”. This means that he may cancel the order for the new spectacles at any time within 7 days of the order being placed. The provider may start the ordering process before the 7 day cooling off period is over but at their own risk of the patient cancelling unless the patient gives written permission. If the patient has given written permission then he/she is liable for the costs of any work carried out after that permission is given.

    1.10.5 For a fuller guidance to lone working see AOP Website Domiciliary section. Information and Regulatory section of the ABDO website.

    Archived version: 16/03/2010

    1.10.1 A domiciliary service is intended for those who are house-bound. A registered dispensing optician offering this service should ensure that the required high standards of care, conduct and professional responsibility are provided.

    1.10.2 Registered dispensing opticians carrying out domiciliary visits should be readily identifiable by name to the patient. As patients retain the right to freedom of choice of dispensing it is important that, should a dispensing be requested, a range of spectacle frames and/or other appliances (such as magnifiers etc.) appropriate to the patient’s need, be made available.

    1.10.3 Proper patient records must be made, kept secure and confidential. Domiciliary visits should not be viewed as a ‘one-off’ service. Specific arrangements must be made for a contact address and telephone number so that patients have access to a local contact for queries, advice and any necessary aftercare service in connection with the dispensing.

  • Professional PublicityOpen

    1.11.1 Although the GOC has ceased to issue rules on publicity, ABDO takes the view that any advertising by a dispensing optician should not bring the profession into disrepute.

    1.11.2 Items for sale should be clearly marked with their price. It is very important that members of the public who might purchase the product or service are fully aware of prices and fees charged. Registered dispensing opticians should encourage the public to use eyecare and eyewear services and may employ acceptable publicity.

    1.11.3 It is universally recognised that the success of the practice depends upon the public reputation it enjoys for the quality of the services and product provided. The public is the only true guide in this matter, since no registered dispensing optician can be competent to claim, directly or indirectly, that his/her quality of service is superior to that of professional colleagues. Any claim of superiority therefore carries a serious risk of being misleading and should not be made.

    1.11.4 Registered dispensing opticians should observe their professional obligation to avoid publicity or advertising which could bring the profession into disrepute or which their colleagues or the public could find distasteful.

    1.11.5 Considerable care has to be exercised when offering discounts or special offers to ensure that the public is not misled in any way. Complete details of any conditions connected with an offer or discount must be included in any advertising material and prominently displayed in the practice. Failure to do so results in prosecution being brought by Trading Standards Officers and involves GOC fitness to practice procedures. False claims of ‘sale’ items will incur similar action and penalties. (See Consumer Protection Act 1987 Part III)

  • Media RelationsOpen

    1.12.1 Registered dispensing opticians are occasionally called on by journalists and radio and television reporters to make statements on current issues in the profession, grant interviews or to help in the composition of feature articles, pamphlets or books. While good publicity and a free flow of information to the public through the news media is desirable and potentially of benefit to the public, such activities must be handled with the greatest of care, especially by the inexperienced.

    1.12.2 It is preferable that questions about dispensing practice be dealt with by the ABDO Secretariat, rather than individuals. If there is no alternative but to make a statement on a professional matter of public interest, ideally advice and guidance should be sought from the Secretariat before responding.

    1.12.3 Local newspapers frequently publish feature articles publicising some (usually retail) enterprise, associated with editorial matter and supportive advertisements by retail shopkeepers. Registered dispensing opticians are advised to treat any such requests for interviews with caution and should insist on the right to approve the text of articles before publication.

    1.12.4 ABDO takes the view that all registered dispensing opticians who own or manage practices must take responsibility for such publicity even if they can claim lack of knowledge.

    Advice

    1.12.5 The registered dispensing optician should be adequately prepared for questioning. Avoid ‘off the cuff’ statements to casual callers; insist on time for reflection on questions from journalists if unprepared.

    1.12.6 If unsure of how to handle the interview either refer the interviewer to the Association’s Secretariat or seek the latter’s advice.

    1.12.7 If wishing to express personal opinions ensure that they are identified as such, and do not be harassed into imprudent over-simplification.

    1.12.8 Avoid overt self-advertisement or assertions of superiority of professional services over colleagues.

    1.12.9 Insist on editorial right to vet any material for publication.

    1.12.10 Be especially cautious of interviews intended to be the basis of feature articles.

  • Consumer ComplaintsOpen

    Updated: 12/02/2015

    1.13.1 Wherever possible complaints should be given priority and speedily resolved within the practice. Unwillingness on the part of any registered dispensing optician to deal with a complaint does not reflect well upon either the individual or on the profession as a whole. It is therefore essential that a sound procedure for handling complaints exists and can be explained to patients by all members of staff.

    1.13.2 ABDO fully supports the independent Optical Consumer Complaints Service, (OCCS) which was established to handle complaints that could not be resolved in-house. Any complaint against a member who refuses to accept any finding of OCCS will render himself/herself liable to investigation for conduct unbefitting membership of ABDO, and could result in GOC fitness to practise procedures being instigated. For advice on managing non-tolerance issues, when the sight test and dispense are delivered by different community practices, see http://www.opticalconfederation.org.uk/downloads/guidance/optical-confederation-managing-non-tolerances-guidance-final-20th-dec-14.pdf

    1.13.3 It is important that when other organisations are involved – including the GOC, Primary Care Trusts (PCTs), Local Health Boards (Wales), Health Authorities, Scottish Executive, OCCS etc., information requested by such an authority is provided as promptly as possible, subject to the guidelines in paragraph 24.

    Archived version(s) of this item - Click date to read:

    1.13.1 Wherever possible complaints should be given priority and speedily resolved within the practice. Unwillingness on the part of any registered dispensing optician to deal with a complaint does not reflect well upon either the individual or on the profession as a whole. It is therefore essential that a sound procedure for handling complaints exists and can be explained to patients by all members of staff.

    1.13.2 ABDO fully supports the independent Optical Consumer Complaints Service, (OCCS) which was established to handle complaints that could not be resolved in-house. Any complaint against a member who refuses to accept any finding of OCCS will render himself/herself liable to investigation for conduct unbefitting membership of ABDO, and could result in GOC fitness to practise procedures being instigated.

    1.13.3 It is important that when other organisations are involved – including the GOC, Primary Care Trusts (PCTs), Local Health Boards (Wales), Health Authorities, Scottish Executive, OCCS etc., information requested by such an authority is provided as promptly as possible, subject to the guidelines in paragraph 24.

  • The Fitness to Practise Jurisdiction of the GOC – see Appendix AOpen

    1.14.1 A registered dispensing optician who becomes involved with the GOC fitness to practise procedures should seek the advice of the Association at an early stage. Legal protection and professional indemnity cover in such an event is a benefit of membership.

    1.14.2 The General Optical Council appoints selected members to its Investigation Committee. This committee investigates an allegation made against a registrant. It decides whether the complaint ought to be considered by the Fitness to Practise Committee, or by the Optical Consumer Complaints Service (OCCS), or whether the allegation warrants no further action.

    1.14.3 The Fitness to Practise Committee is independent of the membership of the General Optical Council. It receives evidence and adjudicates on allegations made against a registrant following referral from the Investigation Committee. Other than in exceptional circumstances it deliberates and adjudicates in public. Its powers in the case of a guilty verdict range from an erasure order or suspension from the register or, if appropriate, conditional registration.

    1.14.4 The committee may impose either in addition or instead of it, a financial penalty order currently not exceeding £50,000. In reaching a decision the committee will, in appropriate cases, take into account ABDO’s Advice and Guidelines.

    1.14.5 If either the Fitness to Practise Committee or the Investigation Committee finds a registered dispensing optician’s fitness to practice is not impaired, they may nevertheless give the registrant a warning regarding his/her future conduct or performance. Such cases may be referred to the ABDO to invoke a Performance Review Procedure (PRP) although the GOC still maintains overall responsibility.

SECTION 2: OPHTHALMIC DISPENSING

Open

SALE AND SUPPLY OF SPECTACLES

Open
  • GuidelineOpen

    2.1 The dispensing optician should ensure that all patients are fully advised of their needs for spectacle frames and lenses and that all spectacles are properly measured for fit and are fitted to the patient and are checked against relevant standards.

  • AdviceOpen

    Updated: 22/03/2010
    Updated: 27/05/2014

    2.2.1 The dispensing optician should ensure that, when dispensing or supplying spectacles to a patient, all appropriate measurements are taken for the lenses and frames, that checks are made against the relevant standards and that the spectacles are fitted to the patient to ensure that the lenses are fitting in the correct plane, at the correct height, and that the frames are adjusted to hold the spectacles in the correct position.

    2.2.2 Registered dispensing opticians, optometrists, and medical practitioners are allowed to dispense spectacles to a prescription that is more than 2 years old. They may also make up spectacles without a prescription e.g. by duplicating an existing pair of spectacles. Practitioners should be aware that if the patient has not had a recent eye examination, they may – by making up spectacles to an out of date prescription – inadvertently encourage patients to delay having another eye examination. This should only be done in exceptional circumstances and the practitioner should consider what is in the best interests of the patient, and the reasons recorded on the patient’s record card.

    2.2.3 The Association believes that the dispensing of all spectacles or other optical appliances sold or supplied should be carried out by or under the supervision of a registered optician; this applies even if the sale could otherwise be conducted by an unregistered person. The practitioner should decide what is in the best interests of the patient. Dispensing opticians/ optometrists should ensure the following when dispensing or supplying spectacles to a patient:

    1. The purpose and function of the appliance is fully and clearly explained to the patient and should be suitable for their particular needs;
    2. Facial, frame and other appropriate measurements are taken as necessary and recorded prior to ordering the appliance;
    3. The spectacles are appropriate, accurate, CE marked and conform to the appropriate standards;
    4. The spectacles correspond to the written prescription or sight test record;
    5. The finished spectacles are checked on the patient for fit, function and comfort and any necessary adjustments made before they are taken from the practice. This may include checking against a letter chart, or equivalent, to ensure the correct acuity is obtained
    6. The patient is provided with advice on the use and maintenance of the spectacles;
    7. Patients know and understand the financial costs of the professional services and products offered before they are asked to commit themselves to payment. To this end, patients should be informed in advance, itemising the options available for lenses and frames and of any additional features such as coatings or tints. Similarly itemised statements of account should be rendered. (The conditions of the Consumer Protection Act Part III and the Price Marking Order 2004 [SI 102 of 2004] must be complied with).

    2.2.4 Practices should note that the Medical Devices Directive does not cover spectacle frames already owned by a patient. Therefore new lenses can be put into a patient’s existing frames (even if they do not have a CE marking). For more information on ophthalmic products as medical devices see http://www.mhra.gov.uk/Howweregulate/Devices/Complyingwithlegislation/ActiveImplantableMedicalDevicesDirective/Ophthalmicproducts/index.htm

    2.2.5 The Association believes that a supervisor of a dispensing function which is regulated under the Opticians Act 1989 as amended 2005, eg paediatric, is responsible for all of the above at the point of collection of the spectacles.


    Archived version(s) of this item - Click date to read:

    Archived version: 27/05/2014

    2.2.1 The dispensing optician should ensure that, when dispensing or supplying spectacles to a patient, all appropriate measurements are taken for the lenses and frames, that checks are made against the relevant standards and that the spectacles are fitted to the patient to ensure that the lenses are fitting in the correct plane, at the correct height, and that the frames are adjusted to hold the spectacles in the correct position.

    2.2.2 Registered dispensing opticians, optometrists, and medical practitioners are allowed to dispense spectacles to a prescription that is more than 2 years old. They may also make up spectacles without a prescription e.g. by duplicating an existing pair of spectacles. Practitioners should be aware that if the patient has not had a recent eye examination, they may – by making up spectacles to an out of date prescription – inadvertently encourage patients to delay having another eye examination. This should only be done in exceptional circumstances and the practitioner should consider what is in the best interests of the patient, and the reasons recorded on the patient’s record card.

    2.2.3 The Association believes that the dispensing of all spectacles or other optical appliances sold or supplied should be carried out by or under the supervision of a registered optician; this applies even if the sale could otherwise be conducted by an unregistered person. The practitioner should decide what is in the best interests of the patient. Dispensing opticians/ optometrists should ensure the following when dispensing or supplying spectacles to a patient:

    1. The purpose and function of the appliance is fully and clearly explained to the patient and should be suitable for their particular needs; 2. Facial, frame and other appropriate measurements are taken as necessary and recorded prior to ordering the appliance; 3. The spectacles are appropriate, accurate, CE marked and conform to the appropriate standards; 4. The spectacles correspond to the written prescription or sight test record; 5. The finished spectacles are checked on the patient for fit, function and comfort and any necessary adjustments made before they are taken from the practice. This may include checking against a letter chart, or equivalent, to ensure the correct acuity is obtained 6. The patient is provided with advice on the use and maintenance of the spectacles; 7. Patients know and understand the financial costs of the professional services and products offered before they are asked to commit themselves to payment. To this end, patients should be informed in advance, itemising the options available for lenses and frames and of any additional features such as coatings or tints. Similarly itemised statements of account should be rendered. (The conditions of the Consumer Protection Act Part III and the Price Marking Order 2004 [SI 102 of 2004] must be complied with).

    2.2.4 The Association believes that a supervisor of a dispensing function which is regulated under the Opticians Act 1989 as amended 2005, eg paediatric, is responsible for all of the above at the point of collection of the spectacles.

    Archived version: 22/03/2010

    2.2.1 The dispensing optician should ensure that, when dispensing or supplying spectacles to a patient, all appropriate measurements are taken for the lenses and frames, that checks are made against the relevant standards and that the spectacles are fitted to the patient to ensure that the lenses are fitting in the correct plane, at the correct height, and that the frames are adjusted to hold the spectacles in the correct position.

    2.2.2 Registered dispensing opticians, optometrists, and medical practitioners are allowed to dispense spectacles to a prescription that is more than 2 years old. They may also make up spectacles without a prescription e.g. by duplicating an existing pair of spectacles. Practitioners should be aware that if the patient has not had a recent eye examination, they may – by making up spectacles to an out of date prescription – inadvertently encourage patients to delay having another eye examination. This should only be done in exceptional circumstances and the practitioner should consider what is in the best interests of the patient, and the reasons recorded on the patient’s record card.

    2.2.3 The Association believes that the dispensing of all spectacles or other optical appliances sold or supplied should be carried out by or under the supervision of a registered optician; this applies even if the sale could otherwise be conducted by an unregistered person. The practitioner should decide what is in the best interests of the patient. Dispensing opticians/ optometrists should ensure the following when dispensing or supplying spectacles to a patient:

    1. The purpose and function of the appliance is fully and clearly explained to the patient and should be suitable for their particular needs;
    2. Facial, frame and other appropriate measurements are taken as necessary and recorded prior to ordering the appliance;
    3. The spectacles are appropriate, accurate, CE marked and of an appropriate quality;

    The finished spectacles are checked on the patient for fit, function and comfort and any necessary adjustments made before they are taken from the practice. This may include checking against a letter chart to ensure the correct acuity is obtained

    Patients know and understand the financial costs of the professional services and products offered before they are asked to commit themselves to payment. To this end, patients should be informed in advance, itemising the options available for lenses and frames and of any additional features such as coatings or tints. Similarly itemised statements of account should be rendered. (The conditions of the Consumer Protection Act Part III and the Price Marking Order 2004 [SI 102 of 2004] must be complied with).

  • Supervision of DispensingOpen

    Updated: 22/03/2010

    2.3.1 When supervising dispensing, the actual work of supplying the spectacles can be delegated but the supervising practitioner remains responsible for the whole process of supervised dispensing. The supervising practitioner must be on the premises at key stages of the dispensing.

    2.3.2 The registered dispensing optician should ensure, when supervising a person who is dispensing or supplying spectacles to a patient, that the supervisee is aware of the need to

    • take appropriate measurements for the lenses and frame,
    • check the lenses against the relevant Standards,
    • fit the spectacles to the correct plane and height

    The supervising practitioner should satisfy themselves that any person under their supervision is able to carry out these measurements or adjustments, or where this is not the case intervene as necessary to ensure these are carried out correctly.

    2.3.3 Where the supply of spectacles is made under the supervision of a registered professional, the supervisor retains full responsibility for the supply. The supervisor must be on the premises, aware of the procedure and that they are supervising it, and have known, understood and accepted this role and responsibilities. The supervisor must be able and in a position to intervene if necessary to ensure that no untoward consequences to the detriment of the patient can arise from the actions of such a person who is being supervised. In the case of General Optical Council v Vision Direct (1989) it was held that supervision by a dispensing optician or optometrist means that the dispensing optician or optometrist is able to exercise his or her professional skill and judgement as a clinician. It does not mean supervision by someone performing a purely clerical or even managerial function, even if the person who is performing that function happens to be a dispensing optician or optometrist.

    2.3.4 If any supply is carried out under supervision, it should be clear, on a daily basis, which registered professional is responsible for supervising the supply. The practice should ensure that supervisors are able, practically, to fulfill their supervisory role.

    Archived version(s) of this item - Click date to read:

    Archived version: 22/03/2010

    2.3.1 When supervising dispensing, the actual work of supplying the spectacles can be delegated but the supervising practitioner remains responsible for the whole process of supervised dispensing. The supervising practitioner must be on the premises at key stages of the dispensing.

    2.3.2 The registered dispensing optician should ensure, when supervising a person who is dispensing or supplying spectacles to a patient, that the supervisee is aware of the need to

    • take appropriate measurements for the lenses and frame,
    • check the lenses against the relevant Standards,
    • fit the spectacles to the correct plane and height

    The supervising practitioner should satisfy themselves that any person under their supervision is able to carry out these measurements or adjustments, or where this is not the case intervene as necessary to ensure these are carried out correctly.

    2.3.3 Where the supply of spectacles is made under the supervision of a registered professional, the supervisor retains full responsibility for the supply. The supervisor must be on the premises, aware of the procedure and in a position to intervene if necessary to ensure that no untoward consequences to the detriment of the patient can arise from the actions of such a person who is being supervised. In the case of General Optical Council v Vision Direct (1989) it was held that supervision by a dispensing optician or optometrist means that the dispensing optician or optometrist is able to exercise his or her professional skill and judgement as a clinician. It does not mean supervision by someone performing a purely clerical or even managerial function, even if the person who is performing that function happens to be a dispensing optician or optometrist.

  • Remote dispensingOpen

    2.4 The supply of spectacles without practice support or individual consultation regarding patients’ measurements, visual requirements, verification and aftercare can put the patient at risk. A dispensing service should not be provided by a procedure where the aforementioned measurements, requirements, verification and aftercare cannot be ensured. These important patient safeguards should apply to any dispensing or supply of spectacles whether regulated or unregulated. If a registered dispensing optician or optometrist is supervising the dispensing or supply of spectacles s/he must ensure that they are in a position to intervene in the dispensing or supply and exercise clinical skill and judgement if necessary.

  • Ready made reading spectaclesOpen

    Updated: 12/02/2015

    2.5 As with any other optical appliance, when selling or supplying a pair of ready made reading spectacles the dispensing optician has a duty of care to satisfy him/herself that the appliance is suitable for the patient’s needs.

    For information on the power of ready-made reading spectacles, see Opticians Act 1989, section 4: 27.1 https://www.optical.org/en/about_us/legislation/opticians_act.cfm

    Archived version(s) of this item - Click date to read:

    2.5 As with any other optical appliance, when selling or supplying a pair of ready made reading spectacles the dispensing optician has a duty of care to satisfy him/herself that the appliance is suitable for the patient’s needs.

  • Regulation and standardsOpen

    2.6.1 Statutory regulation does not permit the dispensing of spectacle prescriptions by unqualified persons to children under 16, and patients who are registered as severely sight impaired or sight impaired (blind or partially sighted). (Opticians Act 1989, s.27). Sales of spectacles to persons in these classes can only be made by or under the supervision of a registered practitioner.

    2.6.2 Various statutory restrictions apply to dispensing by unregistered persons. (Sale of Optical Appliances Order 1984). One of the restrictions is that prescriptions must be less than 2 years old.

    2.6.3 On-line access and links to the relevant Standards are available to ABDO members at Appendix F.

  • Spectacle prescriptionsOpen

    Updated: 03/06/2013

    2.7 Registered dispensing opticians are reminded that under the Sight Testing (Examination and Prescription) (No 2) Regulations 1989 immediately following an eye examination, whether NHS or private, irrespective of whether the prescription is dispensed at the same practice or elsewhere, the prescriber is required to give the patient a copy of any prescription issued (together with an NHS voucher if appropriate) or a statement indicating that no prescription is necessary. Although the onus is on the prescriber, a registered dispensing optician has a moral public duty to ensure compliance. This enhances the reputation of the profession; the prescription is the patient’s entitlement and must be given back to the patient on completion of the dispensing.

    2.7.2 There are many occasions on which a dispensing optician may adjust the power of lenses supplied against a prescription, including for example: change in dispensed power due to a change in vertex distance; change of dispensed addition due to change of working distance. Records must show how and why the adjustment was made.

    Archived version(s) of this item - Click date to read:

    Archived version: 03/06/2013

    2.7 Registered dispensing opticians are reminded that under the Sight Testing (Examination and Prescription) (No 2) Regulations 1989 immediately following an eye examination, whether NHS or private, irrespective of whether the prescription is dispensed at the same practice or elsewhere, the prescriber is required to give the patient a copy of any prescription issued (together with an NHS voucher if appropriate) or a statement indicating that no prescription is necessary. Although the onus is on the prescriber, a registered dispensing optician has a moral public duty to ensure compliance. This enhances the reputation of the profession; the prescription is the patient’s entitlement and must be given back to the patient on completion of the dispensing.

  • Particulars to be included in a prescription or statementOpen

    Updated: 16/03/2010
    Updated: 27/05/2014

    2.8.1 A prescription provided in fulfilment of the duty imposed by section 24(2) of the Opticians Act shall include:-

    1. Particulars of any spherical power of each lens to be included in the appliance prescribed and, where appropriate, particulars of the cylindrical power (including particulars of its axis), prismatic power (including particulars of the orientation of the prism) and near addition of each such lens. (BS No: 2738-3/91 Part 3). Also note the requirement for a back vertex distance to be included for prescriptions >+/- 5.00D. (BS NO. 2738-3:2004+A1:2008.)
    2. The date of the testing of sight.
    3. The name and address of the patient and, if he/she is under the age of 16, his/her date of birth.
    4. The name and practice address of the prescriber who carried out the testing of sight.
    5. The address at which, or the name of the hospital, clinic, nursing home or other institution at which, the testing of sight was carried out.

    2.8.2 The PD is not a required part of the prescription. It is in the patient’s best interests that their spectacles be dispensed by a registered optician and that the patient’s PD is considered to be part of the dispensing, rather than prescribing process. This advice has been reaffirmed following receipt of independent legal opinion which is available in full on request from the Membership Department. Following this advice a suggested form for issuing a PD is available for downloading as appendix H.

    2.8.3 Members might like to use the following information when explaining the issues to patients requesting their PD.

    The Opticians Act 1984 was changed to permit the over-the-counter sale of simple magnifying spectacles which are made to an average centration distance, and did not plan for prescribed use.

    The PD is a facial measurement from which the centration distance of the lenses can be calculated when frame fit and prescription usage are taken into consideration.

    If the public wishes to purchase spectacles on the internet they are free to do so but they must understand the risks of such sales and that all eye care professionals advise against it.

    Archived version(s) of this item - Click date to read:

    Archived version 16/03/2010

    2.8 A prescription provided in fulfilment of the duty imposed by section 24(2) of the Opticians Act shall include:-

    1. Particulars of any spherical power of each lens to be included in the appliance prescribed and, where appropriate, particulars of the cylindrical power (including particulars of its axis), prismatic power (including particulars of the orientation of the prism) and near addition of each such lens. (BS No: 2738-3/91 Part 3).
    2. The date of the testing of sight.
    3. The name and address of the patient and, if he/she is under the age of 16, his/her date of birth.
    4. The name and practice address of the prescriber who carried out the testing of sight.
    5. The address at which, or the name of the hospital, clinic, nursing home or other institution at which, the testing of sight was carried out.

    The PD is not a required part of the prescription. It is in the patient’s best interests that their spectacles be dispensed by a registered optician and that the patient’s PD is considered to be part of the dispensing, rather than prescribing process.

    2.8.1 A prescription provided in fulfillment of the duty imposed by section 24(2) of the Opticians Act shall include:-

    1. Particulars of any spherical power of each lens to be included in the appliance prescribed and, where appropriate, particulars of the cylindrical power (including particulars of its axis), prismatic power (including particulars of the orientation of the prism) and near addition of each such lens. (BS No: 2738-3/91 Part 3).
    2. The date of the testing of sight.
    3. The name and address of the patient and, if he/she is under the age of 16, his/her date of birth.
    4. The name and practice address of the prescriber who carried out the testing of sight.
    5. The address at which, or the name of the hospital, clinic, nursing home or other institution at which, the testing of sight was carried out.

    2.8.2 The PD is not a required part of the prescription. It is in the patient’s best interests that their spectacles be dispensed by a registered optician and that the patient’s PD is considered to be part of the dispensing, rather than prescribing process. This advice has been reaffirmed following receipt of independent legal opinion which is available in full on request from the Membership Department. Following this advice a suggested form for issuing a PD is available for downloading as appendix H.

    2.8.3 Members might like to use the following information when explaining the issues to patients requesting their PD.

    The Opticians Act 1984 was changed to permit the over-the-counter sale of simple magnifying spectacles which are made to an average centration distance, and did not plan for prescribed use.

    The PD is a facial measurement from which the centration distance of the lenses can be calculated when frame fit and prescription usage are taken into consideration.

    If the public wishes to purchase spectacles on the internet they are free to do so but they must understand the risks of such sales and that all eye care professionals advise against it.

  • Issue of Duplicate or Copy PrescriptionsOpen

    Updated: 15/02/2011
    Updated: 03/08/2013

    2.9 When complying with requests from patients for either a copy of an existing prescription from practice records, or the provision of refractive details from an existing pair of spectacles, great care should be taken to ensure that circumstances cannot arise where the practice, or members of staff within a practice, could be alleged to have carried out a sight test and issued a prescription in contravention of the Opticians Act 1989, Section 24. When issuing a copy of the prescription from practice records, particular care should be taken to ensure that any document issued is authorised with the words…

    “This is a copy of the prescription for spectacles issued by…(name of practitioner who carried out the sight test)…following a sight test on…(date of test)…”

    The document should also contain the name, signature and GOC number of the dispensing optician providing the details, and the date of issue of the copy. When providing refractive details from an existing pair of spectacles, any documents issued should be authenticated with a similarly worded caveat…

    “These are the details of the lenses in…(details of frame)…worn by…(name of patient)…on the …(date in question)…”

    The document should also contain the name, signature and GOC number of the dispensing optician providing the details, and the date of issue of the copy.

    Confirmation of prescriptions must be in a written form to eliminate any possibility of error and given only with the patient’s express permission. (Data Protection Act 1998)

    A duplicate prescription form for members’ use can be downloaded at appendix J.

    Archived version(s) of this item - Click date to read:

    Archived version: 15/02/2011

    2.9 When complying with requests from patients for either a copy of an existing prescription from practice records, or the provision of refractive details from an existing pair of spectacles, great care should be taken to ensure that circumstances cannot arise where the practice, or members of staff within a practice, could be alleged to have carried out a sight test and issued a prescription in contravention of the Opticians Act 1989, Section 24. When issuing a copy of the prescription from practice records, particular care should be taken to ensure that any document issued is authorised with the words…

    “Certified copy of the prescription for spectacles issued by…(name of practitioner who carried out the sight test)…following a sight test on…(date of test)…”

    and then issued under the signature of the person certifying the details. When providing refractive details from an existing pair of spectacles, any documents issued should be authenticated with a similarly worded caveat…

    “Certified as the details of the lenses in…(details of frame)…worn by…(name of patient)…on the …(date in question)…”

    Confirmation of prescriptions must be in a written form to eliminate any possibility of error and given only with the patient’s express permission. (Data Protection Act 1998)

    Archived version: 03/08/2013

    2.9 When complying with requests from patients for either a copy of an existing prescription from practice records, or the provision of refractive details from an existing pair of spectacles, great care should be taken to ensure that circumstances cannot arise where the practice, or members of staff within a practice, could be alleged to have carried out a sight test and issued a prescription in contravention of the Opticians Act 1989, Section 24. When issuing a copy of the prescription from practice records, particular care should be taken to ensure that any document issued is authorised with the words…

    “This is a copy of the prescription for spectacles issued by…(name of practitioner who carried out the sight test)…following a sight test on…(date of test)…”

    The document should also contain the name, signature and GOC number of the dispensing optician providing the details, and the date of issue of the copy. When providing refractive details from an existing pair of spectacles, any documents issued should be authenticated with a similarly worded caveat…

    “These are the details of the lenses in…(details of frame)…worn by…(name of patient)…on the …(date in question)…”

    The document should also contain the name, signature and GOC number of the dispensing optician providing the details, and the date of issue of the copy.

    Confirmation of prescriptions must be in a written form to eliminate any possibility of error and given only with the patient’s express permission. (Data Protection Act 1998)

  • Dispensing EquipmentOpen

    2.10 In order to comply with the sale and supply of spectacle requirements, the equipment in a practice should be sufficient to discharge a registered dispensing optician’s responsibilities effectively and efficiently. The following equipment is recommended:

    • Vertex distance gauge
    • Frame rulers
    • Interpupillary distance gauge
    • Demonstration lenses
    • Frame heater
    • Frame repair and adjustment equipment
    • Focimeter
    • Verification locating and marking apparatus
    • Progressive power templates
    • Lens thickness callipers
    • Lens measure
    • Temple head width callipers
    • Facial gauge
  • Safety SpectaclesOpen

    Added: 16/03/2010

    2.11.1 Safety spectacles must be supplied in accordance with the use for which they are required. It is necessary to know what job will be performed whilst using such an appliance, be it in an employment situation or at home for DIY. If a patient is unsure what tasks may be performed further checks can be made through the requirements of particular occupations. (See Appendix F) All appliances must be covered by EN166 and EN167. Full records of what has been supplied and for what use they were advised should be maintained.

    2.11.2 Care must be taken when requests are made to repair safety spectacles. Once supplied and fitted no repairs can be effected to an appliance without rendering the protection of the appliance, guaranteed by the manufacturer, null and void. Even the replacement of a screw could be seen as interfering with the original standards. Safety spectacles must be replaced if damaged in anyway, to maintain the manufacturer’s guarantee and the patient’s ocular protection.

  • Sports EyewearOpen

    2.12 Pending a Privy Council Order prescription sports eyewear can only be supplied under the same conditions as other optical appliances.

  • Supplementary Dispensing ServicesOpen

    Updated: 14/05/2012

    2.13 Registered dispensing opticians may wish to offer their patients other supplementary services to meet particular needs. If the registered dispensing optician is satisfied that he/she possesses the necessary knowledge, either by existing training and examination or by additional knowledge and skill acquired through continuing education and training, such services could include:

    1. The provision of contact lenses (see Section 3 – Contact Lens practice).
    2. Low vision assessment , advice and dispensing [ see Section 2.16 – 2.21].
    3. Delegated Functions in support of the medical or optometric profession.
    4. The provision of and advice on eye protection appliances.

    Note: The practitioner should have information available about other services nationally and locally, e.g. local Social Services, Partially Sighted Society, RNIB etc.

    2.14.1 When supplementary dispensing services are offered it is the registered dispensing optician’s responsibility, to ensure that the precise nature of each service and the reason for it (advantages and disadvantages) are fully understood by the patient, together with the fees or costs to be paid, before the patient is asked to accept the service.

    2.14.2 ABDO is not able to recommend fees to members. The Fair Trading Act 1973 (incorporated in the Enterprise Act 2002), in seeking to remove anti-competitive practices, prohibits associations and similar bodies from setting scales of charges for members to follow or from recommending fees. Fees are entirely a matter for negotiation between the purchaser (usually the patient’s employer or the patient) and the practice undertaking the work. You should make a reasonable charge for the cost of the time, labour and materials needed to undertake the job.

    Archived version(s) of this item - Click date to read:

    Archived version: 14/05/2012

    2.13 Registered dispensing opticians may wish to offer their patients other supplementary services to meet particular needs. If the registered dispensing optician is satisfied that he/she possesses the necessary knowledge, either by existing training and examination or by additional knowledge and skill acquired through continuing education and training, such services could include:

    1. The provision of contact lenses (see Section 3 – Contact Lens practice).
    2. Low vision assessment , advice and dispensing [ see Section 2.16 – 2.21].
    3. Delegated Functions in support of the medical or optometric profession.
    4. The provision of and advice on eye protection appliances.

    Note: The practitioner should have information available about other services nationally and locally, e.g. local Social Services, Partially Sighted Society, RNIB etc.

    2.14.1 When supplementary dispensing services are offered it is the registered dispensing optician’s responsibility, to ensure that the precise nature of each service and the reason for it (advantages and disadvantages) are fully understood by the patient, together with the fees or costs to be paid, before the patient is asked to accept the service.

    2.14.2 ABDO is not able to recommend fees to members. The Fair Trading Act 1973 (incorporated in the Enterprise Act 2002), in seeking to remove anti-competitive practices, prohibits associations and similar bodies from setting scales of charges for members to follow or from recommending fees. Fees are entirely a matter for negotiation between the purchaser (usually the patient’s employer or the patient) and the practice undertaking the work. You should make a reasonable charge for the cost of the time, labour and materials needed to undertake the job.

    2.14.3 Certain delegated functions e.g. refraction, visual fields, muscle balance, tonometry etc., may be carried out by a registered dispensing optician with the appropriate skills and knowledge, or at the direction of an optometrist or registered medical practitioner, as part of a full eye examination.

  • ‘In-House’ glazingOpen

    2.15 Practitioners are advised that because lenses and frames are viewed as medical devices, practitioners must register with the MHRA if they assemble spectacles. This would apply to practices which carry out their own glazing, as well as those where the frame is traced and the lenses are edged remotely before being sent to the practice for assembly into the new frame. This only applies to new products so practitioners do not need to register if they are simply reglazing patients’ own frames. There is a one-off fee for registration. The registration form can be downloaded from the ABDO/AOP/FODO/ websites

  • Patient’s Records – also see Section 5Open

    2.16.1 It is essential in the interests of both registered dispensing optician and patient that full and accurate records, either hard copy or electronic, are kept and stored in a systematic and efficient manner.

    2.16.2 ABDO takes the view that it is the duty of all registered dispensing opticians to ensure that information of a personal nature entrusted to their care be treated as confidential and divulged only with the patient’s consent or when disclosure is required by law. Recorded information should include:

    1. Full name, address and daytime telephone number.
    2. Date of birth.
    3. Occupation (necessary knowledge for giving advice and guidance in dispensing spectacles).
    4. Recreation (for the same reasons as Occupation).
    5. General Practitioner’s name and address.
    6. The prescription.
    7. Measurements, tints, coatings etc, facial measurements and centration distances.
    8. Details of any other services provided – i.e. low vision aids.
    9. Charges and fees.
  • 3D TV spectaclesOpen

    Added: 30/05/2011

    2.17.1 Members should inform their patients that 3D TV spectacles may not be suitable for everyone and that they should only be used for the purpose for which they were specifically designed and should not, under any circumstances, be used for ‘general wear’ or other activities. It would be sensible to advise any member of the public who is seeking to benefit from 3D technology, that, prior to purchase, they should have an eye examination to discover if they will be able to enjoy the benefits it offers.

  • Spectacles for DrivingOpen

    Added: 01/10/2012
    Updated: 03/06/2013
    Updated: 31/07/2015

    2.18.1 The knowledge of a patient’s visual acuity and how this may impinge on their driving ability is a confidential matter, and may not be disclosed to a third party. If a patient is suspected of being below the legal standard for driving, s/he has a legal responsibility to inform the DVLA. Any advice which you give to the patient should be noted on the record.

    In the first instance talk to the patient, advise them they are unfit to drive and try to persuade them to stop. Remind the patient that s/he is legally responsible for informing the DVLA or DVA if they do not meet the vision standard for driving. However, if the patient has told you that they will not stop driving, you may conclude the public interest outweighs the duty of confidentiality. In this case, refer back to the prescribing optometrist. You may wish to seek the advice of your professional body.

    2.18.2 From 1 May 2012 the DVLA has changed the visual standards for driving. Information on the visual standards required for driving various classes of vehicle can be found on the website of the Driver and Vehicle Licensing Authority (www.dvla.gov.uk).

    2.18.3 Group 1 standards. The visual acuity standard required for a person to drive a private motor car or motorcycle (group 1) is that they should be able to read a number plate in good daylight at a distance of 20m for the new style number plates (AB12 XYZ) and, from 1 May 2012, have an acuity of 6/12. Practitioners should note that it is not always possible to predict from a Snellen test exactly which patients would pass the number plate test that is defined in law. People who have a visual acuity measurement of less than 6/12 are considered to have a ‘relevant disability’, and should notify the DVLA.

    2.18.4 In addition to the visual acuity requirements, group 1 drivers must have a binocular visual field of at least 120 degrees on the horizontal measured using a target equivalent to the white Goldmann III4e settings, with extension of at least 50 degrees to each side the right and the left. In addition, there should be no significant defect in the binocular field which encroaches within 20 degrees of fixation above or below the horizontal meridian.

    2.18.5 Group 2 standards. Group 2 (buses and lorries) drivers must have a VA of at least 6/7.5 in the better eye and 6/12 in the other eye. They must also have an uncorrected VA of at least 3/60. They must also be able to read the number plate at 20m. If spectacles are worn to meet the minimum standard for driving they should have a power of no more than +8.00D.

    2.18.6 The visual field requirements for group 2 are the same as for group 1, and DVLA standards also state that any area of defect in a single eye should be totally compensated for by the field of the other eye.

    Tints and driving: information

    2.18.7 BS EN 1836:2005 attributes filters for sunglare use into 5 groups, according to their range of luminous transmittance (Tv).

    FILTER CATEGORY DESCRIPTION RANGE OF LUMINOUS TRANSMITTANCE IN THE VISIBLE SPECTRAL RANGE
    01 Clear or very light tint From over 80% to 100%
    1 Light tint From over 43% to 80%
    2 Medium tint From over 18% to 43%
    3 Dark tint From over 8% to 18%
    4 Very dark tint From over 3% to 8%

    2.18.8 Filters suitable for road use and driving shall be of categories 0, 1, 2 or 32 and in addition:

    a) the spectral transmittance of filters suitable for road use shall be not less than 0.2 x Tv for wavelengths between 500 and 650 nm; and

    b) the relative visual attenuation coefficient Q of filters of categories 0, 1, 2 and 3 suitable for driving and road use shall be not less than 0.8 for red and yellow signal lights, not less than 0.4 for the blue signal light and not less than 0.6 for the green signal.

    Sunglare filters with a luminous transmittance of less than 75% are not suitable for use in twilight or at night.3,4

    Notes
    1 Category 0 applies only to photochromic filters in the faded state, to gradient filters with a luminous transmittance >80% at the reference point, and to filters that have a luminous transmittance >80%, but where a specific protection against any part of the solar spectrum is claimed.
    2 Therefore lenses with a luminous transmittance of <=8% are not intended for driving or road use (BS EN ISO 14889:2009 para 4.5.2.3).
    3 BS EN 1836: 2005 para E2.
    4 BS EN ISO 14889:2009 para 4.5.2.4.

    Archived version(s) of this item - Click date to read:

    Archived version: 03/06/2013

    2.18.1 The knowledge of a patient’s visual acuity and how this may impinge on their driving ability is a confidential matter, and may not be disclosed to a third party. If a patient is suspected of being below the legal standard for driving, s/he has a legal responsibility to inform the DVLA. Any advice which you give to the patient should be noted on the record.

    Archived version: 31/07/2015

    2.18.1 The knowledge of a patient’s visual acuity and how this may impinge on their driving ability is a confidential matter, and may not be disclosed to a third party. If a patient is suspected of being below the legal standard for driving, s/he has a legal responsibility to inform the DVLA. Any advice which you give to the patient should be noted on the record.

    2.18.2 From 1 May 2012 the DVLA has changed the visual standards for driving. Information on the visual standards required for driving various classes of vehicle can be found on the website of the Driver and Vehicle Licensing Authority (www.dvla.gov.uk).

    2.18.3 Group 1 standards. The visual acuity standard required for a person to drive a private motor car or motorcycle (group 1) is that they should be able to read a number plate in good daylight at a distance of 20m for the new style number plates (AB12 XYZ) and, from 1 May 2012, have an acuity of 6/12. Practitioners should note that it is not always possible to predict from a Snellen test exactly which patients would pass the number plate test that is defined in law. People who have a visual acuity measurement of less than 6/12 are considered to have a ‘relevant disability’, and should notify the DVLA.

    2.18.4 In addition to the visual acuity requirements, group 1 drivers must have a binocular visual field of at least 120 degrees on the horizontal measured using a target equivalent to the white Goldmann III4e settings, with extension of at least 50 degrees to each side the right and the left. In addition, there should be no significant defect in the binocular field which encroaches within 20 degrees of fixation above or below the horizontal meridian.

    2.18.5 Group 2 standards. Group 2 (buses and lorries) drivers must have a VA of at least 6/7.5 in the better eye and 6/60 in the other eye. They must also be able to read the number plate at 20m. If spectacles are worn to meet the minimum standard for driving they should have a power of no more than +8.00D.

    2.18.6 Group 2 drivers must also have a visual field, with both eyes open, of at least 160 degrees horizontally, with at least 70 degrees either side of fixation, and at least 30 degrees above and below fixation. There must be no defect within the central 30 degrees.

    Some Grandfather rights will continue to apply.

    Tints and driving: information

    2.18.7 BS EN 1836:2005 attributes filters for sunglare use into 5 groups, according to their range of luminous transmittance (Tv).

    FILTER CATEGORY DESCRIPTION RANGE OF LUMINOUS TRANSMITTANCE IN THE VISIBLE SPECTRAL RANGE
    01 Clear or very light tint From over 80% to 100%
    1 Light tint From over 43% to 80%
    2 Medium tint From over 18% to 43%
    3 Dark tint From over 8% to 18%
    4 Very dark tint From over 3% to 8%

    2.18.8 Filters suitable for road use and driving shall be of categories 0, 1, 2 or 32 and in addition:

    a) the spectral transmittance of filters suitable for road use shall be not less than 0.2 x Tv for wavelengths between 500 and 650 nm; and

    b) the relative visual attenuation coefficient Q of filters of categories 0, 1, 2 and 3 suitable for driving and road use shall be not less than 0.8 for red and yellow signal lights, not less than 0.4 for the blue signal light and not less than 0.6 for the green signal.

    Sunglare filters with a luminous transmittance of less than 75% are not suitable for use in twilight or at night.3,4

    Notes
    1 Category 0 applies only to photochromic filters in the faded state, to gradient filters with a luminous transmittance >80% at the reference point, and to filters that have a luminous transmittance >80%, but where a specific protection against any part of the solar spectrum is claimed.
    2 Therefore lenses with a luminous transmittance of <=8% are not intended for driving or road use (BS EN ISO 14889:2009 para 4.5.2.3).
    3 BS EN 1836: 2005 para E2.
    4 BS EN ISO 14889:2009 para 4.5.2.4.

LOW VISION PRACTICE

Open
  • GeneralOpen

    2.19.1 At present, there is no legally protected title which applies to dispensing opticians or optometrists engaged in low vision work. Although all registered dispensing opticians and optometrists may legally conduct low vision assessments and supply all types of low vision aids, those who do not hold the ABDO Honours Diploma in Low Visual Acuity should avoid using any title or designation which might suggest to the public that they hold a specialist qualification in Low Visual Acuity.

    2.19.2 Registered dispensing opticians wishing to specialise in the field of low vision are encouraged to obtain the Honours Diploma in Low Visual Acuity.

    2.19.3 If you consider you do not have sufficient expertise to assess a patient with low vision you should refer the patient to someone who has, for example an optometrist or a dispensing optician based in a low vision service, or to other specialist services.

    Archived version(s) of this item - Click date to read:

    2.19.1 At present, there is no legally protected title which applies to dispensing opticians or optometrists engaged in low vision work. Although all registered dispensing opticians and optometrists may legally conduct low vision assessments and supply all types of low vision aids, those who do not hold the ABDO Honours Diploma in Low Visual Acuity should avoid using any title or designation which might suggest to the public that they hold a specialist qualification in Low Visual Acuity.

    2.19.2 Registered dispensing opticians wishing to specialise in the field of low vision are encouraged to obtain the Honours Diploma in Low Visual Acuity.

  • Low Vision RecordsOpen

    2.20 Adequate records should be maintained, ideally on specially designed record cards.

  • Low Vision AssessmentOpen

    Registered dispensing opticians should:

    2.20.1 Ensure that the patient has had an eye examination within the last twelve Months.

    2.20.2 Where this is not the case the patient should normally be referred back to the original practitioner before assessment begins, however it may be helpful to the patient in certain circumstances to provide a low vision aid on a temporary basis, for example, following cataract removal. The member should also consider the effectiveness of the refraction and refer the patient back to the original prescriber where appropriate.

    2.20.3 Maintain a stock of low vision aids, which should be to British Standards 15253:2000. A recommended basic selection appears in Appendix C. On collection of the aid full written and verbal instructions should be given to the patient. These should include; how to use the aid, spectacles to use, distance from the eye, distance from the task and any specific lighting requirements.

    2.20.4 Ascertain whether a patient is registered sight impaired (partially sighted) or severely sight impaired (blind). Benefits of registration should be explained and referral initiated if the patient so wishes. Patients should be encouraged to take up registration where this is applicable. Patients may not qualify for registration, nor wish to be registered, however low vision assessment should be offered to all patients who do not achieve the required level of acuity with spectacles alone.

    2.20.5 Inform patients about all costs, local schemes, local and national societies, that are appropriate to their status. Give an explanation of the patient’s pathology/reason for visual impairment with care and sensitivity.

    2.20.6 In some cases, a low vision aid will not be considered necessary or suitable or the patient may reject it. It should be explained to the patient that this situation may well change in the future, for various reasons, and they should be encouraged to return for regular assessments. Their psychological state with regard to their impairment may improve with time and this is an area of optics that is currently subject to innovative technological developments

  • AftercareOpen

    2.21.1 Patients should be reviewed regularly to check whether their acuity levels are deteriorating and their aid(s) are still relevant. The ideal follow-up regime will vary among patients, but a guideline would be at 4 weeks, and then at 6 months. This can be in the form of a phone call to ensure that the patient can still use the aid productively. If any difficulty is being encountered then a full aftercare appointment must be made. Additionally a full re-assessment should be carried annually.

    2.21.2 The patient should be referred for a full eye examination prior to the annual LVA assessment.

    2.21.3 Following the initial visit a report should be sent to all parties involved in the care of the patient. This may include the GP, ophthalmologist, optometrist, and local social services/blind society and school where appropriate. This demonstrates the effectiveness of the Low Vision Practitioner, with regard to a team approach for the visually impaired and is of course in the best interest of the patient. Where a patient has been referred directly for low vision assessment a report should be sent to the referring practitioner with information on aids prescribed, acuities achieved and the date of the first after-care visit.

  • Legal aspects of Low Vision supplyOpen

    2.22.1 Vision aids may be optical or non-optical. Optical aids include magnifiers, telescopes, and certain types of spectacle lenses used to enhance vision by magnification. Non-optical aids include lighting, filters, and mobility aids.

    2.22.2 Under the Opticians Act 1989 (section 27, The Sale of Optical Appliances), the supply of spectacles to registered blind and partially sighted patients and children under 16 years of age is restricted to registered dispensing opticians and optometrists. Members are reminded that only those members registered with the General Optical Council are legally entitled to describe themselves as “dispensing optician” or “optometrist”.

    2.22.3 Moreover, the supply of certain low vision aids is also similarly restricted. In the Act, the ‘restricted low vision aids’ are not defined, but ABDO considers that the supply of spectacle magnifiers and distance telescopes incorporating a distance prescription and/or mounted on a patient’s spectacles, and near vision telescopes with or without a spectacle prescription are restricted, and that the supply of other types of low vision aids is not restricted.

    2.22.4 For a supply to be effected by, or be under the supervision of, a registered optician or medical practitioner, that person must be able to have direct contact with the patient. They must also have access to clinical records before the supply may be made and be aware of the general and ocular health of the patient. Only when these criteria have been fulfilled should the supply be considered to have been made under supervision.

    2.22.5 Under Section 24 of the Act it is a criminal offence for a person other than a registered medical practitioner or optometrist to test the sight of another person with intent to prescribe an optical appliance. However, when restricted low vision aids are supplied by a registered dispensing optician, the use of techniques to verify their performance does not constitute the testing of sight as defined by the Act. This allows for example the incorporation of a higher reading addition in spectacles or in the form of a spectacle magnifier or near vision telescope for use at a closer working distance without contravening the Act.

  • Assessment routineOpen

    2.23 A low vision assessment should include –

    1. General observation of patient.
    2. Recording of patient’s details.
    3. General health, history and symptoms.
    4. Details of ocular condition
    5. Practical problems
    6. Social factors.
    7. Patient expectations.
    8. Refraction.
    9. Assessment of magnification for distance and near/other distances.
    10. Discussion on types of aids.
    11. Demonstration and choice of aids and instructions on their use.
    12. Supply of aids.
    13. Information for the patient, written and verbal, i.e. type of aid and use of, registration, social services, support groups etc.
    14. Aftercare
    15. Reports to low vision team/original referring practitioner.

PAEDIATRIC DISPENSING

Open
  • Paediatric DispensingOpen

    Updated 01/02/2016

    2.24 Statutory regulation does not permit the dispensing of spectacle prescriptions by unqualified persons to children under 16 (Opticians Act 1989, s.27). Sales of spectacles to children can only be made by or under the supervision of a registered practitioner. Best practice dictates that this also extends to adjustments and repairs, as these are part of the ongoing aftercare of the dispense. For further information on paediatric dispensing, please refer to ABDO’s Pathway for dispensing to children.

    2.25 In law, people over the age of 16 are presumed to have capacity to consent (Family Law Reform Act 1969; Mental Capacity Act 2005), and those under this age are not. However, the principle of Gillick competence may apply to children under 16. In the case of Gillick v West Norfolk and Wisbech Area Health Authority 1985, it was held that a child under 16 has capacity to consent to treatment if he or she is able to understand what is proposed (including the consequences of non-treatment if he or she refuses). The degree of understanding is judged according to the seriousness of the decision the child is being asked to make.

    Archived version(s) of this item - Click date to read:

    Added 31/07/2015

    2.24 Statutory regulation does not permit the dispensing of spectacle prescriptions by unqualified persons to children under 16 (Opticians Act 1989, s.27). Sales of spectacles to children can only be made by or under the supervision of a registered practitioner. For further information on paediatric dispensing, please refer to ABDO’s Pathway for dispensing to children.

SECTION 3: CONTACT LENS PRACTICE

Open

FITTING POWERED CONTACT LENSES

Open
  • GuidelinesOpen

    Updated: 25/08/2011

    3.1.1 Whereas it is not a criminal offence for a registered optician to fit contact lenses, the Contact Lens (Qualification etc) Rules 1988 state that a registered optometrist or registered dispensing optician shall not fit a contact lens unless he/she holds:

    1. an approved qualification; or
    2. certification

    and he/she is entered in the appropriate GOC specialty register, and is designated a contact lens optician (CLO).

    3.1.2 The following table may be used to confirm the documents and action required prior to the fitting and/or supply of contact lenses:

    PATIENT DOCUMENT ACTION
    Fitting /refitting contact lenses
    Prospective wearer Prescription less than two years old or stated re-examination time Commence fit if appropriate
    Prospective wearer Prescription over two years old or past stated re-examination time Only commence fit after eye examination
    Contact Lens wearer Prescription less than two years old or stated re-examination time Commence re- fit
    Contact Lens wearer Prescription over two years old or past stated re-examination time Only commence fit after eye examination
    Supplying Contact Lenses
    Contact Lens wearer Contact lens specification is in date Supply Contact Lens/es.
    Contact Lens Wearer Contact lens specification is out of date No supply to old specification but CLO may refit if eye examination in date

    3.1.3 The contact lens optician examining a patient wishing to wear contact lenses has a duty to assess the patient’s suitability for contact lenses and to advise and inform the patient about contact lens wear.

    3.1.4 Following the preliminary assessment the contact lens optician has a duty to ensure that each individual contact lens wearer is fitted with the most appropriate lens type to meet his or her needs (including occupational, lifestyle and cosmetic requirements) and to give optimum vision for the required use.

    3.1.5 The contact lens optician has a duty to provide the patient with an appropriate lens care regimen, instruction on the use and wear of lenses, and instructions and information on the care, wearing, treatment, cleaning and maintenance of the lens or lenses. (See the Opticians Act 1989 s 25[5][b])

    3.1.6 A contact lens optician has a duty to ensure that he or she always works within his or her limit of clinical competency, especially when engaging in specialist areas of contact lens practice.

    Archived version(s) of this item - Click date to read:

    Archived version: 25/08/2011

    3.1.1 Whereas it is not a criminal offence for a registered optician to fit contact lenses, the Contact Lens (Qualification etc) Rules 1988 state that a registered optometrist or registered dispensing optician shall not fit a contact lens unless he/she holds:

    1. an approved qualification; or
    2. certification

    and he/she is entered in the appropriate GOC specialty register, and is designated a contact lens optician (CLO).

    3.1.2 The following table may be used to confirm the documents and action required prior to the fitting and/or supply of contact lenses:

    PATIENT DOCUMENT ACTION
    Fitting /refitting contact lenses
    Prospective wearer Prescription less than two years old or stated re-examination time Commence fit if appropriate
    Prospective wearer Prescription over two years old Make arrangements for eye examination
    Contact Lens wearer Prescription less than two years old or stated re-examination time Commence re- fit
    Contact Lens wearer Prescription over two years old Make arrangements for eye examination
    Supplying Contact Lenses
    Contact Lens wearer Specification is in date Supply Contact Lens/es.
    Contact Lens Wearer Specification is out of date No supply to old specification but CLO may refit

    3.1.3 The contact lens optician examining a patient wishing to wear contact lenses has a duty to assess the patient’s suitability for contact lenses and to advise and inform the patient about contact lens wear.

    3.1.4 Following the preliminary assessment the contact lens optician has a duty to ensure that each individual contact lens wearer is fitted with the most appropriate lens type to meet his or her needs (including occupational, lifestyle and cosmetic requirements) and to give optimum vision for the required use.

    3.1.5 The contact lens optician has a duty to provide the patient with an appropriate lens care regimen, instruction on the use and wear of lenses, and instructions and information on the care, wearing, treatment, cleaning and maintenance of the lens or lenses. (See the Opticians Act 1989 s 25[5][b])

    3.1.6 A contact lens optician has a duty to ensure that he or she always works within his or her limit of clinical competency, especially when engaging in specialist areas of contact lens practice.

  • AdviceOpen

    3.2 If the fitter is not also the supplier of the patient’s contact lenses, once fitting has been completed the responsibility for aftercare transfers to the supplier. However it is recommended that the fitter advise the patient as to when it would be appropriate for clinical review.

  • Advice to patients prior to fittingOpen

    3.3.1 Prior to the fitting of lenses, advice should be given to the patient about the risks and complications of contact lens wear, available lens types, their advantages and disadvantages and any types which might be particularly appropriate or contra-indicated, together with a suitable explanation of the reasons, the care systems required by the different lens types and the total estimated costs. Patients should be given sufficient information to make an informed choice.

    3.3.2 Patients wearing contact lenses on an extended wear basis are at a significantly increased risk of microbial keratitis. Contact lens opticians fitting patients with such lenses should ensure that the patient is aware of this, and that the patient attends for regular aftercare.

    3.3.4 The exact frequency at which patients should attend for contact lens check-ups will depend upon factors such as the patient’s clinical status, history, type of lens and modality of wear. As a general rule, because of the increased risk of complications, patients wearing lenses on an extended wear basis should have more frequent contact lens check-ups than those wearing lenses on a daily wear basis.

    3.3.5 Orthokeratology fitting includes overnight wear, and increases the risk of complications, which may be particularly relevant in the case of children. This increased risk should be explained to patients/parents prior to fitting.

    Archived version(s) of this item - Click date to read:

    3.3 Prior to the fitting of lenses, advice should be given to the patient about the risks and complications of contact lens wear, available lens types, their advantages and disadvantages and any types which might be particularly appropriate or contra-indicated, together with a suitable explanation of the reasons, the care systems required by the different lens types and the total estimated costs. Patients should be given sufficient information to make an informed choice. Patients wearing contact lenses on an extended wear basis are at a significantly increased risk of microbial keratitis. Contact lens opticians fitting patients with such lenses should ensure that the patient is aware of this, and that the patient attends for regular aftercare.

    The exact frequency at which patients should attend for contact lens check-ups will depend upon factors such as the patient’s clinical status, history, type of lens and modality of wear. As a general rule, because of the increased risk of complications, patients wearing lenses on an extended wear basis should have more frequent contact lens check-ups than those wearing lenses on a daily wear basis.

    Archived version: 30/01/2012

    3.3 Patients should be told of the increased risks associated with wearing lenses in an extended wear modality and what signs of possible complications to look out for.

    Prior to the fitting of lenses, advice should be given to the patient about the risks and complications of contact lens wear, available lens types, their advantages and disadvantages and any types which might be particularly appropriate or contra-indicated, together with a suitable explanation of the reasons, the care systems required by the different lens types and the total estimated costs. Patients should be given sufficient information to make an informed choice.

    Archived version: 16/03/2010

    3.3 Prior to the fitting of lenses, advice should be given to the patient about the risks and complications of contact lens wear, available lens types, their advantages and disadvantages and any types which might be particularly appropriate or contra-indicated, together with a suitable explanation of the reasons, the care systems required by the different lens types and the total estimated costs. Patients should be given sufficient information to make an informed choice.

  • Preliminary AssessmentOpen

    3.4.1 The preliminary assessment of a patient wishing to wear powered contact lenses should normally include:

    1. An eye examination as recommended in the appropriate Guideline, including any additional tests that are indicated by symptoms, ocular and medical history and pre-disposing factors. Legally, powered contact lenses can be fitted only to a person in possession of a signed written spectacle prescription issued following a sight test, if the fitting begins before any re-examination date specified in the prescription, and in any event not later than two years after the prescription was issued. (See Opticians Act 1989 s 25 [1A]). Therefore, if the patient is overdue for an eye examination i.e. they have not had their eyes examined for more than 2 years, or less if that is what is stated on their prescription, it is illegal for the contact lens optician to fit the patient with contact lenses.
    2. Consideration of relevant information relating to any allergic history or history of systemic disease, any previous contact lens wear, occupational and recreational needs and the associated environments in which lenses will be worn.
    3. A detailed assessment of the anterior eye which might be affected by contact lens wear. This should require a slit-lamp examination, keratometry, the use of diagnostic stains and the assessment of tear film quality and quantity.
    4. Assessment of other factors that may be linked to successful wear, including the ability to handle lenses safely and appropriate hygiene procedures. If the practitioner considers that the patient is unlikely to be able to handle or maintain contact lenses safely, it would be in the patient’s interest for the fitting not to commence.

    3.4.2 Where a patient is found to be unsuitable for contact lens wear, the patient should be advised accordingly and the patient’s record annotated.

    3.4.3 Occasional practice in contact lens care should be avoided, especially in certain specialist areas such as therapeutic contact lens fitting. In such cases the patient may be suffering from a co-existent disease or condition and the contact lens optician should show due care to involve the patient’s ophthalmologist in the co-management of the patient’s contact lens wear regardless of whether the care is provided in the secondary or primary care setting.

  • Fitting powered contact lensesOpen

    Updated: 24/07/2010

    3.5.1 The Opticians Act states that, subject to certain exceptions, a person who is not a registered medical practitioner, a registered optometrist or a registered dispensing optician must not fit a contact lens to an individual. (See Opticians Act 1989 s 25 [1]). Practitioners who refer patients for others to fit with contact lenses as well as practitioners who fit contact lenses to patients should be fully aware of this requirement.

    3.5.2 When fitting a powered contact lens the contact lens optician should ensure that:

    1. The type and brand of lens and lens care regimen are suitable and appropriate for the patient;
    2. The patient is advised of any requirements in the type of lens, lens wearing pattern or recommended hygiene pattern. Such advice should be recorded clearly in the patient’s records;
    3. Unless there are exceptional circumstances, contact lens opticians should not recommend a wearing schedule to a patient that is contrary to the manufacturer’s labelling instructions, which are based on the terms of the product’s licence. The advice given to the patient, and the reasons for such advice should be noted in the patient’s records.

    3.5.3 Following the fitting, the patient should be provided with instructions and information on:

    • The insertion and removal of lenses, their care, storage, treatment, disinfection and cleaning;
    • The wearing schedule for the lenses;
    • The need for regular periodic review of the appropriateness of the lenses;
    • The importance of seeking professional advice immediately any problem of discomfort, redness, watering, or visual disturbance is experienced and how and where to obtain that advice, both during and outside normal office hours;
    • The importance of seeking professional advice before changing to a solution which has not already been recommended as suitable by the person fitting the lenses.
    • The importance of seeking professional advice before accepting a supply of substitute lenses

    3.5.4 Appropriate elements of the instructions are given in writing to comply with the Medical Devices Directive. (See Medical Devices Directive. Directive 3/42/EEC. UK regulations SI 618 An introduction to this is available on the MHRA website – please see Appendix G)

    3.5.5 The decision as to when the fitting has been completed is a decision to be made by each practitioner depending on the individual circumstances. The period should be long enough for the practitioner to be satisfied that the patient has adapted to the lenses and that there is unlikely to be any change in the patient’s ocular health so that minimum scheduled contact lens check-ups are needed. It is suggested that in most cases a period of less than three months is likely to be sufficient. Fitting may take a longer period however, depending upon the lens type and clinical details of the patient. If the contact lens optician considers that it would take longer than this, he/she should advise the patient of this and make a note in the patient’s record. The contact lens optician should give the patient some indication as to when an acceptable fitting is likely to be achieved.

    3.5.6 Contact Lens Opticians may now instil a limited range of anaesthetics [see below] in the course of appropriate contact lens fitting [see appendix]. The Association recommends that this should only be used for complex fittings where it is needed to achieve a satisfactory result.

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    Archived version(s) of this item - Click date to read:

    Archived version: 24/07/2010

    3.5.1 The Opticians Act states that, subject to certain exceptions, a person who is not a registered medical practitioner, a registered optometrist or a registered dispensing optician must not fit a contact lens to an individual. (See Opticians Act 1989 s 25 [1]). Practitioners who refer patients for others to fit with contact lenses as well as practitioners who fit contact lenses to patients should be fully aware of this requirement.

    3.5.2 When fitting a powered contact lens the contact lens optician should ensure that:

    1. The type and brand of lens and lens care regimen are suitable and appropriate for the patient;
    2. The patient is advised of any requirements in the type of lens, lens wearing pattern or recommended hygiene pattern. Such advice should be recorded clearly in the patient’s records;
    3. Unless there are exceptional circumstances, contact lens opticians should not recommend a wearing schedule to a patient that is contrary to the manufacturer’s labelling instructions, which are based on the terms of the product’s licence. The advice given to the patient, and the reasons for such advice should be noted in the patient’s records.

    3.5.3 Following the fitting, the patient should be provided with instructions and information on:

    • The insertion and removal of lenses, their care, storage, treatment, disinfection and cleaning;
    • The wearing schedule for the lenses;
    • The need for regular periodic review of the appropriateness of the lenses;
    • The importance of seeking professional advice immediately any problem of discomfort, redness, watering, or visual disturbance is experienced and how and where to obtain that advice, both during and outside normal office hours;
    • The importance of seeking professional advice before changing to a solution which has not already been recommended as suitable by the person fitting the lenses.
    • The importance of seeking professional advice before accepting a supply of substitute lenses

    3.5.4 Appropriate elements of the instructions are given in writing to comply with the Medical Devices Directive. (See Medical Devices Directive. Directive 3/42/EEC. UK regulations SI 618 An introduction to this is available on the MHRA website – please see Appendix G)

    3.5.5 The decision as to when the fitting has been completed is a decision to be made by each practitioner depending on the individual circumstances. The period should be long enough for the practitioner to be satisfied that the patient has adapted to the lenses and that there is unlikely to be any change in the patient’s ocular health so that minimum scheduled contact lens check-ups are needed. It is suggested that in most cases a period of less than three months is likely to be sufficient. Fitting may take a longer period however, depending upon the lens type and clinical details of the patient. If the contact lens optician considers that it would take longer than this, he/she should advise the patient of this and make a note in the patient’s record. The contact lens optician should give the patient some indication as to when an acceptable fitting is likely to be achieved.

  • Referral to a colleagueOpen

    Updated: 22/03/2010
    Updated: 14/05/2012

    3.6.1 Where the practitioner refers the patient to be fitted by an appropriately qualified registered colleague, responsibility for that part of the patient’s care is transferred to the colleague. Any information should be given that might a) affect the choice of contact lens type or b) indicate a particular lens type if this is specifically indicated

    3.6.2 The patient should still receive a full eye examination at appropriate intervals as determined by the clinical judgement of the prescribing optometrist or medical practitioner. Best practice would suggest that a CLO should not continue to supply contact lenses unless this eye examination has taken place. If necessary, only a limited supply may be given to allow time for the new examination to take place.

    3.6.3 Contact Lens Opticians are reminded that contact lenses should always be dispensed to a current spectacle prescription. Once the initial fittings are completed, any changes of prescription should be confirmed with the referrer or by an eye examination.

    Archived version(s) of this item - Click date to read:

    Archived version: 14/05/2012

    3.6.1 Where the practitioner refers the patient to be fitted by an appropriately qualified registered colleague, responsibility for that part of the patient’s care is transferred to the colleague. Any information should be given that might a) affect the choice of contact lens type or b) indicate a particular lens type if this is specifically indicated

    3.6.2 The patient should still receive a full eye examination at appropriate intervals as determined by the clinical judgement of the prescribing optometrist or medical practitioner. A CLO SHOULD NOT CONTINUE TO SUPPLY CONTACT LENSES UNLESS THIS EYE EXAMINATION HAS TAKEN PLACE. IF NECESSARY, ONLY A LIMITED SUPPLY MAY BE GIVEN TO ALLOW TIME FOR THE NEW EXAMINATION TO TAKE PLACE. 

    (updated 22/03/2010) 

    3.6.3 Contact Lens Opticians are reminded that contact lenses should always be dispensed to a current spectacle prescription. Once the initial fittings are completed, any changes of prescription should be confirmed with the referrer or by an eye examination.

  • Contact lens specificationOpen

    Updated: 15/02/2011

    3.7.1 There is a legal obligation to provide the patient with a signed written specification of each lens once the fitting has been completed. (Opticians Act 1989 s 25 [5]) This must contain sufficient detail to enable the lens to be replicated. It would normally include details of the base curve, peripheral curves, total diameter, material and design (including details of the underlying brand) of the lens(es), and should be signed by the last person to confirm the fit of the lens(es). If a duplicate specification is issued, it shall only be signed by a dispensing optician on the specialty register or an optometrist. ABDO has a sample contact lens specification form available on its website. It is important that the specification clearly identifies any clinical information that should be taken into account by a supplier.

    3.7.2 The contact lens specification must include its expiry date. (Opticians Act 1989 s 25 [7a]) The expiry date of the contact lens specification would normally be the date at which the patient is due for their next clinical review. However, if the expiry date is not co-incident with this date it would be helpful to include both dates on the specification. Factors to be considered when determining the expiry date will include the type of lens, modality of wear and the clinical features of the patient. A practitioner should consider sending the patient a reminder when their next clinical review is due.

    3.7.3 It is in the best interests of patients that they receive adequate aftercare. Patients should be advised of the importance of having regular eye examinations, in addition to contact lens check ups. When a practitioner performs a contact lens check-up they should be aware that the issue of new lenses and/or specifications would be ‘fitting’ the patient with contact lenses, as defined by the Opticians Act s.(9)(a). Under the Act, the patient must not be fitted with contact lenses unless they have an up to date (spectacle) prescription (Opticians Act 1989 s25 [1A]).

    3.7.4 The fitting practitioner may be asked by a supplier of contact lenses to verify the particulars of the patient’s specification. (Opticians Act s 27 [3]). It is good practice for the fitting practitioner to obtain the details to be verified from the supplier in writing (which may include facsimile or electronic communication), and to keep a record of such requests for verification. If the number of verification requests gives the fitting practitioner cause for concern they should alert the supplier.

    3.7.5 Practitioners are reminded of the provisions of the Data Protection Act and must ensure that they have the patient’s consent to the transfer of patient information to a third party. It is suggested that consent should be noted in the patient’s record.

    3.7.6 There is no confidentiality issue in confirming by receipt of an unambiguous yes that the details in a complete specification as provided to the optometrist/contact lens optician by a supplier are correct. However, if the specification is incorrect in any way, the supplier would need to confirm patient consent.

    3.7.7 When assessing a wearer of contact lenses, the examination should normally include:

    1. A detailed assessment of the patient’s wearing patterns and wearing times;
    2. Identification of any symptoms experienced while wearing lenses or any signs noted during wear or after lens removal;
    3. A record of the current care system being employed;
    4. A measure of the refractive status and acuities with the lens/lenses in situ including astigmatic elements as appropriate;
    5. An assessment of lens fit and the condition of the lenses themselves;
    6. On removal of the lenses, a detailed examination of the eye and adnexa as required to detect any contact lens related adverse effects. This will include the use of appropriate diagnostic agents;
    7. Assessment of other ocular attributes such as keratometry as required to identify changes from baseline;
    8. Determination of best spectacle visual acuities following lens removal, if appropriate;
    9. An assessment of the patient’s compliance with the care regimen and general contact lens related hygiene, irrespective of lens type;
    10. Reinforcement of the need for regular follow-up care and specifically a contact lens assessment before expiry of the time-dated specification, to enable the further supply of contact lenses. It is appropriate to reinforce to existing wearers the various aspects of contact lens wear that may have become less obvious over time. Good practice would suggest that it is in patients’ best interests for follow up care to be at least every twelve months;
    11. The tests and assessments relevant to the new prospective wearer may be applicable to an existing wearer where changes in lens type are being considered.

    Archived version(s) of this item - Click date to read:

    Archived version: 15/02/2011

    3.7.1 There is a legal obligation to provide the patient with a signed written specification of each lens once the fitting has been completed. (Opticians Act 1989 s 25 [5]) This must contain sufficient detail to enable the lens to be replicated, and must contain the details outlined in the Contact Lens Specification Rules 1989. It would normally include details of the base curve, peripheral curves, total diameter, material and design (including details of the underlying brand) of the lens(es). ABDO has a sample contact lens specification form available on its website. It is important that the specification clearly identifies any clinical information that should be taken into account by a supplier.

    3.7.2 The contact lens specification must include its expiry date. (Opticians Act 1989 s 25 [7a]) The expiry date of the contact lens specification would normally be the date at which the patient is due for their next clinical review. However, if the expiry date is not co-incident with this date it would be helpful to include both dates on the specification. Factors to be considered when determining the expiry date will include the type of lens, modality of wear and the clinical features of the patient. A practitioner should consider sending the patient a reminder when their next clinical review is due.

    3.7.3 It is in the best interests of patients that they receive adequate aftercare. Patients should be advised of the importance of having regular eye examinations, in addition to contact lens check ups. When a practitioner performs a contact lens check-up they should be aware that the issue of new lenses and/or specifications would be ‘fitting’ the patient with contact lenses, as defined by the Opticians Act s.(9)(a). Under the Act, the patient must not be fitted with contact lenses unless they have an up to date (spectacle) prescription (Opticians Act 1989 s25 [1A]).

    3.7.4 The fitting practitioner may be asked by a supplier of contact lenses to verify the particulars of the patient’s specification. (Opticians Act s 27 [3]). It is good practice for the fitting practitioner to obtain the details to be verified from the supplier in writing (which may include facsimile or electronic communication), and to keep a record of such requests for verification. If the number of verification requests gives the fitting practitioner cause for concern they should alert the supplier.

    3.7.5 Practitioners are reminded of the provisions of the Data Protection Act and must ensure that they have the patient’s consent to the transfer of patient information to a third party. It is suggested that consent should be noted in the patient’s record.

    3.7.6 There is no confidentiality issue in confirming by receipt of an unambiguous yes that the details in a complete specification as provided to the optometrist/contact lens optician by a supplier are correct. However, if the specification is incorrect in any way, the supplier would need to confirm patient consent.

    3.7.7 When assessing a wearer of contact lenses, the examination should normally include:

    1. A detailed assessment of the patient’s wearing patterns and wearing times;
    2. Identification of any symptoms experienced while wearing lenses or any signs noted during wear or after lens removal;
    3. A record of the current care system being employed;
    4. A measure of the refractive status and acuities with the lens/lenses in situ including astigmatic elements as appropriate;
    5. An assessment of lens fit and the condition of the lenses themselves;
    6. On removal of the lenses, a detailed examination of the eye and adnexa as required to detect any contact lens related adverse effects. This will include the use of appropriate diagnostic agents;
    7. Assessment of other ocular attributes such as keratometry as required to identify changes from baseline;
    8. Determination of best spectacle visual acuities following lens removal, if appropriate;
    9. An assessment of the patient’s compliance with the care regimen and general contact lens related hygiene, irrespective of lens type;
    10. Reinforcement of the need for regular follow-up care and specifically a contact lens assessment before expiry of the time-dated specification, to enable the further supply of contact lenses. It is appropriate to reinforce to existing wearers the various aspects of contact lens wear that may have become less obvious over time. Good practice would suggest that it is in patients’ best interests for follow up care to be at least every twelve months;
    11. The tests and assessments relevant to the new prospective wearer may be applicable to an existing wearer where changes in lens type are being considered.

  • SupervisionOpen

    Updated: 22/03/2010

    3.8 Contact lenses can be fitted by a medical or optometry student or a dispensing optician training as a contact lens optician, providing that they are supervised by a registered optometrist, medical practitioner or contact lens optician. Supervision requires that the supervising optometrist/contact lens optician is on the premises when the fitting is taking place, is able to exercise their professional skill and judgement as a clinician, and can intervene in the fitting if necessary to ensure that no untoward consequence to the detriment of the patient can arise from the actions of the person who is being supervised. It is essential that both the registered professional in a supervisory capacity and those being supervised are aware of their roles and duties and particularly what functions cannot be carried out without a GOC/GMC registered supervisor being present on the premises and in a position to intervene.

    Archived version(s) of this item - Click date to read:

    Archived version: 22/03/2010

    3.8 Contact lenses can be fitted by a medical or optometry student or a dispensing optician training as a contact lens optician, providing that they are supervised by a registered optometrist, medical practitioner or contact lens optician. Supervision requires that the supervising optometrist/contact lens optician is on the premises when the fitting is taking place, is able to exercise their professional skill and judgement as a clinician, and can intervene in the fitting if necessary to ensure that no untoward consequence to the detriment of the patient can arise from the actions of the person who is being supervised.

  • RecordsOpen

    3.9 It is essential that full and complete records are kept and maintained. (See Appendix B.)

  • Information on legal mattersOpen

    3.10.1 The Opticians Act defines fitting of a contact lens as:

    1. assessing whether a contact lens meets the needs of the individual; and, where appropriate
    2. providing the individual with one or more contact lenses for use during a trial period. (Opticians Act 1989 s 25[9])

    3.10.2 The Contact Lens (Specification) Rules 1989 state that a contact lens specification must include the following particulars:

    1. the name and address of the individual;
    2. if the individual has not attained the age of sixteen on the day the specification is issued, his or her date of birth;
    3. the name and registration number of the person signing the specification;
    4. the practice address of the person signing the specification;
    5. the name of the practice on whose premises the fitting was done;
    6. the date the fitting was completed;
    7. sufficient details of any lens fitted to enable a person who fits or supplies a contact lens to replicate the lens
    8. the date the specification expires; and
    9. such information of a clinical nature as the person fitting the lens considers to be necessary in the particular case.

  • Contact lens equipment and facilitiesOpen

    3.11.1 Contact lens opticians who fit contact lenses should possess suitable equipment for contact lens practice and be fully conversant with its use.

    3.11.2 The following items are essential:

    • Slit-lamp biomicroscope (capable of at least 25x magnification)
    • Keratometer or other calibrated instrument for the assessment of corneal curvature.

    3.11.3 The following items are recommended:

    • Range of single patient use diagnostic soft contact lenses
    • Range of special complex diagnostic contact lenses
    • Contact lens verification apparatus, e.g. radiuscope
    • Facility for contact lens disinfection/sterilisation
    • Range of appropriate care systems for patients
    • Range of appropriate topical drugs and diagnostic agents
    • Facility for disinfection/sterilisation of all ‘contact’ apparatus

    3.11.4 The following items may be considered:

    • Tear assessment equipment
    • Corneal topographer
    • Placido disc
    • Keratoscope
    • Wet cell illuminated magnifier
    • Burton lamp

    3.11.5 A facility for verification and calibration of all equipment must be available and used on a regular basis.

SUPPLYING POWERED CONTACT LENSES

Open
  • GuidelinesOpen

    3.12.1 Whenever a contact lens is supplied by a registered optometrist, dispensing optician or contact lens optician, he or she has a duty to ensure that the lens or lenses meet the specification, and fulfil their legal obligation to make arrangements for the patient to receive aftercare insofar as, and for as long as, may be reasonable for each particular case. (Opticians Act 1989 s 27[3B])

    3.12.2 Whenever a contact lens is supplied by a person who is acting under the supervision of a registered optometrist, dispensing or contact lens optician, the registered optometrist, dispensing optician or contact lens optician has a duty to ensure that they are able to intervene in the supply if necessary, and exercise their professional skill and judgement as a clinician to make sure that the lens or lenses meet the specification, and that appropriate arrangements for the patient to receive aftercare are made.

    3.12.3 Whenever a contact lens is supplied by a person who is acting under the general direction of a registered optometrist, dispensing optician or contact lens optician, the registered optometrist, dispensing optician or contact lens optician has a duty to ensure that written protocols and procedures are in place to protect patient health and safety, that the person conducting the supply is appropriately trained and themselves able to ensure that the lens or lenses will meet the specification and make appropriate arrangements for the patient to receive aftercare.

  • AdviceOpen

    3.13.1 The Opticians Act 1989 (s27(3B)) states that a person shall not sell a contact lens for use by any person who does not have a valid specification. (Defined as being “signed, written specification of each lens fitted sufficient to enable the lens to be replicated” Opticians Act 1989 s25(5)(a)). However, a person can sell contact lenses where, instead of the original specification, the seller has

    1. a copy of the original specification; or
    2. an order from the purchaser, submitted in writing or electronically, which contains the particulars of the specification of the person who intends to wear the contact lens. If the sale is made under the general direction of a registered optometrist, dispensing optician or contact lens optician, the law requires that the seller verifies the particulars of the specification with the person who issues it (Opticians Act 1989, s27(3)(a)).

    If the sale is made by or under the supervision of a registered optometrist, dispensing optician or contact lens optician, it remains in the best interests of patients that, where the seller does not have the original specification, that the specification should be verified, where practicable.

    3.13.2 Powered contact lenses can only be sold by, under the supervision of a registered medical practitioner or a registered optometrist, dispensing optician or contact lens optician, or under the general direction of a registered medical practitioner or a registered optometrist, dispensing optician or contact lens optician (Opticians Act 1989 s 27[1][b] and s 27 [3][d]). Zero powered contact lenses can only be sold under the supervision of a registered medical practitioner , or a registered optometrist, dispensing optician or contact lens optician.

    3.13.3 Before supplying any lenses a registered optometrist, dispensing optician or contact lens optician should understand the difference between direct supply, supervision and general direction (see below for further details).

    3.13.4 If powered contact lenses are supplied by a person working under either the supervision of a registered optometrist, dispensing optician or contact lens optician, or the general direction of a registered optometrist, dispensing optician or contact lens optician, the registered optometrist, dispensing optician or contact lens optician must ensure that the supplier has a full understanding of the respective roles and responsibilities of the registered optometrist, dispensing optician or contact lens optician and supplier under the relevant relationship (be it supervision or general direction).

    3.13.5 The registered optometrist, dispensing optician or contact lens optician should ensure that clear written procedures are in place for those working under their general direction, and that all those supplying lenses are familiar with them and understand them.

    3.13.6 Before supplying contact lenses, the registered optometrist, dispensing optician or contact lens optician or anyone working under their supervision or the registered optometrist, dispensing optician or contact lens optician or anyone working under their general direction, should satisfy him/herself that the lenses are in accordance with the patient’s contact lens specification.

    3.13.7 On receipt of the contact lens specification, or verified copy or order, if any of the details are not clear or complete the supplier should check the details with the person who issued the specification.

    3.13.8 On supplying the lenses, the supplier should provide sufficient written information to enable the patient to be able to handle lenses appropriately and comply with an appropriate lens care regime.

    3.13.9 The patient should not be supplied with more than the anticipated number of lenses needed until the expiry of the patient’s contact lens specification. It is recommended that the supplier annotates the patient’s contact lens specification with the date of supply, and the number of lenses that were supplied to this specification.

    3.13.10 As it is a contravention of the Opticians Act to supply powered contact lenses after the patient’s specification has expired, practitioners should advise the patient to have a contact lens fitting shortly before the expiry date of the contact lens specification, and an eye examination if appropriate.

    3.13.11 If the supplier is unable to supply lenses that exactly meet the contact lens specification of the patient, refitting is required before an alternative lens is supplied. A lens may be deemed to meet the specification, if it is an identical lens made by the same manufacturer but sold under a different name to that stated on the specification.

  • SupervisionOpen

    3.14.1 Where the supply of lenses is under the supervision of a registered optometrist, dispensing optician or contact lens optician, the supervisor retains full responsibility for the supply. The provisions of the supply fall under section 27(1)(b) of the Opticians Act. The supervisor must be on the premises, aware of the procedure and in a position to intervene if necessary to ensure that no untoward consequences to the detriment of the patient can arise from the actions of such a person who is being supervised. In the case of General Optical Council v Vision Direct (1989) it was held that supervision by an optometrist (or contact lens optician) means that the optometrist (or contact lens optician) is able to exercise his or her professional skill and judgement as a clinician. It does not mean supervision by someone performing a purely clerical or even management function, even if the person who is performing that function happens to be an optometrist (or contact lens optician).

    3.14.2 Protocols for the supply of lenses under supervision should also include:

    • Checking that the lenses are for the correct person
    • Checking that the specification is current and that the supply of lenses will not be for a longer period of time than the expiry of the specification
    • Checking that the lenses that are supplied to the patient are those specified in the patient’s contact lens specification
    • Ensuring the patient knows which lens is for which eye
    • Ensuring those who perform supervised tasks are trained in the procedures to be followed
    • Ensuring the patient is given written information on care solutions and knows how to handle the lenses
    • Reinforcing the need for regular contact lens check-ups, and reminding the patient when their next scheduled contact lens consultation is due
    • Ensuring adequate records are kept
    • Ensuring that the audit trail is sufficient to ensure that any errors that occur are drawn to the attention of the supervising registered optometrist, dispensing optician or contact lens optician For zero-powered lenses, ensuring that the patient is fitted with lenses if no specification is provided
  • General DirectionOpen

    3.15.1 Where the supply of lenses is under the general direction of a registered optometrist, dispensing optician or contact lens optician, the registered optometrist, dispensing optician or contact lens optician should ensure that robust procedures are in place to protect the patient. A directing registered optometrist, dispensing optician or contact lens optician has a responsibility to ensure that the systems used for verification and supply are robust and are followed. Whilst the registered optometrist, dispensing optician or contact lens optician need not be on the premises while the sale takes place, any protocol for such supply should be in writing with an audit trail that can be followed. The protocol should include the requirement for suppliers to be adequately trained and to have working knowledge of the types of contact lenses available and the different care regimes. Suppliers should be trained to advise the patient appropriately as to what to do if the patient suffers an adverse event from the use of the lenses or care solutions. Suppliers working under general direction should not interpret or make judgements in relation to any clinical information contained in the specification, and should refer such matters to a registered optometrist, dispensing optician or contact lens optician or registered medical practitioner and seek direction from them before supplying lenses. The generally directing person should be in the management chain in a position of authority to monitor the effectiveness of protocols and procedures for the supply of lenses and make amendments if required.

    3.15.2 Protocols for the supply of lenses under general direction should also include:

    • Checking that the lenses are for the correct person
    • Checking that the specification is current and that the supply of lenses will not be for a longer period of time than the expiry of the specification
    • Checking that the lenses that are supplied to the patient are those specified in the patient’s contact lens specification
    • Ensuring the patient knows which lens is for which eye
    • Ensuring those who perform delegated tasks are trained in the procedures to be followed.
    • Ensuring the patient is given written information on care solutions and knows how to handle the lenses.
    • Ensuring as far as reasonable that the patient is not registered as sight impaired or severely sight impaired or under 16
    • Reinforcing the need for regular contact lens check-ups, and reminding the patient when their next scheduled contact lens consultation is due
    • Ensuring adequate records are kept
    • Ensuring that the audit trail is sufficient to ensure that any errors that occur are drawn to the attention of the generally directing registered optometrist, dispensing optician or contact lens optician
  • Duty to provide aftercareOpen

    Updated: 30/01/2012

    3.16.1 The Opticians Act includes a duty which states that the seller must make ‘arrangements’… ‘for the individual for whom the optical appliance or’ ‘zero powered contact lens’ is supplied to ‘receive aftercare in so far as, and for so long as, may be reasonable in his particular case’. (Opticians Act 1989 S27[3B]) The generally directing registered optometrist, dispensing optician or contact lens optician or the supervising registered optometrist, dispensing optician or contact lens optician will therefore need to make sure that these ‘arrangements’ are in place.

    3.16.2 Individual ‘aftercare’ arrangements would reasonably be understood to include where to go for routine aftercare in a manner convenient to the patient and should make arrangements for:

    • Where the patient can go in an emergency,
    • What signs or symptoms they should look out for,
    • The importance of having regular contact lens check-ups.
    • How to remove the contact lenses in an emergency,
    • Having a local contact or helpline for advice,
    • Monitoring that aftercare arrangements are effective and work for the patient. This would include monitoring that the local contact or helpline works in practice and that the emergency provisions are appropriate.

    3.16.3 Good practice would suggest that it is in patients’ best interests for scheduled contact lens check-ups to be at least every twelve months, but may be more frequent depending upon the lens type and wearing modality.

    Archived version(s) of this item - Click date to read:

    Archived version: 30/01/2012

    3.16.1 The Opticians Act includes a duty which states that the seller must make ‘arrangements’… ‘for the individual for whom the optical appliance or’ ‘zero powered contact lens’ is supplied to ‘receive aftercare in so far as, and for so long as, may be reasonable in his particular case’. (Opticians Act 1989 S27[3B]) The generally directing registered optometrist, dispensing optician or contact lens optician or the supervising registered optometrist, dispensing optician or contact lens optician will therefore need to make sure that these ‘arrangements’ are in place.

    3.15.2 Individual ‘aftercare’ arrangements would reasonably be understood to include where to go for routine aftercare in a manner convenient to the patient and should make arrangements for:

    • Where the patient can go in an emergency,
    • What signs or symptoms they should look out for,
    • The importance of having regular contact lens check-ups.
    • How to remove the contact lenses in an emergency,
    • Having a local contact or helpline for advice,
    • Monitoring that aftercare arrangements are effective and work for the patient. This would include monitoring that the local contact or helpline works in practice and that the emergency provisions are appropriate.

ZERO POWERED CONTACT LENSES – FITTING AND SUPPLY

Open
  • GuidelinesOpen

    3.17. Wearers of zero-powered contact lenses are exposed to the same risks to ocular health as wearers of powered contact lenses. Therefore the same degree of care is required with fitting or supplying a patient with zero-powered contact lenses as when fitting a patient with powered contact lenses.

  • AdviceOpen

    3.18.1 A practitioner who fits zero-powered contact lenses should regard his responsibilities as being the same to those applying to a practitioner who fits powered contact lenses.

    Whilst there is no legal requirement to fit a person with zero-powered contact lenses, it is in the best interests of the patient to do so. Therefore, before supplying any patient with zero-powered lenses who does not have a valid written specification, the patient should be fitted with appropriate lenses by a registered optometrist, dispensing optician or contact lens optician and issued with a written specification, where appropriate. Any registered optometrist, dispensing optician or contact lens optician who is responsible for supervising the sale and supply of zero-powered lenses where the patient does not possess a written specification should ensure that the supervisee refers the patient for fitting.

    3.18.2 It is particularly important that patients who are fitted with zero-powered contact lenses are given adequate instruction on solutions, hygiene and handling. Patients may see zero-powered contact lenses as ‘fashion accessories’ and this belief may lead to a more haphazard care regime. Patients should be advised strongly that they should not share their lenses as to do so carries a serious health risk.

    3.18.3 Whilst powered contact lenses may be supplied under the general direction of a registered optometrist, dispensing optician or contact lens optician or under the supervision of a registered optometrist, dispensing optician or contact lens optician, zero powered contact lenses may only be supplied under the supervision of those practitioners indicated. (Opticians Act 1989 s27 [1][b]). (See Section 2 of these guidelines)

    3.18.4 Zero powered contact lenses cannot be supplied under the general direction provisions of Section 27(3)(d) of the Opticians Act which relates only to powered contact lenses.

    3.18.5 Any person who supplies zero powered contact lenses has the same duties and responsibilities as a person who supplies powered contact lenses. (See Section 2 of these guidelines)

    3.18.6 Whilst there is no legal requirement to give a patient a written specification after fitting a patient with a zero powered contact lens, it is in the patient’s best interest to do so. (See Section 1 of these guidelines)

SECTION 4: INFECTION CONTROL

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    Please read this section of the guidance carefully as it has new important text and the paragraphs have been re-arranged and re-numbered, although the original contents are not substantially changed from the previous version [12.08]. The previous version [12.08] has been archived.
  • GuidelineOpen

    Updated: 15/02/2011

    4.1 The dispensing optician should practice appropriate infection control procedures, for the protection of both the dispensing optician and their patients.

    Archived version(s) of this item - Click date to read:

    Archived version: 15/02/2011

    4.1.1 The Health & Safety at Work etc. Act (1974) requires employers to ensure, so far as is reasonably practical, the health, safety and welfare at work of all employees. The Act covers the provision and maintenance of equipment, the handling and storage of articles and substances, the provision of instruction, training and supervision and the provision and maintenance of a safe working environment.

    4.1.2 In order to comply with the Act, all equipment must be properly maintained and all clinical procedures must be carried out safely. Drugs and harmful substances must be handled with care and stored safely.

    4.1.3 It is the duty of all employers and practitioners to update their hygiene routines in the light of new information and products.

  • GeneralOpen

    Updated: 15/02/2011

    4.2.1 It is in the patient’s and the practitioner’s best interests to avoid the transmission of any infection between patient and practitioner or between patients.

    4.2.2 Practitioners should maintain high levels of hygiene.

    Archived version(s) of this item - Click date to read:

    Archived version: 15/02/2011

    4.2.1 Infection is the pathological state that results from the invasion of the body by pathogenic micro-organisms. Cross-infection (or nosocomial infection) is infection contracted during the course of clinical care in a hospital or other healthcare facility (such as an optical practice).

    4.2.2 Cross-infection is a common, but partly avoidable, complication of healthcare provision. A patient may present at a clinic or practice with an infectious illness, which may be either symptomatic or asymptomatic, and pose a risk of infecting the practitioner or passing on the infection to other patients either directly or through the use of medical devices. Practitioners themselves may also be harbouring infectious disease, which they may be at risk of passing on to their patients. In addition, the clinic or practice environment may pose a microbiological hazard and present an infection risk to both staff and patients.

    4.2.3 The risk of the accidental transmission of infection in optical practice is low compared with that encountered in some other healthcare disciplines, Nevertheless the direct transmission of skin infections, respiratory infections and enteric infections does occur, and ophthalmic infections such as bacterial and viral conjunctivitis may also be transmitted if inadequate infection control measures are in place. The close proximity (< 1m) between staff and patients in optical practice poses special risks which must always be borne in mind.

  • IntroductionOpen

    Updated: 15/02/2011

    4.3.1 Infection is recognised as a common, but largely avoidable, complication in healthcare provision. Patients may present to the dispensing optician in practice with an infectious illness, either knowingly or unknowingly, and pose a risk of cross infecting the dispensing optician or passing on the infection to other patients through use of medical devices. Dispensing Opticians themselves may also be harbouring infectious disease, which they may be at risk of passing on to their patients. In addition, the practice environment may pose a microbiological hazard and provide an infection risk to both staff and patients.

    4.3.2 The main routes through which infections may be transmitted are: through physical contact, contact with body fluids and via airborne particles. The risk of the accidental transmission of infection in optical practice is low compared with that encountered in some other healthcare disciplines. Nevertheless, the direct transmission of skin infections, respiratory infections and enteric infections does occur, and ophthalmic infections such as bacterial and viral conjunctivitis may also be transmitted if inadequate infection control measures are in place. The close proximity (< 1m) between staff and patients in optical practice poses special risks which must always be borne in mind.

    4.3.3 In recent years, attention has been drawn to the risk of transmission of blood borne viruses such as human immunodeficiency virus (HIV) and hepatitis B and C. The main risk of transmission is associated with invasive procedures in which injury e.g. needlestick, could result in blood from the infected individual entering open tissues of another person. The risk of transmission of blood borne viruses in practice is extremely low but transmission of skin infections e.g. staphylococcus, herpes simplex, fungi, respiratory infections (e.g. tuberculosis) and enteric infections (e.g. viral gastroenteritis) are more likely. Ophthalmic infections e.g. bacterial and adenoviral conjunctivitis may also be transmitted within the practice if inadequate infection control measures are in place.

    4.3.4 Concern has also been raised about how to treat patients infected or colonised with Meticillin (formerly Methicillin)-Resistant Staphylococcus aureus (MRSA) or Clostridium difficile (C. diff) to avoid contracting or transmitting the infection. Defence against these infections in common with most others, is largely down to fastidious hand hygiene.

    4.3.5 The theoretical transmission of prion proteins, implicated in Creutzfeldt Jakob Disease (CJD) and variant CJD (vCJD), through re-usable ophthalmic devices and trial contact lenses has been identified as a risk by the Department of Health (DH). Currently, there is no evidence that such transmission has occurred.

    4.3.6 The Health and Safety at Work Act (1974) places a general duty on the employer to provide a working environment that is safe and without risks to health. Thus, infection control procedures in the practice are essential to protect anyone working in or visiting the practice and to ensure that the legal obligations of the employer are met.

    4.3.7 This advice is aimed at dispensing opticians in general practice. Hospital opticians and optometrists should abide by the infection control procedures of their Trust.

    Immunisation Keep up to date with tetanus, polio, tuberculosis
    Hepatitis B
    Hand hygiene Before patient contact
    Between patients (see below for more detail)
    After contact with body fluid
    Maintain integrity of skin Cover cuts to skin with waterproof dressing[preferably coloured.
    Dry skin properly with paper hand towels after washing.
    Use hand cream as appropriate. Jars of hand-cream should not be shared with others,
    Protective clothing Use to protect against direct contact with body fluid
    Sharps safety Use equipment with safety devices
    Use safe handling and disposal procedures
    Decontamination of equipment Decontaminate equipment after use(see below)
    Disinfect used linen by laundering
    Use protective clothing whilst handling and cleaning
    Decontamination of the environment Keep environment clean and free from dust
    Disinfect spills of body fluid

    Archived version(s) of this item - Click date to read:

    Archived version: 15/02/2011

    Infections transmitted by physical contact

    4.3.1.1 Physical contact can be directly between individuals, for example hand-lid contact during the course of examination or contact lens fitting. It can also be indirect, between objects or surfaces and individuals. Examples of such indirect contact are soiled tissue wipes and trial rigid contact lenses.

    4.3.1.2 Viruses that can be transmitted by direct and indirect physical contact include adenovirus, herpesvirus, papilloma virus and molluscum contagiosum.

    4.3.1.3 Bacteria that can be transmitted in this way include methicillin-resistant Staphylococcus aureus (MRSA).

    4.3.1.4 Fungal infections can also be transmitted through contact. Examples are athlete’s foot (Tinea pedis) and Ringworm (Tinea corporis).

    Infections borne in the blood and other body fluids

    4.3.2. Blood-borne and other body fluid-borne infections are transmitted by contamination by blood or body fluids. The commonest examples are HIV, hepatitis B and C and viral haemorrhagic fever. These are all viral diseases. Other diseases, including TSEs (transmissible spongiform encephaolopathies also known as prion diseases] have been transmitted by the transfusion of blood and blood products. There is a small degree of risk to practitioners, support staff and patients from cross-infection with such diseases Infection may be transmitted via contaminated instruments and devices including contact lenses. It is necessary to be aware of this possibility and to observe strict infection control procedures in the course of clinical practice. No case has yet been identified of the transmission of a prion disease during optical practice, but the possibility is thought to exist.

    Airborne infection

    4.3.3.1 Potentially infectious respiratory aerosols are generated when an individual sneezes, coughs, or talks. A single cough can transmit up to 100,000 particles and a sneeze 20 times this number. Particles over 5 microns in diameter do not normally travel more than 1m while smaller particles can travel longer distances and remain airborne for longer. Large particles are deposited in the vulnerable mucous membranes (nose, eyes, mouth). Small particles can reach the respiratory tract including its lower parts. Environmental conditions, including temperature, humidity and airflow, influence the transmission of disease by droplet infection. Infections that can be transmitted in this way include a number of respiratory diseases such as the common cold and influenza.

    4.3.3.2 Because of their professionally-necessary proximity to the patient’s nose and mouth, optical practitioners (along with other healthcare workers such as ophthalmologists, otorhinolaryngolgists and dentists) are at special risk of airborne infection and of infecting their patients in the same way.

    4.3.3.3 The risk of airborne infection can be minimised in a number of ways. Persons with signs and/or symptoms of a respiratory infection of any type should be instructed:

    • to cover the nose and mouth when coughing
    • to use disposable tissues to contain respiratory secretions
    • to dispose of tissues in the nearest receptacle after use
    • to perform hand hygiene after contact with respiratory secretions and contaminated objects or materials

    Influenza and Droplet Transmission

    4.3.4 [ Information currently being updated ]

    CJD / vCJD

    4.3.5.1 The theoretical transmission of prion proteins, implicated in Creutzfeld Jacob Disease (CJD) and variant CJD (vCJD), through re-usable ophthalmic devices and trial contact lenses has been identified as a risk by the Department of Health (DH). These untreatable diseases affect the central nervous system and some other tissues and are invariably fatal.

    4.3.5.2 The entire population of the UK currently above the age of ten years has been identified as having been exposed to beef or beef products contaminated with the bovine spongiform encephalopathy (BSE) agent. This agent has caused disease (vCJD) in 162 individuals since 1990.

    4.3.5.3 In addition to the general risk of vCJD, certain patient groups have been identified as being at greater than normal risk (which is one per million per annum) of developing classical CJD:

    • recipients of pituitary derived hormones such as human growth hormone or gonadotrophins
    • people known or assumed to have had human dura mater implanted, including people who have had brain surgery before August 1992, and people who have had an operation for a tumour or cyst of the spine before August 1992
    • people diagnosed of suffering from CJD of any type or with a family history of CJD
    • people with degenerative neurological diseases of unknown causation

    As a precautionary measure, patients in any of these groups who require ocular interventions of any kind should be referred to the Hospital Eye Service.

  • Principles of cleaning, sterilisation and disinfectionOpen

    Updated: 15/02/2011

    4.4.1 There are numerous pieces of equipment that regularly come into contact with patients e.g. trial frames, chin rests, refractor heads, hand held occluders and rulers, as well as ophthalmic devices which come into direct contact with ocular tissues e.g. tonometer heads, gonioscope and other contact lenses. It is essential that they are all appropriately decontaminated, for example by wiping headrests and/or chin rests with a disinfectant wipe, to reduce the risk of transmission of infection.

    There are three levels of decontamination:

    (a) Cleaning – The removal of organic and inorganic debris from a surface which might support micro-organisms and provide insulation that reduces the efficiency of disinfecting or sterilisation procedures. Detergents and ultrasonic cleaners are frequently used for cleaning purposes.

    (b) Disinfection – A treatment that reduces the number of viable micro-organisms but not necessarily bacterial spores or some viruses. Disinfection can be achieved by physical methods such as heat or by the use of chemical disinfecting agents. Chemical disinfection can be an uncertain procedure as it involves an integration between the chemical used, the micro-organism and exposure time.

    (c) Sterilisation – A treatment, which completely kills or removes all kind of micro-organisms including spores. Sterilisation can be achieved by ionising radiation, by gaseous ethylene oxide, by gaseous hydrogen peroxide, by low pressure steam and formaldehyde, by filtration, by dry heat (hot air oven) or by moist heat (autoclave).

    4.4.2 To be effective all items must be physically clean before being exposed to any sterilisation or disinfection process.

    4.4.3 Not all equipment, however, needs to be sterile before use and the following is a general guideline:

    • Sterile – Equipment introduced into a sterile body area or in contact with a break in the skin or mucous membrane
    • Disinfected – Equipment in close contact with body surfaces or intact mucous membranes, such as the ocular surface e.g. tonometer heads, gonioscope and other contact lenses
    • Clean – Equipment not coming into close contact with mucous membranes or sterile body areas e.g. trial frames, refractor heads

    4.4.4 Surfaces in the consulting room should be cleaned periodically with detergent and water unless contaminated with body fluids. If contaminated with body fluids a chlorine based disinfectant should be used. All consulting rooms should have access to a wash hand basin and it is good practice for this to be within the consulting room.

    Archived version(s) of this item - Click date to read:

    Archived version: 15/02/2011

    Routine infection control precautions

    4.4.1 There are routine infection control procedures which can be used to minimise the transmission of infection [summarized in the table below]. Although contact with body fluids and use of sharps is rare within optical practice, it is important that the practitioner understands how to minimise the risk of infection and uses the appropriate techniques to ensure his safety and the safety of the patient. Sharps e.g. needles may be used in optical practice for the removal of foreign bodies and the metallic caps from contact lens bottles may also cause a sharp injury.

    Immunisation Keep up to date with tetanus, polio, tuberculosis Hepatitis B
    Hand hygiene Before and after contact with all patients (see below for more detail) After contact with body fluid
    Maintain integrity of skin Cover cuts to skin with waterproof dressing. Dry skin properly with paper hand towels
    Use hand cream as appropriate
    Protective clothing Use to protect against direct contact with body fluid
    Sharps safety Use equipment with safety devices
    Use safe handling and disposal procedures
    Decontamination of equipment Decontaminate equipment after use(see below)
    Disinfect used linen by laundering. Use protective clothing whilst handling and cleaning
    Decontamination of the environment Keep environment clean and free from dust
    Disinfect spills of body fluid

    Personal Protection

    4.4.2.1 Immunisation – All practitioners and support staff should be up to date with immunisations against infectious diseases including tetanus, polio, hepatitis B and tuberculosis.

    4.4.2.2 Barrier Techniques – All cuts and abrasions should be covered with waterproof sticking plasters. Although HIV has been isolated in tears it is considered unlikely that this would lead to a risk of cross-infection between patient and practitioner.

    Hand hygiene

    4.4.3.1 Good hand hygiene practice is now widely acknowledged as being the single most effective intervention for reducing the risk and preventing the spread of infection. It is a means of removing transient micro organisms and significantly reducing resident microorganism [also called skin commensals] to a level which is not harmful to patients. Hand hygiene also removes blood, body fluids and any other infectious or hazardous agents

    4.4.3.2 It is recommended that sinks with warm water used only for hand washing are available in all clinical areas and that they are easily accessible.

    4.4.3.3 The National Institute for Health and Clinical Excellence (NICE) recommends that hands must be decontaminated immediately before each and every episode of direct patient contact or care and after any activity or contact that could potentially result in hands becoming contaminated .

    4.4.3.4.There is no set frequency for washing your hands, this is determined by actions that are completed and those that are about to be performed. Hand hygiene should always be performed:

    • Before and after contact lens insertion/removal
    • After going to the toilet
    • Before [and after as appropriate] contact with ocular surfaces/adnexa in each and every episode of patient contact /care
    • Before and after administering medication e.g. eye drops
    • After any possible microbial contamination (e.g. contact with body fluids, wounds, clinical waste)
    • After handling soiled / contaminated materials
    • When hands are visibly dirty
    • Before wearing and after removing gloves

    4.4.3.5 This technique is usually all that is required for most procedures performed in the clinical setting –

    • Wet hands under running water.
    • Dispense soap/antiseptic into cupped hand.
    • Rub hands vigorously and thoroughly for 10-15 seconds without adding more water.
    • Ensure all surfaces of the hands are covered.
    • Rinse hands thoroughly under warm running water.
    • Dry hands with a disposable paper towel. The use of non disposable towels is not good practice.

    4.4.4 Hand washing agents.

    4.4.4.1 Soap
    Handwashing with soap and water is effective in removing most transient micro-organisms and is usually all that is necessary in most situations to prevent cross infection. In clinical areas, soap should be preferably supplied as liquid soap in disposable containers or containers that are washed and dried before refilling. The containers should not be “topped up”.

    4.4.4.2 Antiseptic
    Antiseptic agents are more effective in reducing both transient and resident micro-organisms (e.g. Chlohexidine, Povidine -iodine). Chlorhexidine (4%) preparations have shown to be more effective as they have shown a residual effect against transient organisms influencing the survival time on hand surfaces. The use of an antiseptic agent is recommended

    • Before and after direct contact with patients in clinical settings where there is an outbreak of antimicrobial resistant organisms (e.g. Residential /Nursing Homes)
    • Where there is heavy microbial contamination
    • Before performing invasive procedures/minor operations.

    4.4.4.3 Alcohol-based handrub
    Alcohol based handrubs are effective antiseptic agents which rapidly destroy microorganisms on the skin surface. It is indicated that, when used correctly, alcohol hand rubs reduce microbial load and increases compliance with hand hygiene. However they are not a cleaning agent and should not be used if hands are visibly dirty or contaminated with blood, bodily fluids or other potentially infectious agents. To be effective against MRSA hand rubs must contain 70% of either ethyl or isopropyl alcohol. They are especially useful in situations where handwashing and drying facilities are inadequate e.g. domiciliary visits.

    Whilst the efficacy of alcohol hand rubs has been proven, they are not to be used as a substitute for good handwashing technique using soap and water when available.

    4.4.4.4 Handwashing technique

    The World Health Organisation has produced guidance on handwashing and handrubbing technique:

    World Health Organisation – Pictorial Advice on Hand Washing

    A rapid decontamination of the hands can be achieved by rubbing the whole surface with an alcoholic solution e.g. Hibisol.

    Frequent hand washing and the use of alcohol preparations can cause damage to the skin. Cracked skin may harbour more bacteria and increase the risk of the transmission of infection. Soap should always be applied to wet hands to minimise irritation to the skin. Regular use of hand creams may help to prevent skin damage.

    Cleaning, disinfecting and decontamination

    4.4.5.1 There are numerous pieces of equipment and appliances with which patients regularly come into contact, e.g. trial frames, chin rests, refractor heads, hand held occluders and rulers as well as ophthalmic devices which come into direct contact with ocular tissues e.g. tonometer heads, gonioscopes and other contact lenses. It is essential that they are all appropriately decontaminated, for example by wiping headrests and/or chin rests with a disinfectant wipe, to reduce the risk of transmission of infection.

    Decontamination is defined as the process of cleansing to remove microorganisms or foreign matter from contaminated materials. There are three levels of decontamination:

    • Cleaning – The removal of organic and inorganic debris from a surface which might support micro-organisms and provide insulation that reduces the efficiency of disinfecting or sterilisation procedures. Detergents and ultrasonic cleaners are frequently used for cleaning purposes.
    • Disinfection – A treatment that reduces the number of viable micro-organisms but not necessarily bacterial spores or some viruses. Disinfection can be achieved by physical methods such as heat or by the use of chemical disinfecting agents. Chemical disinfection can be an uncertain procedure as it involves an integration between the chemical used, the micro-organism and exposure time.
    • Sterilisation – A treatment, which completely kills or removes all kind of microorganisms including spores. Sterilisation can be achieved by ionising radiation, by gaseous ethylene oxide, by low pressure steam and formaldehyde, by filtration by dry heat (hot air oven) or by moist heat (autoclave).

    4.4.5.2 To be effective all items must be physically clean before being exposed to any sterilisation or disinfection process. Not all equipment, however, needs to be sterile before use and the following is a general guideline:

    • Sterile – Equipment introduced into a sterile body area or is in contact with a break in the skin or mucous membrane
    • Disinfected – Equipment in close contact with body surfaces of intact mucous membranes, such as the ocular surface e.g. tonometer head, gonioscopes
    • Clean – Equipment not coming into close contact with mucous membranes or sterile body areas e.g. trial frames, refractor heads.

    All surfaces used as a preparation area for dealing with patients and disinfected/sterile appliances must also be cleaned and disinfected regularly. Surfaces should be cleaned with detergent and water unless contaminated with body fluids, then a chlorine based disinfectant should be used. It is considered good practice for the consulting room to contain a wash hand basin and for the practitioner to maintain good hand hygiene between patients and certain procedures as necessary.

    The table below summarises agents recommended for cleaning, disinfection and decontamination procedures.

    AGENT PREPARATION EXAMPLES OF USE
    Liquid soap As supplied Handwash (level 1)
    Chlorhexidene Gluconate 4% skin cleanser 500 ml bottles with pump dispenser e.g. Hibiscrub Antiseptic handwash(Level 2)
    Chlorhexidene 5% in 70% Isopropyl Alcohol 500 ml bottles with pumpdispenser e.g. Hibisol Antiseptic handwash for clean hands
    Detergent General purpose detergentDetergent impregnated wipes e.g. Cutan Multisurface wipes Cleaning of hard surfaces
    Isopropyl alcohol Isopropyl alcohol 70% Impregnated swabs e.g.Mediswabs or wipese.g.Mediwipes Disinfection of hardsurfaces, chinrests etc.
    Hypochlorite solution(1,000 ppm availablechlorine) Available from pharmacies–e.g. Milton or own brand ‘sterilising solution’ (dilute to concentration required) General disinfection
    Hypochlorite solution(10,000 ppm available chlorine) Available from pharmacies–e.g. Milton or own brand ‘sterilising solution’ (dilute to concentration required) Disinfection of body fluid spills
    Hypochlorite solution(20,000 ppm availablechlorine) Available from pharmacies–e.g. Milton or own brand ‘sterilising solution’ (dilute to concentration required) Decontamination of trial contact lenses and tonometer heads

  • Hand hygieneOpen

    Updated: 15/02/2011

    4.5.1 Handwashing is perhaps the single most important means of preventing the spread of infection. There are a number of organisms present in healthy skin, some are resident organisms (also called skin commensals) and are mostly harmless, although some are known to cause mild eye infections.

    4.5.2 There are other transient organisms that can be deposited on the skin, including certain gram-negative bacteria which could lead to more serious corneal infections. Most of these transient organisms can be removed with a thorough wash with liquid soap and water. The skin commensals, however, are mostly left on the skin after washing with soap and water but can be greatly reduced in number by washing with an antiseptic detergent preparation.

    4.5.3 The National Institute for Health and Clinical Excellence (NICE 2003) recommends that hands must be decontaminated immediately before each and every episode of direct patient contact or care and after any activity or contact that could potentially result in hands becoming contaminated.

    4.5.4 There is no set frequency for washing your hands, this is determined by actions that are completed and those that are about to be performed.

    The following list gives some examples of when hand hygiene may be appropriate:

    • Before and after contact lens insertion/removal
    • After going to the toilet
    • When hands are visibly dirty
    • Before (and after as applicable) contact with ocular surfaces/adnexa
    • Before (and after as applicable) administering medication e.g. eye drops
    • After any possible microbial contamination (e.g. contact with body fluids, wounds, clinical waste)
    • After handling soiled / contaminated materials
    • Before wearing and after removing gloves

    4.5.5 This technique is usually all that is required for most procedures performed in the clinical setting

    • Wet hands under running water.
    • Dispense soap/antiseptic into cupped hand (N.B. bar soap should not be used).
    • Rub hands vigorously and thoroughly for 10-15 seconds without adding more water.
    • Ensure all surfaces of the hands are covered.
    • Rinse hands thoroughly under warm running water.
    • Dry hands with a disposable paper towel. The use of non disposable towels is not good practice.
    AGENT PREPARATION EXAMPLES OF USE
    Liquid soap As supplied Handwash
    Chlorhexidene Gluconate 4% skin cleanser 500 ml bottles with pump dispenser e.g. Hibiscrub Antiseptic handwash
    Chlorhexidene 5% in 70% Isopropyl Alcohol 500 ml bottles with pump dispenser e.g. Hibisol Antiseptic handwash for clean hands
    Detergent General purpose detergent
    Detergent impregnated wipes e.g. Cutan Multisurface wipes
    Cleaning of hard surfaces
    Isopropyl alcohol 70% Impregnated swabs e.g. Mediswabs or wipes e.g.Mediwipes Disinfection of hard surfaces, chinrests etc.
    Hypochlorite solution (1,000 ppm available chlorine) Available from pharmacies e.g. Milton or own brand ‘sterilising solution’ (dilute to concentration required) General disinfection
    Hypochlorite solution (10,000 ppm available chlorine) Disinfection of body fluid spills
    Hypochlorite solution (20,000 ppm available chlorine) Decontamination of trial contact lenses and tonometer heads

    Archived version(s) of this item - Click date to read:

    Archived version: 15/02/2011

    Contact Lens Solutions

    4.5.1.1 Contact lens opticians must ensure that all contact lens care products used during the examination are carefully maintained and discarded prior to their expiry date. As recent studies have demonstrated, varying levels of contamination exist in the plastic bottles containing contact lens solutions. Clinicians should note when these bottles are opened and discard them in accordance with manufacturer’s guidelines, which vary depending on the product and its use. All solutions run the risk of infection during the time that caps are removed, they must therefore be replaced immediately after each application.

    4.5.1.2 Chlorine can be toxic to the eye. Should any sodium hypochlorite solution come into contact with the eye, irrigate with sterile normal saline, check the ocular area for inflammation and for damage using fluorescein, and if there are any clinically significant signs, re-examine the next day or refer as appropriate.

    Contact Lens Practice

    4.5.2. General points

    All surfaces used for preparation prior to contact lens fitting or after care should be disinfected regularly. All containers used for temporary storage, whilst the patient is undergoing an examination, should be cleaned and disinfected before and after use.

    The re-use of trial contact lens fitting sets ceased in 1999, following advice from SEAC [the Spongiform Encephalopathy Advisory Committee] to the Medical Devices Agency. Since that time single patient use contact lenses have been considered to be best practice. However it was agreed that special complex diagnostic contact lenses might be re-used and decontamination was recommended after each use.

    Re–use of contact lenses and ophthalmic equipment

    4.5.3 Decontamination

    A solution containing 20,000 parts per million of available chlorine sodium hypochlorite is effective in reducing Transmissible Spongiform Encephalopathies, including vCJD.

    Decontamination of contact lenses and ophthalmic devices should be carried out using the following procedure:

    1. The item should not be allowed to dry following use.
    2. It should be cleaned as usual and then soaked in 2% sodium hypochlorate (Milton) solution for one hour.
    3. It should be removed from the solution and residual solution shaken off.
    4. It should be thoroughly rinsed with sterile solution saline or boiled water.
    5. Then disinfected using the normal procedure before storage.

    The item may then be safely used.

  • Hand washing agentsOpen

    Updated: 15/02/2011

    4.6.1.Soap

    Hand washing with soap and water is effective in removing most transient micro-organisms and is usually all that is necessary to prevent cross infection. In clinical areas, soap should be supplied as liquid soap in disposable containers or containers that are washed and dried before refilling. The containers should never be “topped up”.

    4.6.2 Antiseptic

    Antiseptic agents are more effective in reducing both transient and resident micro-organisms (e.g. chlorhexidine, povidine – iodine). Chlorhexidine (4%) preparations have shown to be more effective as they have a residual effect against transient organisms influencing the survival time on hand surfaces. The use of an antiseptic agent is recommended:

    • Before and after direct contact with patients in clinical settings where there is an outbreak of antimicrobial resistant organisms (e.g. Residential or Nursing Homes);
    • Where there is heavy microbial contamination;
    • Before performing invasive procedures/minor operations.

    4.6.3 Antibacterial (alcohol-based) handrub

    Antibacterial handrubs (generally but not exclusively alcohol based) are effective antiseptic agents which rapidly destroy micro-organisms on the skin surface. It is indicated that, when used correctly, alcohol hand rubs reduce microbial load and increase compliance with hand hygiene. However they are not a cleaning agent and should not be used if hands are visibly dirty or contaminated with blood, bodily fluids or other potentially infectious agents. To be effective against staphylococci, including MRSA, hand rubs must contain 70% of either ethyl or isopropyl alcohol. They are especially useful in situations where handwashing and drying facilities are inadequate e.g. domiciliary visits, or between patient contacts.

    Using an unperfumed alcohol-based hand rub prior to contact lens insertion has been shown to have a negligible effect on ocular comfort, redness and lens wettability providing that the hand-rub has been allowed to dry on the hands as per the manufacturer’s instructions (often 15 seconds).

    Whilst the efficacy of alcohol hand rubs has been proven, they are not to be used as a substitute for good handwashing technique using soap and water when available. Good hand-washing is strongly advised at the start and finish of a session. Alcoholic hand-rubs are not effective against Clostridium difficile spores or norovirus (a cause of viral gastro-enteritis)

    Archived version(s) of this item - Click date to read:

    Archived version: 15/02/2011

    4.6.1 Under section 34 of the Environmental Protection Act 1990 any person who ‘…imports, produces, carries, keeps, treats or disposes of…’ controlled waste has a duty of care to take all reasonable steps to deal with it appropriately. Controlled waste is defined as being waste from households, commerce or industry. Optometrists and Dispensing Opticians therefore have a responsibility to dispose of the waste that they produce responsibly. This applies to producers of both non-hazardous and hazardous waste.

    4.6.2.1 The Hazardous Waste Regulations 2005, which came into force in July 2005 have reclassified waste to fall in line with European legislation. This has two main implications for optometrist and dispensing optician:

    4.6.2.2 The separate category of ‘special waste’ (pharmaceutical waste) has been removed. POMs are now either hazardous (which depends upon their toxicity and concentration) or not. The POMs commonly used by optometrist and dispensing optician are not of a sufficient concentration to be classed as hazardous and so are not subject to the consignment regulations that used to apply to special waste.

    POMs that are not classed as ‘hazardous’ do not need a consignment note, or special transportation arrangements. However, as ‘medicinal waste’, the POMs may possess hazardous properties and therefore require appropriate disposal . Under their duty of care (see para 8.1 above) optometrist and dispensing optician must identify any medicines in their waste to their waste disposal company, to ensure they are able to dispose of them properly.

    It is recommended that best practice is to have a waste transfer note system with the waste contractor to ensure that the waste is incinerated at high temperature. Waste medicines should as far as possible be disposed of in their original packaging.

    4.6.2.3 Clinical waste is defined in the Controlled Waste Regulations 1992. It means any waste which consists wholly or partly of:

    • human or animal tissue;
    • blood or bodily fluids;
    • excretions;
    • drugs or other pharmaceutical products;
    • swabs or dressings; or;
    • syringes, needles or other sharp instruments;

    which unless rendered safe may prove hazardous to any person coming into contact with it. And:

    • any other waste arising from medical, nursing, dental, veterinary, pharmaceutical or similar practice, investigation, treatment, care teaching or research, or the collection of blood for transfusion, being waste which may cause infection to any person coming into contact with it.

    4.6.3 Waste is considered to be hazardous if it is amongst other things irritant, harmful or infectious.

    4.6.4 The ‘soft’ healthcare waste produced by most optical practices (e.g. used contact lenses, tonometer probes, tissues etc) is unlikely to be considered hazardous, and as such is not classed as clinical waste. This can be disposed of in the normal refuse unless it is of large quantities in which case it can be considered as ‘offensive waste’. For non-hazardous healthcare waste, DEFRA and the RPSGB recommend the separate packaging of large quantities of offensive wastes under the heading ‘Does the quantity of waste produced affect its classification?’, but this is good practice rather than a requirement.

    4.6.5 If the waste is likely to be infectious it is classed as hazardous (and it is therefore within the definition of clinical waste), and must not be mixed with non-hazardous waste. Advice from the DH states that where a patient in the community has been diagnosed with MRSA and is being cared for by a healthcare worker, the healthcare waste generated is not necessarily infectious.

    4.6.6 Clinical waste should be segregated from other types of waste and be treated/disposed of appropriately in suitably permitted, licensed or exempt facilities on the basis of the hazard it poses.

    4.6.7 Contact lenses and solutions do not normally fall within any of the categories of Hazardous Waste and should be classified as non-infectious healthcare waste.

    4.6.8 Sharps are defined as items that could cause puncture wounds. These would include needles, broken glass ampoules, scalpels etc. Sharps should be disposed of in sharps boxes. They are considered to be Hazardous Waste if their collection and disposal is ‘subject to special requirements to prevent infection’ (SI 895 of 2005 18.01.03). Sharps which are classed as non-hazardous will be treated differently for transport and disposal, but they should still be in sharps boxes. A separate box should be used for ‘hazardous’ and non-hazardous sharps. Practitioners who use sharps should contact their waste contractor who will be able to advise on the most appropriate form of disposal.

    4.6.9 In England and Wales details of the premises at which hazardous waste is produced or from which it is removed must be notified to the Environment Agency. There is an exemption for various types of premises, which we have been assured includes optometrists and dispensing opticians, providing that they produce less than 200kg of hazardous waste in any 12 month period. It is extremely unlikely that any optical practice will produce this quantity of hazardous waste, if any, so they will not need to notify the Agency. In Scotland and Northern Ireland premises do not have to be registered. Instead of registration the relevant authorities must be notified of any movement of hazardous waste at least 3 days in advance. Further details of the consignment regulations can be found at www.ehsni.gov.uk/pubs/publications/Hazardous_Waste_leaflet_2005.pdf. In Scotland Hazardous Waste is termed ‘Special Waste’, but is defined as that waste which is hazardous waste as defined by Article 1(4) of the Hazardous Waste Directive.

    4.6.10 Further information for those classified as waste producers can be found in the Department of Health’s guidance on the Safe Management of Healthcare Waste (Health Technical Memorandum 07-01). This guidance also applies to offensive/hygiene and infectious waste produced in the community from non-NHS healthcare sources. The producers of waste should complete and sign a waste transfer note (or consignment note for hazardous waste) prior to waste being transferred to another party. Prior to waste being disposed of, it should be stored securely on site.

    A summary of the different types of waste and their disposal is tabulated below:

    Item Classifica-tion Disposal method Responsible person Legislative information
    DRUGS / PHARMACE-UTICAL PRODUCTS
    Ophthalmic – POMs
    Non-hazardous Incineration* Contractor No consignment note required
    No special transportation
    Waste contractor must be informed of nature of waste under ‘duty of care’.
    *Best practice – Have a waste transfer note system with a waste contractor to ensure high temperature incineration
    GENERAL OPHTHALMIC HEALTHCARE WASTE – used contact lenses, blunt tonometer probes, tissues etc Non-hazardous healthcare waste Small quantities
    –normal refuse disposal
    Large quantities – are considered ‘offensive waste’
    Contractor DEFRA AdviceRPSGB AdviceDH GuidanceSee text
    Contact lens solutions and cases Non-hazardous Normal refuse disposal    
    Infectious healthcare waste is classed as CLINICAL WASTE Hazardous Must be packaged separately to non-hazardous waste Contractor Consignment note required for hazardous waste1
    SHARPS
    Anything able to cause a puncture wound. This would include soft CL glass bottles and their metal caps
    Non hazardous -unless infected Sharps boxSeparate Sharps box if infected   See text
    See text for further information

    4.6.11 A national colour coding system has been suggested. This is not mandatory, but may help to aid the identification and segregation of waste to aid appropriate treatment and disposal. The colours that would apply to optometrists are:

    Suggested colour coding Description
    Yellow bin Waste which requires disposal by incineration such as POMs
    Yellow bin marked ‘sharps’ with orange lid Sharps not contaminated with medicinal products
    Yellow/black striped bag Offensive/hygiene waste
    Orange bin/bag Infectious waste or potentially infectious waste (must be treated prior to disposal).
    Black Domestic (municipal) waste. Clear/opaque receptacles may also be used for domestic waste.

  • Hand washing techniqueOpen

    Updated: 15/02/2011

    4.7.1 Frequent hand washing and the use of alcohol preparations can cause damage to the skin. Cracked skin may harbour more bacteria and increase the risk of the transmission of infection. Soap should always be applied to wet hands to minimise irritation to the skin. Thorough drying and the regular use of hand creams may help to prevent skin damage. Jars of hand cream should not be shared with others.

    4.7.2 The World Health Organisation has produced guidance on handwashing and handrubbing technique (see below).

    World Health Organisation – Pictorial Advice on Hand Washing

    Archived version(s) of this item - Click date to read:

    Archived version: 15/02/2011

    College of Optometrists Guidance on Infection Control [2006] – currently under revision

    Circular No, DGS/5C/D110S/E2/2001/138 (14th March 2001): Republic of France Ministries of Health and Employment & Solidarity

    Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, Mallaghan C, Tucker DR; Joint Working Party of the British Society of Antimicrobial Chemotherapy; Hospital Infection Society; Infection Control Nurses Association. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. Published in J Hosp Infect. 2006 May;63 Suppl 1:S1-44.

    College of Optometrists (2001) Guidance on the re-use of Contact Lenses and Ophthalmic devices.

    Environmental Protection Act 1990

    Guidelines for the Control of MRSA in Ireland, HSE, Health Protection Surveillance Centre 2005

    Health Services Advisory Committee (1999) Safe disposal of clinical waste. HSE Books, Sudbury.

    Health Technical Memorandum 07-01. Department of Health www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_063274

    HSC 2000/032 Decontamination of medical devices. NHS Executive

    MDA AN1999 (03) Single patient use of contact lenses: implications for clinical practice. October 1999. Medical Devices Agency

    MDA AN1999 (04) Single patient use of ophthalmic medical devices: implications for clinical practice. October 1999. Medical Devices Agency

    Methicillin-resistant Staphylococcus aureus (MRSA) Guidance for nursing staff, RCN 2005

    Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003; 290(22):2976-2984.

    NICE Guideline CG2 Prevention of healthcare-associated infections using in primary and community care. Section 2 Standard Principles: 25-97 www.nice.org.uk/Guidance/CG2 Accessed 9th September 2008

    SI 895 of 2005 The Hazardous Waste (England and Wales) Regulations 2005

    SI 895 of 2005 The List of Wastes (England) Regulations 2005

    Special Waste Amendment (Scotland) Regulations 2004 (SI 112 of 2004)

    Statutory Rule 300 of 2005 The Hazardous Regulations (Northern Ireland) 2005

    Taylor DM: Inactivation of prions by physical and chemical means. Journal of Hospital Infection 1999; 43: S69-S76

    Taylor DM: Inactivation of Transmissible Degenerative Encephalopathy Agents: A Review. The Veterinary Journal 2000; 159: 10-17

    The Hazardous Waste (Wales) Regulations 2005 SI 1806 of 2005 (W138)

    UK Health Departments (1998) Guidance for Clinical Health Care Workers: Protection against infection with blood borne viruses. Recommendations of the Expert Advisory Group on AIDS and Advisory Group on Hepatitis Viruses Department of Health, Wetherby, UK.

    Wilson, J. (2001) Infection control in clinical practice (Second Edition) Pub: BallierTindal.

    www.ni-environment.gov.uk/waste.htm accessed 9/9/08

    new.wales.gov.uk/topics/environmentcountryside/epq/waste_recycling/?lang=en Accessed 9 September 2008

    www.npsa.nhs.uk/cleanyourhands

    This section of the Advice and Guidelines has been revised by the ABDO Working party on Infection Control – Professor Roger Buckley, Dr Cindy Tromans, Rosemary Bailey.

  • Airborne infectionOpen

    Added: 15/02/2011

    4.8.1 Potentially infectious respiratory aerosols are generated when an individual sneezes, coughs or talks. A single cough can transmit up to 100 000 particles and a sneeze 20 times this number. Particles over 5 microns in diameter do not normally travel more than 1m but smaller particles can travel longer distances and remain airborne for longer. Large particles are deposited in the vulnerable mucous membranes (nose, eyes, mouth). Small particles can reach the respiratory tract including its lower parts. Environmental conditions, including temperature, humidity and airflow, influence the transmission of disease by droplet infection. Infections that can be transmitted in this way include a number of respiratory diseases such as the common cold and influenza.

    4.8.2 Because of their professionally-necessary proximity to the patient’s nose and mouth, practitiners are at a special risk of airborne infection and of infecting their patients in the same way.

    4.8.3 The risk of airborne infection can be minimised in a number of ways:

    • People who are coughing and/or sneezing should cover their nose and mouth whilst coughing/sneezing and use tissues to catch their cough or sneeze
    • People should dispose of these tissues into the nearest receptacle as soon as possible after use (tissues should be disposed of in normal domestic refuse and do not require special treatment
    • Hand hygiene should be performed after coughing/sneezing.

    In addition

    • People should avoid touching their mouth, eyes and/or nose, unless hand hygiene has been performed.

    Masks

    4.8.4 Research into whether the use of masks can help prevent infection is inconclusive. According to the Epic2 Guidelines research has not proved that facemasks prevent the transmission of hospital CA infections in routine procedures so the routine use of masks is not recommended or needed unless there is a serious respiratory risk involved (e.g. tuberculosis within the first two weeks of treatment or epidemic or pandemic flu (where there is no vaccination available)). NICE (2003) has concluded that surgical masks are not effective protection and specialised respiratory protective protection should be worn (e.g. particular filter mask).

    4.8.5 The Royal College of Ophthalmologists does not issue advice to wear masks for normal ophthalmic examinations and minor procedures where there is no likelihood of cross-inoculation with bodily fluids.

  • Situation of increased concernOpen

    4.9.1 Whilst all infections should be avoided wherever possible, infections such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. diff) have caused particular concern in recent times.

    MRSA

    4.9.2 Staphylococcus aureus is a bacterium that can reside on the skin, or can be found in the nose. About one third of healthy individuals carry S. aureus . It is generally non-pathogenic except where it gains access to deep tissues, such as; broken skin, resulting in wound infection; the bloodstream, leading to bloodstream infection (bacteraemia), and to the lungs causing for example ventilator-associated pneumonia. MRSA is a less common variant of S. aureus which may be resistant to many antibiotics making it more difficult to treat than normal strains of the bacterium. MRSA may be a problem in many hospitals and, although the risk of serious infection with MRSA is lower in the community, it still exists and this organism is increasingly seen in community health care units such as nursing homes.

    4.9.3 The impact of MRSA is considerable; patients with a MRSA bloodstream infection are twice as likely to die from their infection as patients with bloodstream infection caused by methicillin-sensitive S. aureus. Measures to control the emergence and spread of MRSA are justified therefore because the options available for the treatment of these infections are reduced and because they may spread amongst vulnerable, at risk, patients.

    4.9.4 It is important to note, however, that MRSA infection does not cross intact skin and that there is very little risk of infection for normal, healthy clinical staff.

    MRSA in the community

    4.9.5 MRSA detected in the community may be the result of:

    • Patients discharged from hospital with MRSA
    • Nursing home residents who have acquired MRSA
    • MRSA transmitted to non-hospitalised patients or individuals from MRSA patients
    • MRSA arising naturally in the community.

    4.9.6 It has been shown that 12% of MRSA cases are community-associated , and skin and soft tissue infections are more common among community-associated cases compared with those acquired in hospital.

    4.9.7 A patient/resident from whom MRSA is isolated, but who is not suffering from an obvious infection is said to be colonised with MRSA. People may be unknowingly colonised with MRSA for many years, and therefore anybody from whom MRSA has been isolated at any time in the past may still be carrying the organism. Unlike those who are infected with MRSA, those who are colonised are not treated with antibiotics but should exercise good personal hygiene control.

    Archived version(s) of this item - Click date to read:

    Added: 15/02/2011

    4.9.1 Whilst all infections should be avoided wherever possible, infections such as MRSA and C. diff have caused particular concern in recent times.

    MRSA

    4.9.2 Staphylococcus aureus is a bacterium that can reside on the skin, or can be found in the nose. About one third of healthy individuals carry S. aureus . It is generally non-pathogenic except where it gains access to deep tissues, such as; broken skin, resulting in wound infection; the bloodstream, leading to bloodstream infection (bacteraemia), and to the lungs causing for example ventilator-associated pneumonia. MRSA is a less common variant of S. aureus which may be resistant to many antibiotics making it more difficult to treat than normal strains of the bacterium. MRSA may be a problem in many hospitals and, although the risk of serious infection with MRSA is lower in the community, it still exists and this organism is increasingly seen in community health care units such as nursing homes.

    4.9.3 The impact of MRSA is considerable; patients with a MRSA bloodstream infection are twice as likely to die from their infection as patients with bloodstream infection caused by meticillin-sensitive S. aureus. Measures to control the emergence and spread of MRSA are justified therefore because the options available for the treatment of these infections are reduced and because they may spread amongst vulnerable, at risk, patients.

    4.8.4 It is important to note, however, that MRSA infection does not cross intact skin and that there is very little risk of infection for normal, healthy clinical staff.

    MRSA in the community

    4.9.5 MRSA detected in the community may be the result of:

    • Patients discharged from hospital with MRSA
    • Nursing home residents who have acquired MRSA
    • MRSA transmitted to non-hospitalised patients or individuals from MRSA patients
    • MRSA arising naturally in the community.

    4.9.6 It has been shown that 12% of MRSA cases are community-associated , and skin and soft tissue infections are more common among community-associated cases compared with those acquired in hospital.

    4.9.7 A patient/resident from whom MRSA is isolated, but who is not suffering from an obvious infection is said to be colonised with MRSA. People may be unknowingly colonised with MRSA for many years, and therefore anybody from whom MRSA has been isolated at any time in the past may still be carrying the organism. Unlike those who are infected with MRSA, those who are colonised are not treated with antibiotics but should exercise good personal hygiene control.

  • Infection control measuresOpen

    Added: 15/02/2011

    4.10.1 Staphylococci are common in skin folds and contaminated skin scales may contaminate flat surfaces if they become airborne, for example during activities such as bed making, or if the affected person has a condition such as eczema. Staphylococci that are shed into the environment may survive for long periods in dust. Flat surfaces act as reservoirs for S. aureus, including MRSA, and contamination will transfer easily to hands when such surfaces are touched. Contamination on hands and/or gloves may be similarly transferred by contact with curtains, equipment, switches, phones, computer keyboards, door handles, light switches etc.

    4.10.2 When examining a patient/resident with a MRSA infection, or who is known to be colonised with MRSA, the following precautions are advised –

    Personal

    4.10.3 Hand hygiene is the single most important intervention to prevent transmission of infection.

    (a) Hand hygiene must be carried out before and after each patient contact and before and after leaving the patient’s home or care facility. Hands should either be washed using an effective technique (see above) using liquid soap and water or a 70% alcohol hand rub should be used;
    (b) Hands should be dried thoroughly preferably using a disposable paper towel;
    (c) While alcohol hand gels and rubs are a practical alternative to soap and water, alcohol is not a cleaning agent. Hands that are visibly dirty or potentially grossly contaminated must be washed with liquid soap and water and dried thoroughly;
    (d) Suitable preparation increases the effectiveness of hand washing. You should therefore:

    • Keep nails short and clean and free of nail varnish
    • Where possible avoid wearing jewellery, especially rings with ridges or stones
    • Avoid wearing wristwatches
    • Artificial nails should not be worn;
    • Cuts or breaks in the skin of anyone coming into contact with a known MRSA patient or carrier should be covered with impermeable waterproof dressings (preferably coloured);
    • To prevent possible contamination from the skin and skin flakes consider:
      • Wearing short sleeves or rolling up long sleeves
      • Not wearing a tie.

    Gloves

    4.10.4 NICE (2003) recommend that gloves are worn for invasive procedures, contact with sterile sites and non-intact skin or mucous membranes, and for all activities that have been assessed as carrying a risk of exposure to blood, body fluids, secretions or excretions, or sharp or contaminated instruments.

    4.10.5 Gloves may be required (to protect the dispensing optician from the patient, and subsequent patients from cross infection), but only if contact with body fluids (e.g. tears) or other contaminated material (e.g. dressings) is likely. Gloves do not provide complete protection so hand hygiene measures are necessary before wearing, and after the removal of gloves. If you believe that the gloves are contaminated they should be considered as likely to cause an infection and disposed of appropriately. Many care homes will have dedicated disposal facilities.

    4.10.6 There are two types of disposable gloves available – disposable examination gloves, and close fitting sterile surgical gloves, which are individually packaged for surgical procedures. The disposable gloves (which are not individually packaged) are not sterile.

    4.10.7 When deciding whether or not to use gloves practitioners should consider the risk of infection. Factors to consider include:

    • Whether the patient has an overt infection such as ulcerative blepharitis, acute viral or bacterial conjunctivitis;
    • The degree of contact with body fluids or infected tissue;
    • The consequences of infection;
    • The fact that latex gloves may cause asthma in the wearer or their co-workers.

    4.10.8 The Royal College of Ophthalmologists does not issue advice to wear gloves for normal ophthalmic examinations and minor procedures where there is no likelihood of cross-inoculation with bodily fluids. They suggest that hand hygiene is sufficient for contact lens fitting.

    4.10.9 The most contagious condition that practitioners are likely to encounter in the tears of patients is adenovirus. Previous experience with adenovirus outbreaks in eye departments has shown that transmission can be prevented by strict hand hygiene, single use tonometer prisms and disinfection of surfaces (especially slit lamps).

    Equipment

    4.10.10 The following precautions are advised in the case of any equipment or instruments that come into contact with a patient known to be infected with MRSA, who is known to be colonised with MRSA, or where the environment is contaminated or suspected of being contaminated:

    (a) Hand washing before and after contact with every potentially contaminated piece of equipment.
    (b) Clean and dry all equipment

    • Cleaning may comprise washing with soap or detergent, or alcohol if suitable.
    • Please note some modern trial frames with rubberised finishes are not suitable for cleaning with alcohol.

    4.10.11 The principles described above apply to all situations where patients or the dispensing optician are at risk of any known transmissible infection. This could include situations where patients spend time in close proximity to each other. Examples include residential or nursing homes, schools and workplaces.

    4.10.12 Dispensing Opticians are also advised to take appropriate hygiene measures when leaving a patient’s house or care home. Environments such as care homes and hospitals frequently provide hand gels for visitors to use. Dispensing Opticians should use these according to the instructions given by the care home or hospital.

  • Contamination via contact lens solutions and medicine bottlesOpen

     Added: 15/02/2011

    4.11. Dispensing Opticians must ensure that all contact lens care products and medicines used during the examination are carefully maintained and discarded prior to their expiry date. Any multidose container can be a source of cross infection and varying levels of contamination exist in the plastic bottles containing contact lens solutions. Clinicians should note when these bottles are opened and discard them in accordance with manufacturer’s guidelines, which vary depending on the product and its use. Care must be taken not to contaminate the dropper tip and the lid must be replaced on the container after use as all solutions are susceptible to contamination during the time that caps are removed. If suspected of contamination, solutions should be disposed of immediately. Single use drug delivery systems are recommended where possible.

  • The re-use of contact lenses and ophthalmic devicesOpen

    Added: 15/02/2011

    4.12.1 There are no known cases of transmission of variant Creutzfeldt-Jakob Disease (vCJD) by contact lenses or ophthalmic devices. However, the Spongiform Encephalopathy Advisory Committee (SEAC) in 1999 advised the Department of Health (DH) of a remote theoretical risk of transmitting prions from one patient to another by the re-use of contact lenses or ophthalmic devices that come into contact with the eye. Whether such a risk could exist has been called into question by a study1 which found abnormal prion protein in the retina and optic nerve of a vCJD victim, but not in any of the anterior segment structures that were examined. The Ophthalmology Sub-Group of the Government’s Advisory Committee on Dangerous Pathogens (ACDP) Transmissible Spongiform Encephalopathy (TSE) working group re-visited the topic in 2009, following the redesignation of the anterior eye as low risk. Where single patient use of lenses and devices contacting the surface of the eye is impracticable, best decontamination procedures should be applied. These procedures include the use of a solution of sodium hypochlorite (see later).

    4.12.2 Clearly the risk of transmission of disease has to be balanced against the benefits that patients receive from contact lenses and ophthalmic devices, both directly and indirectly, so that other clinical outcomes are not compromised. Decontamination procedures include the removal of cellular and proteinaceous deposits from surfaces followed by the use of a disinfection agent to eliminate microorganisms. Future advice may vary with the advent of new lenses, materials and decontamination procedures, and increasing knowledge of prion disease.

    These guidelines are intended to assist a clinician to render whatever services are clinically and professionally necessary to serve the best interests of the patient.

    General principle

    4.12.3 Wherever practicable, a contact lens or ophthalmic device that comes into contact with the ocular surface should not be used on more than one patient, as to do so may expose patients to unnecessary risk through the transmission of disease. Where this is impracticable suitable items should be decontaminated using a recognised method.

    Contact lenses

    4.12.4 The definitions below apply to the following categories of lenses:

    • Hydrogel lenses;
    • Silicone hydrogel lenses;
    • Hybrid lenses; and
    • Rigid lenses (including corneal lenses, scleral lenses, scleral shells and ocular prostheses).

    (a) Trial contact lens: a lens that is used to assess fitting, following which it is either disposed of by the clinician or dispensed to the patient. Currently the majority of contact lens patients are fitted with single patient use lenses of various types.

    (b) Special complex diagnostic contact lens: a lens used by the clinician to assess performance of the design on the eye. It is recognised that in certain cases, particularly where there is disease or abnormality of the lid, cornea or ocular surface, special complex diagnostic contact lenses may be necessary for a successful clinical outcome. These lenses may need to be re-used.

    4.12.5 Special complex diagnostic lenses may be of any type. When using such lenses, the following conditions shall be observed:

    (a) The lenses should be used solely within the clinician’s premises and under the control of the clinician at all times.
    (b) The clinician should ensure that decontamination is carried out to the highest possible standards.
    (c) The clinician should keep full records to show the usage of each lens.
    (d) The clinician should inform the patient of all the relevant risks and benefits associated with contact lens fitting. It is best practice to obtain the patient’s signature on an acknowledgement form. A suitable form of words recommended by the DH can be found in the College Guidance on fitting contact lenses (chapter G2).

    Ophthalmic devices

    4.12.6 An ophthalmic device is any instrument that comes into contact with the ocular surface. There are many examples, but commonly used devices are tonometers, contact pachymeters, gonioscopes and other lenses to aid diagnoses of disease.

    4.12.7 The single use of these devices may be practicable in some cases, for example disposable tonometer heads. Alternatively some devices can be decontaminated using a recognised method (see below). Where a disposable form of the device is not available and the device is not able to withstand decontamination the optometrist must exercise professional judgement as to the risks and benefits of re-using the device, bearing in mind that undetected disease may have sight- or life-threatening consequences.

    Information for the patient

    4.12.8 When a device that cannot withstand decontamination is to be re-used in the management of a patient, the risks and benefits of using the device must be explained to that patient.

  • Decontamination of contact lenses and ophthalmic devicesOpen

    Added: 15/02/2011
    Updated: 01/10/2012

    4.13.1 The DH has issued the following advice on the proper decontamination of surgical instruments before re-use, which also has relevance for the re-use of contact lenses and ophthalmic devices that come into contact with the ocular surface:

    ‘The abnormal protein associated with Transmissible Spongiform Encephalopathies (TSEs), including vCJD, is very resistant to all common methods of inactivation. Expert advice is that effective cleaning of surgical instruments prior to sterilisation is of the utmost importance in reducing the risk of transmission of vCJD via surgical procedures. It is therefore essential that all existing cleaning and sterilisation procedures operate to the highest standards.’

    Alcohol wipes

    4.13.2 The practice of decontaminating contact devices with alcohol wipes alone is not sufficient to remove prion material, and may in fact fix the prion protein to the surface of the instrument.

    How to decontaminate

    4.13.3. It is now agreed that there is a low potential for prion infectivity via the anterior eye and corneal and conjunctival surfaces. The guidelines on decontamination of contact lenses and ophthalmic devices that come into contact with the patient’s eye have therefore been revised. Prion proteins adhere strongly to materials including smooth surfaces. A key stage in the decontamination of the device is therefore to ensure that it is thoroughly cleaned to remove adhered debris as the potential for the transmission of cellular and proteinacious debris via tonometer prisms has been demonstrated. The concentration of the sodium hypochlorite advised has been reduced to a level that is appropriate for inactivating infectious agents such as bacteria and viruses, and is probably less harmful to the eye if it accidentally comes into contact with it. It has been reported that all viruses tested in saline (>99.9%) were inactivated within 10 min by 0.1-0.5 ppm chlorine and that protozoan cysts (Giardia, Acanthamoeba and Naegleria spp) were significantly reduced (>90%) by 1-4 ppm chlorine. The 1% solution that is recommended by the ACDP working group should therefore eradicate conventional microorganisms, including protozoal cysts.

    4.13.4 Equipment needed for decontamination of contact lenses or other ophthalmic devices:

    • Water for irrigation BP or sterile normal saline
    • Cleaning solution, such as liquid soap or detergent
    • Sodium hypochlorite solution 10 000 ppm

    4.13.5 If a contact lens or ophthalmic device is to be reused it needs to be decontaminated and made ready for its next use. The essential steps are:

    • The item must not be allowed to dry. Immediate decontamination is ideal, but if this is not possible, the item should be kept in a container of water for irrigation BP or sterile normal saline until it can be decontaminated.
    • The item must be thoroughly cleaned (including by rubbing) to remove cellular debris and adherent protein.
    • The item must then be decontaminated using sodium hypochlorite. Sodium hypochlorite is extremely toxic to the eye and it is vital that it is thoroughly rinsed off before re-use.
    • The item can then be reused, unless other steps are necessary (subsequent to decontamination), to enable it to be reused

    Current advice is in bold (adapted from Buckley 2010):

    Step ACDP TSE WG, 2009 recommendation Coll Optom / ABDO 2001 (included for comparison purposes only)
    When to decontaminate Immediately after use
    Drying Do not allow to dry Do not allow to dry
    Rinsing In Water for Irrigation BP/sterile normal saline for at least 30 sec
    Cleaning Rubbing with liquid soap or detergent In usual manner
    Rinsing In Water for Irrigation BP/ sterile normal saline for at least 30 sec
    Hypochlorite 10,000 ppm for 10 min 20,000 ppm for one hour
    Rinsing In Water for Irrigation BP/ sterile normal saline for at least 10 min with 3 changes of water/saline Thorough rinse in saline or boiled water
    Drying Shake off excess, dry with tissue, reuse immediately or store dry
    Further measures. If necessary. Conventional disinfection to follow

    The item may then be safely re-used.

    4.13.6 Agents or procedures capable of binding proteins to surfaces (e.g. isopropyl alcohol, glutaraldehyde, autoclaving) should never be used unless devices are first decontaminated using the protocol above1. See para 4.12.1.

    4.13.7 A lens or device intended by the manufacturer for single use should not be re-used.

    Archived version(s) of this item - Click date to read:

    Archived version: 01/10/2012

    4.13.1 The DH has issued the following advice on the proper decontamination of surgical instruments before re-use, which also has relevance for the re-use of contact lenses and ophthalmic devices that come into contact with the ocular surface:

    ‘The abnormal protein associated with Transmissible Spongiform Encephalopathies (TSEs), including vCJD, is very resistant to all common methods of inactivation. Expert advice is that effective cleaning of surgical instruments prior to sterilisation is of the utmost importance in reducing the risk of transmission of vCJD via surgical procedures. It is therefore essential that all existing cleaning and sterilisation procedures operate to the highest standards.’

    Alcohol wipes

    4.13.2 The practice of decontaminating contact devices with alcohol wipes alone is not sufficient to remove prion material, and may in fact fix the prion protein to the surface of the instrument.

    How to decontaminate

    4.13.3. It is now agreed that there is a low potential for prion infectivity via the anterior eye and corneal and conjunctival surfaces. The guidelines on decontamination of contact lenses and ophthalmic devices that come into contact with the patient’s eye have therefore been revised. Prion proteins adhere strongly to materials including smooth surfaces. A key stage in the decontamination of the device is therefore to ensure that it is thoroughly cleaned to remove adhered debris as the potential for the transmission of cellular and proteinacious debris via tonometer prisms has been demonstrated. The concentration of the sodium hypochlorite advised has been reduced to a level that is appropriate for inactivating infectious agents such as bacteria and viruses, and is probably less harmful to the eye if it accidentally comes into contact with it. It has been reported that all viruses tested in saline (>99.9%) were inactivated within 10 min by 0.1-0.5 ppm chlorine and that protozoan cysts (Giardia, Acanthamoeba and Naegleria spp) were significantly reduced (>90%) by 1-4 ppm chlorine. The 1% solution that is recommended by the ACDP working group should therefore eradicate conventional microorganisms, including protozoal cysts.

    4.13.4 Equipment needed for decontamination of contact lenses or other ophthalmic devices:

    • Water for irrigation BP or sterile normal saline
    • Cleaning solution, such as liquid soap or detergent
    • Sodium hypochlorite solution 10 000 ppm

    4.13.5 If a contact lens or ophthalmic device is to be reused it needs to be decontaminated and made ready for its next use. The essential steps are:

    • The item must not be allowed to dry. Immediate decontamination is ideal, but if this is not possible, the item should be kept in a container of water for irrigation BP or sterile normal saline until it can be decontaminated.
    • The item must be thoroughly cleaned (including by rubbing) to remove cellular debris and adherent protein.
    • The item must then be decontaminated using sodium hypochlorite. Sodium hypochlorite is extremely toxic to the eye and it is vital that it is thoroughly rinsed off before re-use.
    • The item can then be reused, unless other steps are necessary (subsequent to decontamination), to enable it to be reused

    Current advice is in bold (adapted from Buckley 20101):

    Step ACDP TSE WG, 2009 recommendation Coll Optom / ABDO 2001 (included for comparison purposes only)
    When to decontaminate Immediately after use
    Drying Do not allow to dry Do not allow to dry
    Rinsing In Water for Irrigation BP/sterile normal saline for at least 30 sec
    Cleaning Rubbing with liquid soap or detergent In usual manner
    Rinsing In Water for Irrigation BP/ sterile normal saline for at least 30 sec
    Hypochlorite 10,000 ppm for 10 min 20,000 ppm for one hour
    Rinsing In Water for Irrigation BP/ sterile normal saline for at least 10 min with 3 changes of water/saline Thorough rinse in saline or boiled water
    Drying Shake off excess, dry with tissue, reuse immediately or store dry
    Further measures. If necessary. Conventional disinfection to follow

    The item may then be safely re-used.

    4.13.6 Agents or procedures capable of binding proteins to surfaces (e.g. isopropyl alcohol, glutaraldehyde, autoclaving) should never be used unless devices are first decontaminated using the protocol above1. See para 4.12.1.

    4.13.7 A lens or device intended by the manufacturer for single use should not be re-used.

     

  • Recognised risk categoriesOpen

    Added: 15/02/2011

    4.14.1 Although the risk of transmission of prion disease via contact lenses and ophthalmic devices is no more than theoretical in people with no predisposition to developing Transmissible Spongiform Encephalopathies (TSEs), there exist certain patient groups which have been identified as being at greater than normal risk of developing classical CJD:

    • Recipients of pituitary derived hormones such as human growth hormone or gonadotrophins;
    • People known or assumed to have had human dura mater implanted, including people who have had brain surgery before August 1992, and people who have had an operation for a tumour or a cyst of the spine before August 1992;
    • People diagnosed or suspected of suffering from CJD of any type, or with a family history of CJD;
    • People with degenerative neurological diseases of unknown causation.

    4.14.2 Before carrying out any procedure that might involve re-use of a contact lens or ophthalmic device the practitioner should as far as possible question the patient to establish whether he or she falls into any of these categories. In such a situation, only single patient use items should be used. If this is not possible the clinician should consider referring the patient to the Hospital Eye Service.

    4.14.3 If emergency management of a patient who falls into one of the above groups necessitates the use of a re-usable item, it should be discarded immediately after use.

    Contamination via contact lens solutions and medicine bottles

    4.14.4 Dispensing opticians must ensure that all contact lens care products and medicines used during the examination are carefully maintained and discarded prior to their expiry date. Any multidose container can be a source of cross infection and varying levels of contamination exist in the plastic bottles containing contact lens solutions. Clinicians should note when these bottles are opened and discard them in accordance with manufacturer’s guidelines, which vary depending on the product and its use. Care must be taken not to contaminate the dropper tip and the lid must be replaced on the container after use as all solutions are susceptible to contamination during the time that caps are removed. If suspected of contamination, solutions should be disposed of immediately. Single use drug delivery systems are recommended where possible.

  • Safe disposal of wasteOpen

    Added: 15/02/2011

    4.15.1 Under section 34 of the Environmental Protection Act 1990 any person who ‘…imports, produces, carries, keeps, treats or disposes of…’ controlled waste has a duty of care to take all reasonable steps to deal with it appropriately. Controlled waste is defined as being waste from households, commerce or industry. Dispensing Opticians therefore have a responsibility to dispose of the waste that they produce responsibly. This applies to producers of both non-hazardous and hazardous waste.

    4.15.2 Clinical waste is defined in the Controlled Waste Regulations 1992 10. It means any waste which consists wholly or partly of:

    • human or animal tissue;
    • blood or bodily fluids;
    • excretions;
    • drugs or other pharmaceutical products;
    • swabs or dressings; or;
    • syringes, needles or other sharp instruments;

    which unless rendered safe may prove hazardous to any person coming into contact with it. And:

    • any other waste arising from medical, nursing, dental, veterinary, pharmaceutical or similar practice, investigation, treatment, care teaching or research, or the collection of blood for transfusion, being waste which may cause infection to any person coming into contact with it.

    4.15.3 The disposal of waste must be safe, environmentally sound and legal.

    4.15.4. For information, common optical/ophthalmic waste should be categorized and disposed of as follows

    Optical/Ophthalmic items Waste Category Method of disposal
    Used or unused minims
    Used or unused fluorets
    Non-hazardous pharmaceutical waste Store in a rigid leakproof container
    Incinerate
    Empty CL solution bottles
    Tonometer probes
    Large quantities of CLs [eg time expired bank lenses]
    Non-hazardous healthcare waste Place in tiger bags [Yellow/ black striped bags]
    Dispose of in the offensive waste stream
    Chloramphenicol Hazardous waste Store in a rigid leakproof container
    Send for specialist incineration
  • Further information, Acknowledgments & BibliographyOpen

    Updated: 15/02/2011
    Updated: 27/05/2014

    Further information can be found at:

    https://www.gov.uk/managing-your-waste-an-overview/overview

    Further information

    Blakeney SL 2009 Infection control in optometric practice Optometry in Practice 10(1) 1-12

    Circular No, DGS/5C/D110S/E2/2001/138 (14th March 2001): Republic of France Ministries of Health and Employment & Solidarity

    Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, Mallaghan C, Tucker DR; Joint Working Party of the British Society of Antimicrobial Chemotherapy; Hospital Infection Society; Infection Control Nurses Association. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. Published in J Hosp Infect. 2006 May;63 Suppl 1:S1-44.

    College of Optometrists (1999) Guidance on the re-use of Contact Lenses and Ophthalmic devices.

    College of Optometrists (2009) H1N1 Virus (Swine Flu) Advice for Optical Practices

    Environmental Protection Act 1990

    Guidelines for the Control of MRSA in Ireland, HSE, Health Protection Surveillance Centre 2005

    HSC 2000/032 Decontamination of medical devices. NHS Executive

    MDA AN1999 (03) Single patient use of contact lenses: implications for clinical practice. October 1999. Medical Devices Agency

    MDA AN1999 (04) Single patient use of ophthalmic medical devices: implications for clinical practice. October 1999. Medical Devices Agency

    Methicillin-resistant Staphylococcus aureus (MRSA) Guidance for nursing staff, RCN 2005

    Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003; 290(22):2976-2984.

    National Institute for Health and Clinical Excellence, 2003 Prevention of healthcare-associated infections in primary and community care. Available from www.nice.org.uk/guidance/index.jsp?action=download&o=29119

    Pratt RJ, Pellowe CM, Wilson JA et al 2007 Epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England J. Hosp Infect 65(S1) S1-S61, but see page S22)

    Statutory Rule 300 of 2005 The Hazardous Regulations (Northern Ireland) 2005

    Taylor DM: Inactivation of prions by physical and chemical means. J. Hosp Infect 1999; 43: S69-S76

    Taylor DM: Inactivation of Transmissible Degenerative Encephalopathy Agents: A Review. The Veterinary Journal 2000; 159: 10-17

    Transmissible spongiform encephalopathy agents: safe working and the prevention of infection. www.advisorybodies.doh.gov.uk/acdp/tseguidance/faq.htm accessed 10/2/09

    UK Health Departments (1998) Guidance for Clinical Health Care Workers: Protection against infection with blood borne viruses. Recommendations of the Expert Advisory Group on AIDS and Advisory Group on Hepatitis Viruses Department of Health, Wetherby, UK.

    Wilson J. (2006) Infection control in clinical practice (Third Edition) Edinburgh: Balliere Tindal.

    Acknowledgements

    This is a joint guidance section with the College of Optometrists, following revisions by the ABDO Working party on Infection Control [Professor Roger Buckley, Dr Cindy Tromans, Rosemary Bailey] and the College Working Party of Infection Control [ Dr Susan Blakeney, Rosemary Bailey, Geoff Roberson, Dawn Roberts, Professor Steve Taylor }

    Bibliography

    Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, Mallaghan C, Tucker DR; Joint Working Party of the British Society of Antimicrobial Chemotherapy; Hospital Infection Society; Infection Control Nurses Association. Guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect. 2006 May;63 Suppl 1:S1-44.

    Purslow C, Hunt O and Nasso M Using alcohol hand-rubs in contact lens practice: does this affect comfort and wettability of hydrogel contact lenses? Poster at the Conference of the British Contact Lens Association 2005.

    Department of Health Catch it, Bin it, Kill it – Respiratory and hand hygiene Campaign. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080839 Accessed 16/1/09

    Department of Health and Health Protection Agency 2008 Pandemic Flu. Guidance for Environmental Health Practitioners

    Naimi TS, LeDell KH, Como-Sabetti K et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003 Dec 10;290(22):2976-84

    www.hse.gov.uk/latex/experience.htm

    Wadsworth J et al: Tissue distribution of protease resistant prion protein in variant Creutzfeldt-Jakob disease using a highly sensitive immunoblotting assay. The Lancet 2001; 358: 171-180

    Department of Health (2009). Managing CJD/vCJD risk in ophthalmology (Annex L). Guidance from the TSE Working Group (www.dh.gov.uk/ab/ACDP/TSEguidance/index.htm)

    HSC 1999/178 Variant Creutzfeldt-Jakob disease (vCJD): Minimising the risk of transmission. August 1999. NHS Executive

    Lim R, Dhillon B, Kurian KM et al Retention of corneal epithelial cells following Goldmann tonometry: implications for CJD risk Br J Ophthalmol 87(5) 583-586 2003

    Amin SZ, Smith L, Luthert PJ et al Minimising the risk of prion transmission by contact tonometry Br J Ophthalmol 87(11) 1360-1362 2003

    Buckley R Decontamination Optometry in Practice 11(1) 25-29 2010

    Sobsey MD Inactivation of health-related micro-organisms in water by disinfection processes Water Sci Technol 21 179-195 1989 cited in Rutala WA and Weber DJ Uses of inorganic hypochlorite (bleach) in health-care facilities Clinical Microbiology Reviews 1997 p.602

    Archived version(s) of this item - Click date to read:

    Archived version: 15/02/2011

    Further information can be found at:

    www.advisorybodies.doh.gov.uk/acdp/tseguidance/faq.htm

    www.defra.gov.uk/environment/waste/topics/clinical.htm Accessed 16/10/08 Further information

    Blakeney SL 2009 Infection control in optometric practice Optometry in Practice 10(1) 1-12

    Circular No, DGS/5C/D110S/E2/2001/138 (14th March 2001): Republic of France Ministries of Health and Employment & Solidarity

    Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, Mallaghan C, Tucker DR; Joint Working Party of the British Society of Antimicrobial Chemotherapy; Hospital Infection Society; Infection Control Nurses Association. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. Published in J Hosp Infect. 2006 May;63 Suppl 1:S1-44.

    College of Optometrists (1999) Guidance on the re-use of Contact Lenses and Ophthalmic devices.

    College of Optometrists (2009) H1N1 Virus (Swine Flu) Advice for Optical Practices

    Environmental Protection Act 1990

    Guidelines for the Control of MRSA in Ireland, HSE, Health Protection Surveillance Centre 2005

    HSC 2000/032 Decontamination of medical devices. NHS Executive

    MDA AN1999 (03) Single patient use of contact lenses: implications for clinical practice. October 1999. Medical Devices Agency

    MDA AN1999 (04) Single patient use of ophthalmic medical devices: implications for clinical practice. October 1999. Medical Devices Agency

    Methicillin-resistant Staphylococcus aureus (MRSA) Guidance for nursing staff, RCN 2005

    Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003; 290(22):2976-2984.

    National Institute for Health and Clinical Excellence, 2003 Prevention of healthcare-associated infections in primary and community care. Available from www.nice.org.uk/guidance/index.jsp?action=download&o=29119

    Pratt RJ, Pellowe CM, Wilson JA et al 2007 Epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England J. Hosp Infect 65(S1) S1-S61, but see page S22)

    Statutory Rule 300 of 2005 The Hazardous Regulations (Northern Ireland) 2005

    Taylor DM: Inactivation of prions by physical and chemical means. J. Hosp Infect 1999; 43: S69-S76

    Taylor DM: Inactivation of Transmissible Degenerative Encephalopathy Agents: A Review. The Veterinary Journal 2000; 159: 10-17

    Transmissible spongiform encephalopathy agents: safe working and the prevention of infection. www.advisorybodies.doh.gov.uk/acdp/tseguidance/faq.htm accessed 10/2/09

    UK Health Departments (1998) Guidance for Clinical Health Care Workers: Protection against infection with blood borne viruses. Recommendations of the Expert Advisory Group on AIDS and Advisory Group on Hepatitis Viruses Department of Health, Wetherby, UK.

    Wilson J. (2006) Infection control in clinical practice (Third Edition) Edinburgh: Balliere Tindal.

    Acknowledgements

    This is a joint guidance section with the College of Optometrists, following revisions by the ABDO Working party on Infection Control [Professor Roger Buckley, Dr Cindy Tromans, Rosemary Bailey] and the College Working Party of Infection Control [ Dr Susan Blakeney, Rosemary Bailey, Geoff Roberson, Dawn Roberts, Professor Steve Taylor }

    Bibliography

    Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, Mallaghan C, Tucker DR; Joint Working Party of the British Society of Antimicrobial Chemotherapy; Hospital Infection Society; Infection Control Nurses Association. Guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect. 2006 May;63 Suppl 1:S1-44.

    Purslow C, Hunt O and Nasso M Using alcohol hand-rubs in contact lens practice: does this affect comfort and wettability of hydrogel contact lenses? Poster at the Conference of the British Contact Lens Association 2005.

    Department of Health Catch it, Bin it, Kill it – Respiratory and hand hygiene Campaign. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080839 Accessed 16/1/09

    Department of Health and Health Protection Agency 2008 Pandemic Flu. Guidance for Environmental Health Practitioners

    Naimi TS, LeDell KH, Como-Sabetti K et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003 Dec 10;290(22):2976-84

    www.hse.gov.uk/latex/experience.htm

    Wadsworth J et al: Tissue distribution of protease resistant prion protein in variant Creutzfeldt-Jakob disease using a highly sensitive immunoblotting assay. The Lancet 2001; 358: 171-180

    Department of Health (2009). Managing CJD/vCJD risk in ophthalmology (Annex L). Guidance from the TSE Working Group (www.dh.gov.uk/ab/ACDP/TSEguidance/index.htm)

    HSC 1999/178 Variant Creutzfeldt-Jakob disease (vCJD): Minimising the risk of transmission. August 1999. NHS Executive

    Lim R, Dhillon B, Kurian KM et al Retention of corneal epithelial cells following Goldmann tonometry: implications for CJD risk Br J Ophthalmol 87(5) 583-586 2003

    Amin SZ, Smith L, Luthert PJ et al Minimising the risk of prion transmission by contact tonometry Br J Ophthalmol 87(11) 1360-1362 2003

    Buckley R Decontamination Optometry in Practice 11(1) 25-29 2010

    Sobsey MD Inactivation of health-related micro-organisms in water by disinfection processes Water Sci Technol 21 179-195 1989 cited in Rutala WA and Weber DJ Uses of inorganic hypochlorite (bleach) in health-care facilities Clinical Microbiology Reviews 1997 p.602

SECTION 5: PRACTICE MANAGEMENT

Open
  • Professional DisciplineOpen

    Updated: 22/03/2010

    5.1.1 The professional activities of registered dispensing opticians are regulated in five ways: by education and training to standards set by ABDO; by ABDO as the professional body with its powers for peer review; by fitness to practise procedures at the instigation of the GOC; by criminal law; by civil law – litigation.

    5.1.2 If any restricted function is carried out under supervision, policies should be in place so that it is clear, on a daily basis, which registered professional is responsible for the supervision. The policies should ensure that supervisors are able, practically, to fulfill their supervisory role.

    Archived version(s) of this item - Click date to read:

    Archived version: 22/03/2010

    5.1 The professional activities of registered dispensing opticians are regulated in five ways: by education and training to standards set by ABDO; by ABDO as the professional body with its powers for peer review; by fitness to practise procedures at the instigation of the GOC; by criminal law; by civil law – litigation.

  • Use and supply of pupil dilating drugsOpen

    Updated: 16/03/2010
    Updated: 27/07/2010

    5.2.1 Optometrists and Dispensing Opticians are reminded that Tropicamide and other pupil dilating drugs are prescription only medicines (POMs). As such the supply of these drugs is controlled by law and only certain classes of person, such as optometrists (and OMPs), are the only members of the practice team who legally are responsible for the instillation of these POMs. Registered Dispensing Opticians may order a limited list of POMs [see below] including these drugs for use in the practice. The use of pupil dilating eye drops should always, therefore, be done under the direction and supervision of an optometrist (or doctor/OMP).

    Amethocaine hydrochloride
    Chloramphenicol
    Cyclopentolate hydrochloride
    Fusidic acid
    Lignocaine hydrochloride
    Oxybuprocaine hydrochloride
    Proxymetacaine hydrochloride
    Tropicamide

    Contact Lens Opticians may now instil a limited range of anaesthetics [see below] in the course of appropriate contact lens fitting. The Association recommends that this should only be used for complex fittings where it is needed to achieve a satisfactory result.

    Lignocaine hydrochloride
    Oxybuprocaine hydrochloride
    Proxymetacaine hydrochloride

    In the case of acute bacterial conjunctivitis ONLY, the sale and supply of 0.5% Chloramphenicol drops [1% ointment] may now be instigated by all Dispensing Opticians. The restrictions of the pharmacy classification limit the supply to

    • a maximum pack size of 10ml[ drops]/4gms[ointment]
    • only in adults and children over 2 years of age
    • for a maximum of 5 days.

    All actions and advice should be noted on the patient’s record.

    For diagnosis of acute bacterial conjunctivitis and further advice – see Dispensing Optics – Special educational supplement – April 2010

    5.2.2 Practices should have Standard Operating Procedures to ensure that drugs are managed in accordance with the legislation. This is particularly crucial if the practice relies on locum optometric/OMP cover.

    5.2.3 Optometrists are referred to the Appendix A of the College Formulary, and College Guidance on delegation. If they are in any doubt about what to do in their particular circumstances they are advised to contact their professional and/or defence body for advice.

    For further information see www.college-optometrists.org.

    Archived version(s) of this item - Click date to read:

    Archived version: 16/03/2010

    5.2.1  Optometrists and Dispensing Opticians are reminded that Tropicamide and other pupil dilating drugs are prescription only medicines (POMs).  As such the supply of these drugs is controlled by law and only certain classes of person, such as optometrists (and OMPs), are the only members of the practice team who are legally permitted to acquire and or supply the POMs.  They are therefore responsible for any other members of the practice team who place orders with wholesalers, or those, such as retinal screeners, who wish to instil the drug into a patient’s eyes.  The use of pupil dilating eye drops should always, therefore, be done under the direction and supervision of an optometrist (or doctor/OMP).

    5.2.2  Practices should have Standard Operating Procedures to ensure that drugs are managed in accordance with the legislation.  This is particularly crucial if the practice relies on locum optometric/OMP cover.

    5.2.3  Optometrists are referred to the Appendix A of the College Formulary, and College Guidance on delegation.  If they are in any doubt about what to do in their particular circumstances they are advised to contact their professional and/or defence body for advice.

    For further information see www.college-optometrists.org

  • Practice Policies and Government RegulationsOpen

    Updated: 25/02/2011
    Updated: 25/08/2011

    5.3.1 Practice owners and/or managers should be aware of policies and requirements to contract directly with the National Health Service in accordance with the GOS regulations [see NHS Regulations in website appendix]

    5.3.2. Dispensing opticians are reminded that they have a responsibility to apply the infection control procedures outlined in this guidance and to dispose of waste safely so are advised to read the following –

    Section 4 – Infection Control
    Appendix F[4] Advice on the disposal of waste

    5.3.3 Practice owners and managers are advised to refer to the Optical Confederation advice regarding bribery, available in ABDO’s Information and Regulatory section here

    Archived version(s) of this item - Click date to read:

    Archived version: 25/02/2011

    5.3.1 Practice owners and/or managers should be aware of policies and requirements to contract directly with the National Health Service in accordance with the GOS regulations [see NHS Regulations in website appendix]

    5.3.2. Dispensing opticians are reminded that they have a responsibility to apply the infection control procedures outlined in this guidance and to dispose of waste safely so are advised to read the following –

    Section 4 – Infection Control
    Appendix F[4] Advice on the disposal of waste

    Archived version: 25/02/2011

    5.3. Practice owners and/or managers should be aware of policies and requirements to contract directly with the National Health Service in accordance with the GOS regulations [see NHS Regulations in website appendix]

  • Occupational visual standards – see Appendix F1Open

    5.4 Some occupations have visual standard and optical appliance requirements. Information on occupational visual standards is available in Appendix F[1]

  • Patient’s Records (also see Section 2)Open

    5.5.1 It is essential in the interests of both the registered dispensing optician and the patient that full and accurate records, either hard copy or electronic, are kept and stored in a systematic and efficient manner. The retention period for records must be greater than the statutory limitation period. These periods will cover:

    1. the statutory limitation period which allows claims to be brought within: a) 6 years for contractual matters; b) 3 years for personal injury. The three year period runs from the time that someone becomes aware that they have grounds for a claim (therefore reliance cannot be made on claims being brought within 3 years of the patient being seen).
    2. The NHS requires NHS patients’ records to be retained for seven years.

    5.5.2 Minors, that is children under 18 years old, are entitled to bring claims in respect of personal injury upon reaching their majority, i.e. on becoming 18 years old, and for three years thereafter. Therefore their records should be kept until they are 21 years old, and it is recommended that they are kept until they are 25 years old.

    Note: In view of the fact that hospital records should be kept for 10 years, it is suggested that it is wise to use a blanket 10 year rule for the retention of all adult patient records. This does not conflict with the fifth data protection principle because the purpose of retaining patient data includes complying with the dispensing optician’s ongoing legal and professional obligations. Before destroying any patient record dispensing opticians should satisfy themselves that they will have no further need for that record. Disposal should be done securely.

    5.5.3 The dispensing records remain the property of the practice, however the Data Protection Act 1998 confers upon living patients and, in certain circumstances, other interested persons, the right of access to records held by, amongst other medical and paramedical practitioners, registered dispensing opticians. For deceased patients similar provisions are made in the Access to Health Records 1990. Patients also have a right to an explanation of the records and a right to copies. A charge of up to £50 can be made for supplying copies (if the dispensing optician thinks it appropriate). Where records are considered to be inaccurate, the patient has a right to have those records corrected. Accordingly it is necessary that a registered dispensing optician’s records are complete, intelligible, reliable and maintained in a way which would not produce difficulties or embarrassment if examined by persons unconnected with the holder’s profession or practice. The Act allows 40 days for response to an application for access to records. However, under the Access to Health Records Act, the practitioner may withhold the record if, in his or her judgement, it would be harmful to the patient to release it, although such a decision must be justified in the event of a dispute.

    5.5.4 If a registered dispensing optician is uncertain about the appropriate response, it is important that, without undue delay, legal advice or advice from ABDO is sought.

    5.5.5 ABDO takes the view that it is the duty of all registered dispensing opticians to ensure that information of a personal nature entrusted to their care be treated as confidential and divulged only with the patient’s consent or when disclosure is required by law. Recorded information should include:

    1. Full name, address and daytime telephone number.
    2. Date of birth.
    3. Occupation (necessary knowledge for giving advice and guidance in dispensing spectacles).
    4. Recreation (for the same reasons as occupation).
    5. General practitioner’s name and address.
    6. The prescription.
    7. Measurements, tints, coatings etc, facial measurements and centration distances.
    8. Details of any other services provided – i.e. low vision aids.
    9. Charges and fees.

    Note: If the General Optical Council (GOC) requests information from the dispensing optician, the dispensing optician should, subject to any statutory restrictions, promptly give the GOC the information that is requested. If such information is not supplied within fourteen days the GOC may seek a court order requiring that the information be produced (unless this is prohibited by any other enactment e.g. the Data Protection Act.)

  • Electronic RecordsOpen

    5.6.1 Many practices are now equipped with electronic record systems. In such cases it is necessary to register as data users under the terms of the Data Protection Act 1998. Details and application forms are available from the Data Protection Register, Information Commissioners Office, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF, Tel. 01625 545745. It is important that compliance with the Data Protection Act’s requirements concerning patient information, including publication of information to third parties, for example other opticians, and medical practitioners, is observed. In particular, patient permission should be obtained to record data and screen privacy should be maintained to ensure such data remains confidential.

    5.6.2 In a practice using an electronic records system, all members of the team, including locums, should be able to use and access the IT system effectively.

    5.6.3 Every patient record should have an audit trail to identify:

    • time/date of each entry
    • author of each entry, and
    • additions, changes or deletions

    5.6.4 If you or your practice change the IT system, audit trails may be lost, therefore you should create and maintain a verified backup of the clinical data from the old system, and maintain a means to read this backup.

    Archived version(s) of this item - Click date to read:

    5.6 Many practices are now equipped with electronic record systems. In such cases it is necessary to register as data users under the terms of the Data Protection Act 1998. Details and application forms are available from the Data Protection Register, Information Commissioners Office, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF, Tel. 01625 545745. It is important that compliance with the Data Protection Act’s requirements concerning patient information, including publication of information to third parties, for example other opticians, and medical practitioners, is observed. In particular, patient permission should be obtained to record data and screen privacy should be maintained to ensure such data remains confidential.

  • Ownership of RecordsOpen

    5.7.1 The owner of the practice where a sight test takes place owns all records, including the clinical records. However to avoid any dispute over ownership it is advisable to include a clause clarifying ownership in any contract of employment, including any agreement with a temporary employee or a locum.

    5.7.2 The confidentiality of records means that they should, in no circumstances, be passed on in a change of ownership of the practice to other than a registered optician, registered medical practitioner or enrolled body corporate and the patient must be notified. Should patients themselves choose another registered practice it is appropriate to provide a copy of the dispensing records on request as being in the best interests of all concerned, it is advisable to obtain signed authorisation from the patient before passing on the copy of the dispensing record.

    5.7.3 Registered dispensing opticians who end employment in a practice in order to set up their own practice or work for a new employer must not use the records or their knowledge of the records of their previous practice for the purpose of canvassing for potential patients for their new practice.

  • Disposal of a PracticeOpen

    Updated: 22/03/2010

    5.8 When a practice is sold or otherwise disposed of, or when a particular practice association ends, registered dispensing opticians have a duty to ensure the continuing welfare of patients. In the case of closure, arrangements should be made for the transfer of patients’ records to another practice. When the practice is transferred, the public, and in particular existing patients, should be informed and the new owners identified. If it is not possible for the records to be transferred to another practice, rather than their being destroyed, records should be offered to the Primary Care Organisation (PCO) or a person nominated by the PCO.

    Archived version(s) of this item - Click date to read:

    Archived version: 22/03/2010

    5.8 When a practice is sold or otherwise disposed of, or when a particular practice association ends, registered dispensing opticians have a duty to ensure the continuing welfare of patients. In the case of closure, arrangements should be made for the transfer of patients’ records to another practice. When the practice is transferred, the public, and in particular existing patients, should be informed and the new owners identified.

  • Existing EmployeesOpen

    5.9 Employers may only carry out CRB checks if employees sanction such checks or it is a condition of their employment. If a CRB disclosure is sought where there is no entitlement to do so e.g. on existing staff, this may be an offence under The Police Act 1977. This could result in imprisonment for up to 6 months or a fine (currently between £2,500 and £5,000).

  • Recruitment of New StaffOpen

    5.10 Employers are entitled to have details of potential employees’ spent convictions and ask for candidates to produce a basic disclosure from the CRB to assess the candidates’ suitability for the role. There is no legal obligation for employers to ask this question, but if asked the candidate is required to reveal any spent convictions. If at a later date it is found that the employee gave false information then the employer may be able to dismiss them. It is recommended that employers advise the candidates of this in the contract of employment.

  • Work experience studentsOpen

    5.11 When employing those under 18 such as students on work experience, employers should be mindful of such issues as –

    • health and safety
    • confidentiality of data
    • insurance
  • Criminal Records’ DisclosureOpen

    5.12.1 With the implementation of new legislation in Part V of the Police Act 1997, many organisations will now be able to access criminal record information, as part of their recruitment process, through a new service called Disclosure.

    5.12.2 The CRB Disclosure service is used to help assess the suitability of applicants for positions of trust and has been set up to facilitate safer recruitment of staff by making more information available from police and other records. The CRB provides a service to check on criminal records of candidates for jobs. The object of this checking procedure is to vet potential candidates and thereby reduce the risk of harm to children and vulnerable adults.

    5.12.3 Standard Disclosure is the level recommended by the CRB for persons working with children, or who have regular contact with vulnerable adults on a one to one basis. These include optometrists and dispensing opticians. This disclosure will include:

    • spent and unspent convictions, cautions, reprimands and warnings held on the Police National Computer
    • information from the Department of Health and Department of Education and Skills lists for childcare positions.
  • Criminal OffencesOpen

    5.13.1 Under Section 28 of the Opticians Act it is a criminal offence for a person who is not appropriately registered to use any of the titles dispensing optician, registered optician, enrolled optician or optician. However in the case of the use of ‘optician’ without a qualifying adjective the user will have a defence against a charge if it can be proved that in the circumstances of the title’s use it would be unreasonable for people to believe that the user was registered.

    5.13.2 Under section 24 of the Opticians Act 1989 it is a criminal offence for a registered dispensing optician to test the sight of another person with intent to prescribe an optical appliance. However, when contact lenses are fitted by registered dispensing opticians in accordance with the advice in Section 3 of these guidelines, when a refraction by a registered dispensing optician forms part of an LVA examination, or when certain types of low vision aids are supplied, the use of techniques to check their performance does not constitute the testing of sight within the meaning of the Opticians Act.

    5.13.3 By Section 25 of the 1989 Act it is a criminal act for any person (other than in the excepted cases) who is not a registered medical practitioner or an optometrist or a registered dispensing optician with the appropriate qualifications, to fit contact lenses. The excepted cases are medical students and, by the Rules on the Fitting of Contact Lenses 1985, students training as opticians (optometrists or dispensing opticians); those engaged on approved basic training and pre-registration students. Such optical trainees, however, may fit contact lenses only when the fitting is done in the course of obtaining practical experience under supervision of a registered medical practitioner, optometrist or contact lens optician. It should be noted that contact lens fitting under the above circumstances may not continue if four unsuccessful attempts of any of the contact lens theory or practical examinations have occurred.

    5.13.4 By Section 27 of the Act it is a criminal offence for optical appliances designed to correct a defect of sight to be sold (with some exceptions which include sales for the wholesale trade, for export and antiques) unless the sale is:

    1. Effected by or under the supervision of a registered medical practitioner, optometrist or registered dispensing optician.
    2. An excluded sale, that is a sale for a person not under the age of 16, of spectacles which have two single vision lenses of the same positive spherical power not exceeding four dioptres, where the sale is wholly for the purpose of correcting, remedying or relieving the condition known as presbyopia.
    3. Exempt by reason of the Sale of Optical Appliances Order 1984, that is, where the appliance is not a contact lens or low vision aid, where the sale is not for a person under 16, or who is registered severely sight impaired [blind] or sight impaired [partially sighted], and where the purchaser produces a prescription not more than two years old signed by a registered medical practitioner or registered optometrist.

    5.13.5 These sections, for the most part, do not penalise registered opticians. It is important to note, however, that if a dispensing optician’s registration is revoked or suspended (for example, because of non-payment of GOC fees or the effect of a fitness to practise order) he/she will be liable to prosecution if he/she continues to practise as though registered during the period of revocation or suspension.

    5.13.6 It is also a serious criminal offence to defraud the National Health Service (NHS) of money through submitting false claims. Registered dispensing opticians, as trustees of NHS money, have a professional duty to handle payments appropriately, effectively and honestly. Abuse of NHS procedures is considered a serious breach of trust and may incur prosecution and GOC investigation, with possible consequential penalties imposed by ABDO.

    5.13.7 It should also be noted that it is a serious and criminal offence to steal from an employer.

  • Counter Fraud CharterOpen

    5.14 ABDO and the Department of Health have agreed a Counter Fraud Charter to which they are both signatories. The Charter spells out the need to fight fraud and commits both the Government and the Association to do all in their power to educate, encourage and inform both professionals and patients about this vital issue. As well as reducing fraud and corruption to an absolute minimum the aims of the Charter are to free-up resources for the best possible patient care and to maximise the confidence that the public has in the NHS professions.

SECTION 6: ENHANCED SERVICES

Open
  • IntroductionOpen

    6.1 Members must recognise their limitations by seeking further advice and guidance, or refer elsewhere when appropriate. In particular, those wishing to practise in specialised areas must be sure of their ability to do so, by obtaining specialist qualifications as available.

  • PUNCTAL PLUGGINGOpen

    6.1.1 ABDO’s professional indemnity insurance (PII) covers the procedure of fitting punctum plugs when carried out by contact lens optician members.

    6.1.2 Any member performing the procedure must be on the GOC Contact Lens Specialty register.

    6.1.3 Members must be adequately trained and competent in the procedure before performing it on a patient, and this training should contain a practical element.

    6.1.4 Prior to commencement of the procedure, a consent form must be signed by the patient, following a full discussion of risks and benefits, and explanation of the procedure.

    6.1.5 You should arrange to follow up the patient. Give the patient written advice about when to schedule a follow up visit and about what to do if they have new symptoms or an adverse reaction. In any event, if side effects occur, the patient must be referred appropriately.

    6.1.6 You should ensure that you use appropriate aseptic and sterilisation techniques to ensure infection control.

  • Coloured overlays and tinted lenses for patients with specific learning difficultiesOpen

    6.2  Before supplying tinted lenses or coloured overlays to improve reading performance, members are advised to refer to the most recent research, and not to make claims for such products which are not evidence-based.

  • Diabetic retinopathy screeningOpen

    6.3 Members who are practising as diabetic retinopathy screeners will have taken a separate qualification in this area. They will usually be operating under an NHS contract, which should include indemnity insurance for this activity. They are advised to check this with their employer/contractor. ABDO professional indemnity insurance does not cover diabetic retinopathy screening or the instillation of pupil dilating drops.

APPENDIX A

Open
  • [1] GOC GOC Standards of PracticeOpen

    GOC STANDARDS OF PRACTICE  FOR INDIVIDUAL REGISTRANTS and GOC STANDARDS OF PRACTICE FOR BUSINESS REGISTRANTS

    Select this link to view the current GOC Standards of Practice .

  • [2] GOC Fitness to Practise procedureOpen

    GOC FITNESS TO PRACTISE PROCEDURE FLOWCHART

    Allegation received by the GOC (and consideration given to whether to apply to the Fitness to Practise Committee for an interim order to restrict an individual from practising or training)

    Evidence gathered by the GOC about the allegation and papers disclosed to the registrant inviting representations on the allegation

    GOC’s solicitors consider representations and decide whether further evidence should be gathered from the person making the allegation.

    Further evidence gathered (if necessary) and forwarded to Investigation Committee

    Further investigations conducted (if necessary) and allegation reconsidered

    Investigation Committee meets to consider the evidence gathered about the allegation and decide whether to:

      • take no further action
      • direct further investigation (including an assessment of an individual’s health direct that the allegation ought to be referred to the Fitness to Practise Committee

    Further investigations conducted [if necessary] and formal allegation drafted

    If the matter is referred to the Fitness to Practise Committee, the Fitness to Practise Committee meets to consider the allegation. There are usually at least two hearings: a procedural hearing where directions for the future conduct of the case are made, and a substantive hearing when the evidence is heard and the final decisions about the case are taken

  • [3] GOC statement on testing of sight (May 2013)Open

    Added: 03/06/2013

    In response to a number of enquiries from registrants about refraction following recent press articles, we wish to remind registrants of the restrictions surrounding the testing of sight.

    Refraction for the purpose of issuing a prescription is an essential part of the sight test1. As such, refraction for the purpose of sight testing is restricted2 and can only be conducted by a registered optometrist, a registered medical practitioner or a student optometrist under supervision. No part of the sight test can be delegated to a dispensing optician or contact lens optician, even under supervision.

    Refraction for purposes not associated with the testing of sight, for example to verify a prescription issued by an optometrist or registered medical practitioner, is not restricted. This can therefore be undertaken by dispensing opticians and contact lens opticians.

    Footnotes:
    1. under Section 26 of the Opticians Act 1989 (as amended by the Opticians Act 1989 Amendment Order 2005) and the Sight Testing (Examination and Prescription) (No. 2) Regulations 1989.
    2. by Section 24 of the Opticians Act and Rule 3 of the Testing of Sight by Persons Training as Optometrists Rules 1993

APPENDIX B

Open
  • [1] Contact Lens RecordsOpen

    The following details the areas which should be addressed when making records of patients’ appointments-

    A. FOR INITIAL APPOINTMENT OF A NEW PATIENT:

    (1) General Information

    Date fitting commenced
    Name
    Address
    Telephone numbers
    Date of birth
    Referring optometrist/OMP
    Spectacle prescription and VAs
    Any initial contraindications to CL fitting
    Patient’s reason for wanting contact lenses
    Occupation and working environment
    Sports, hobbies and pastimes
    Allergies/Hay Fever (Seasonal allergic conjunctivitis)
    Personal and family ocular history
    Personal and family general health and specific pathologies
    Medications
    Smoker
    Driving
    General practitioner
    Contact lens history

    (2) Detailed examination of the anterior eye

    Should include space for assessments of:

    Each layer of the cornea
    Limbus
    Conjunctiva
    Lids, lid margins, and lid position (upper and lower)
    Lid tensions
    Tear assessments – quality and quantity
    Other relevant data (e.g. horizontal visible iris diameter, pupil diameter [varied illumination], vertical palpebral aperture)
    A grading scale and diagrammatic recording should be used.

    (3) Keratometric information

    Type of instrument, values measured and mire quality; dioptric values, radii and axes/meridians. Topographical information if available.

    (4) Lens options discussed with the patient

    Should be recorded.

    (5) Contraindications found in the examination (6) Trial lenses used

    With full details of fit assessment, over refraction and visual acuities.

    (7) Details of lenses to be ordered (8) Next scheduled appointment.

    B. FOR COLLECTION APPOINTMENT:

    (1) Instruction given to the patient

    Lens handling and ability to insert, removal, recentration; case hygiene, personal hygiene, care system and wearing schedule.

    An assessment of the patient’s ability to handle their lenses should be recorded.

    (2) The recommended care system

    (3) Assessment of lens fit and visual acuities

    (4) Recommended next aftercare appointment and attendance record

    (5) Patient acknowledgement form (DoHCL1 – now discontinued)

    Should be completed and attached to the record.

    C. FOR SUBSEQUENT APPOINTMENTS:

    (1) General information

    History and symptoms since last visit
    Wearing pattern
    Patient’s impressions of vision and comfort
    Care system, compliance and handling

    (2) Over refraction

    Visual acuities with lenses
    Objective assessment where appropriate (retinoscopy/autorefractor)
    Subjective assessment and acuities
    Confirmation tests (duochrome, + 1.00 blur, pinhole) where appropriate

    (3) Examination of lenses on the eyes

    Assessment of lens condition

    (4) Other examinations the practitioner considers appropriate

    e.g. Pre-lens tear break-up time, keratometry.

    (5) Detailed examination of the anterior eye

    Should include space for assessments of:

    Each layer of the cornea
    Limbus
    Conjunctiva
    Lids and lid margins
    Tears
    Where possible a grading scale and diagrammatic recording should be used.

    (6) Conclusions/Advice/Actions

    Space should be available for practitioners to record, for instance, changes in wearing pattern, refit, replacement, discontinue lens wear (temporary or permanent), change in care system, adjustments to power or fit, etc. This should include the rational for changes including patient requests to meet any specific challenges, circumstances and requirements. Also included under this heading would be advice on time of next contact lens aftercare check and/or full eye examination.

    (7) Contact Lens Specification

    The issue of the contact lens specification and its expiry date should be noted – and it is advisable that a copy be made of the document issued and kept in the patient’s records.

    See Appendix B [2] Contact Lens Specification for further information.

  • [2] Contact Lens SpecificationOpen

    Updated: 12/02/2015

    Contact Lens Specification

    The issue of the contact lens specification and its expiry date should be noted – and it is advisable that a copy be made of the document issued and kept in the patient’s records.

    In Section 5 – Practice Management [paragraphs 5.5 – 5.8] dispensing opticians are advised as to the keeping and storing of patients’ records, the effect of the Access to Health Records Act 1990 and the duty to preserve the records’ confidentiality. In relation to contact lens work this advice is particularly important.

    Where aftercare is concerned, when a patient is told of the arrangements for aftercare, or afterwards, if it appears that the patient will not return for further consultation or treatment despite several reminders; or, if faced with a downright refusal, the contact lens optician should record the facts in his records. No further lenses should be supplied without the patient attending for aftercare.

    For a sample Contact Lens Specification form which can be personalised with your practice details, select this link Appendix B [2] Contact Lens Specification sample form for personalisation (2)

    Archived version(s) of this item - Click date to read:

    Contact Lens Specification

    The issue of the contact lens specification and its expiry date should be noted – and it is advisable that a copy be made of the document issued and kept in the patient’s records.

    In Section 5 – Practice Management [paragraphs 5.5 – 5.8] dispensing opticians are advised as to the keeping and storing of patients’ records, the effect of the Access to Health Records Act 1990 and the duty to preserve the records’ confidentiality. In relation to contact lens work this advice is particularly important.

    Where aftercare is concerned, when a patient is told of the arrangements for aftercare, or afterwards, if it appears that the patient will not return for further consultation or treatment despite several reminders; or, if faced with a downright refusal, the contact lens optician should record the facts in his records. No further lenses should be supplied without the patient attending for aftercare.

    For a sample Contact Lens Specification form which can be personalised with your practice details, select this link Sample Contact Lens Specification form

APPENDIX C

Open
  • Suggested Low Vision Basic StockOpen

     

    Hand Magnifiers Stand Magnifiers Spectacle Magnifiers
    2x, 3x, 4x, 5x, 6x 2x, 3x, 4x, 6x,8x, 12x 6x, 8x, 12x, 15x,20x
    Illuminated Stand Magnifiers Torch Type Magnifiers Prism Half-Eye Spectacles
    2.5x, 3x, 4x, 5x, 6x, 7x,10x, 12.5x(batteries/mains) 3x, 5x, 7x,9x, 11x,(plus batteries) +6.00DS, + 8.00DS,+12.00DS(mixed eye and bridge sizes)
    Clip-On Binocular Loupes Clip-On Monocular Loupes Knitting/Chest Magnifiers
    2x, 2.5x, 3x 4x, 7x 2x/4x
    Distance Telescopes Near Vision Telescopes DV/Near Focus Telescope
    2x (binoc) 4x, 8x Spectacle binoculars 2x, 3x, 4x,5x, 6x, 8x3x & 4xheadband type Rapid focus 1.9x 8 to50cm
    Pocket Magnifiers Flat Field Magnifiers Tinted Overspecs
    3.5x & 6x Dome Magnifier Hedgehog magnifier Amber 49% LTFBrown 16% LTFBrown 2% LTFGrey 40% LTF
    Non-Optical Aids Bar Magnifiers
    Occluders
    Reading lamp
    Reading stand
    Clamp
    Typoscope
    Large print/book/ newspaper
    2 sizes

APPENDIX D

Open
  • Advice to ABDO Members concerning Refractive SurgeryOpen

    Advice to Patients

    AD1 Dispensing opticians are well-placed to educate patients by providing general information about a variety of surgical procedures, including refractive surgery.

    This is likely to be verbal but can also be supplemented by offering leaflets, web-site addresses, CD-ROMs and/or videos that provide additional information and further assists the patient in their decision making process.

    AD2 ABDO recommends that you inform patients, who express an interest in refractive surgery procedures, about the different treatments that are available. The relative pros and cons of each as well as the comparison with alternative forms of correction (such as contact lenses) should be discussed. It is important that this information is factual and objective; if you are not up-to-date with the latest established techniques, then it is prudent to refer the patient to another party who is up to date, or alternatively, to another educational resource, such as internet websites.

    AD3 A qualified and unbiased recommendation of refractive surgery is appropriate where, with the information available, the patient fits the general suitability criteria for surgery. It MUST be made clear that you are giving general advice and that ultimately only an ophthalmologist specialising in refractive surgery can determine individual patient suitability. The final decision will be made jointly between the surgeon and the patient and will be accompanied by the signing of an informed consent form.

    AD4 In an increasingly litigious society dispensing opticians are advised to only provide objective information in accordance with their knowledge of the subject. As stated in ABDO’s general Advice and Guidelines a registered dispensing optician should be satisfied that he or she possesses the necessary knowledge, either by existing training and examination or by additional knowledge and skill. Documentation is, as always, the only suitable defence in the unlikely event a patient decides to seek redress for their outcome, following the issuing of advice. You must therefore be clear in the advice you give to patients and keep clear, detailed records of that advice on the patient’s record card. This applies equally to those in general practice as it does for those working for a refractive surgery clinic.

    AD5 It is ideal, but not essential to provide details of more than one clinic to a patient. You may have a relationship with a particular refractive surgery clinic (or clinics), whereby to the best of your knowledge and your considered clinical judgement they offer a good service that you are happy to recommend to your patients. However referral to another clinician or organisation for clinical care must not involve a fee or its equivalent. You or a colleague may be providing a local co -management programme for your patients on behalf of your preferred clinic, either pre-operatively, post-operatively, or both. Any financial recompense for professional time and/or consultation MUST also be divulged to the patient in order that this remuneration is transparent to all and seen as appropriate.

APPENDIX E

Open
  • [1] Disability Discrimination Act 1995Open

    AE1.1 ‘An act to make it unlawful to discriminate against disabled persons in connection with employment, the provision of goods, facilities and services or the disposal or management of premises; to make provision about the employment of disabled persons; and to establish a National Disability Council.’ [8th Nov 1995] This advice is a reminder and update of advice produced in consultation with the AOP, the ABDO, the College of Optometrists, FODO and the Disability Rights Commission.

    Who Has Rights Under The Act?

    AE1.2 Disabled People – A person is disabled if he/she has a physical or mental impairment, which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities. The effect must be substantial (that is, more than minor or trivial), and adverse, and long term (that is, likely or is likely to last for at least a year or for the rest of the life of the person affected):

    • People who have had a disability within the definition are protected from discrimination even if they have since recovered
    • Physical or mental impairment includes sensory impairment. Hidden impairments are also covered ( for example, mental illness or mental health problems, learning disabilities, dyslexia, diabetes and epilepsy)

    Duty as an Employer

    AE1.3.1 This duty applies to all employers regardless of how many staff you have.

    You must not discriminate against a disabled person in relation to the recruitment or retention of staff. There are four forms of discrimination which are unlawful:

    • Direct discrimination
    • Failure to comply with a duty to make reasonable adjustments
    • Disability-related discrimination
    • Victimisation of a person ( whether or not he is disabled)

    AE1.3.2 The duty to make reasonable adjustments applies for example, to selection and interview procedures and the premises used for such procedures, as well as to job offers, contractual arrangements and working conditions. Reasonable adjustments may include:

      • Making adjustments to premises
      • Allocating some of the disabled person’s duties to another person
      • Transferring the person to fill an existing vacancy
      • Altering the person’s hours of working or training
      • Assigning the person to a different place of work or training
      • Allowing the person to be absent during working hours for
        rehabilitation, assessment or treatment
      • Giving, or arranging for, training or mentoring ( whether for the disabled person or any other person)
      • Acquiring or modifying equipment
      • Modifying instructions or reference manuals
      • Modifying procedures for testing or assessment
      • Providing a reader or interpreter
      • Providing supervision or other support

    This is not an exhaustive list and it might be reasonable for you to take other steps. The employer owes the duty to the individual employee and does not have to anticipate the disabled person’s requirements. However, although there is no duty under Part 2 of the Act to anticipate the needs of disabled people in general, you should keep all your policies under review and consider the needs of disabled people in the process. It would also be sensible and cost-effective to consider access issues during any major alterations to the work place environment.

    AE1.3.3 Access to Work – In the event that your employment duties are triggered when an employee becomes disabled, you employ a disabled person or when a disabled person applies for a job you may get help from ‘Access to Work’ (AtW). AtW provides advice and practical support to disabled people and their employers to help overcome work related obstacles resulting from disability. In addition AtW pays a grant, through Jobcentre Plus, towards any extra employment costs that result from disability.

    AE1.3.4 The Disability Symbol – The Disability Symbol is a recognition given by Jobcentre Plus to employers who have agreed to meet five commitments regarding employment, retention, training and career development of disabled employees:

    • To interview all disabled applicants who meet the minimum criteria for a job vacancy and consider them on their abilities
    • To ensure there is a mechanism in place to discuss, at any time, but at least once a year, with disabled employees what can be done to make sure they can develop and use their abilities
    • To make every effort when employees become disabled to make sure that they stay in employment
    • To take action to ensure that all employees develop the appropriate level of disability awareness needed to make these commitments work
    • Each year, to review these commitments and what had been achieved, plan way to improve on them and let employees and Jobcentre Plus know about progress and future plans

    AE1.3.5 Policies, Procedures and Practices – As an employer you may be liable for any discrimination which happens in the work place whether or not you are aware of it! You should therefore have anti-discriminatory policies and practices and make all staff aware of them. If such policies and training can be demonstrated an employer may be able to defend themselves in a legal action. A primary area of attention is training for all staff on your policy towards disabled people and their legal rights, disability awareness and disability etiquette.

    Your responsibilities as an employer under the DDA

    Scope

    • All employers covered by DDA except Armed Forces
    • Practical work experience, whether paid or unpaid, is covered
    • Provisions on discriminatory advertisements
    • Employment services are covered

    Types Of Discrimination Four kinds of discrimination

    • Direct discrimination
    • Failure to make reasonable adjustments
    • ‘Disability-related discrimination’
    • Victimisation

    When Is Justification Relevant?

    Justification is NOT relevant in cases about:

    • Direct discrimination
    • Failure to make reasonable adjustments

    Justification is relevant in cases about

    • Disability-related discrimination

    Harassment

    • Provisions on harassment

    The Legal Requirements as a Service Provider

    AE14.1 Unlike the duties as an employer the duties as a service provider are anticipatory and the duty is owed to all disabled people. It requires the service provider to plan ahead.

    You must not discriminate against a disabled person because of their disability. This could include:

    • Refusing to serve a disabled patient
    • Offering a disabled patient a lower standard of service
    • Offering a disabled patient a service on worse terms
    • Failing to make reasonable adjustments to the way services are provided to disabled patients
    • Failing to make reasonable adjustments to the physical features of service premises, to overcome physical barriers to access.

    A service provider will have to take reasonable steps to

    • Remove the feature; or
    • Alter it so that it no longer has the effect; or
    • Provide a reasonable alternative means of avoiding it; or
    • Provide a reasonable alternative method of making the service available

    The legislation does not deal with the above concepts hierarchically: the question is what is reasonable. In broad terms, reasonableness will depend on the type of service being provided; the nature of the service provider and its size and resources; and the effect of the disability on the individual disabled person. The Disability Rights Commission’s statutory Code of Practice (Rights of Access: Goods, Facilities, Services and Premises) covers the legal position and may assist service providers’ legal advisors to give best advice. However, the fact remains that the DDA is an evolving piece of legislation and the concept of what is reasonable will develop and change as legal precedents are set.

    AE1.4.2 You must make reasonable adjustments for disabled people.

    • Undertake a disability access audit in each of your practices covering not only physical access but other issues such as lighting, colour schemes, signage etc.
    • Review all your policies, procedures and practices and make reasonable changes to anything which might make it more difficult for a disabled person to use your services
    • Take reasonable steps to introduce equipment or other methods which make it easier for your disabled patients to access your services. Examples would be to provide a range of information in larger print for the visually impaired or the provision of a text telephone for deaf patients or an induction loop for patients who use a hearing aid
    • Assess the physical features of your premises and make reasonable adjustments to overcome physical barriers to access
    • Consider alternative methods of providing a service. For example home-visits for wheelchair-users

    Good Practice – Training

    AE1.5.1 All your staff must be aware of the law. They need to know that services for disabled patients are more than just a part of good customer care. All staff should have disability awareness training covering the etiquette of serving patients with the full range of disabilities.

    AE1.5.2 Training should be carried out by suitably qualified trainers. The Disability Rights Commission website has a list of licensed trainers who have been licensed to use the DRC Best Practice Trainers Resource Pack to train others in DDA implementation. There are also numerous organisations and companies who can provide training for your staff either on-site or by distance learning. The DRC has a list of organisations and companies which provide training; however, it is not exhaustive and does not imply endorsement. When commissioning training identify what you need for your staff, and explore with potential trainers what they are willing and able, to undertake.

    AE1.6 How Friendly, Or Otherwise, Is Your Practice to Disabled Patients?

    • Do all your plans include disability issues?
    • Do you know who your disabled patients are and their requirements?
    • Are your premises user-friendly? Can your disabled patients get in and out easily?
    • Are there any physical barriers to access on your premises?
    • Is your complaints procedure accessible? For example, could a deaf person complain easily?
    • Is your information clear and accessible? For example, could a visually impaired person access practice information in larger print or Braille?

    Enforcement and Remedies

    AE1.7 To minimise the possibility of a County Court action or employment tribunal emphasis should be put on internal grievance procedures to handle any claims of disability discrimination. If a claim is upheld the court can make a declaration, award compensation for financial loss, injury to feelings and issue an injunction to prevent future discriminatory acts. In a case in 2003 Purves v Joydisc where an appeal against the level of damages was heard, the Court of Session found that £750 is the least that can be awarded ‘for the very slightest injury to feelings’. If a claim is upheld at employment tribunal compensation can be claimed for loss of earnings, personal injuries, injury to feelings and aggravated damages.

    AE1.8 Conclusions

    • Good access, both physical and environmental, is good business!
    • Complying with the law and striving for good practice in patient care can only reflect well on your practice and the profession generally
    • Don’t assume that the DDA doesn’t or won’t apply to you
    • Be fair. You should treat disabled customers exactly like any other customers and be prepared to make reasonable adjustments
    • Consider whether you need to change the way you treat your customers or employees in the light of the DDA and act on it
  • [2] Mental Capacity Act 2005Open

    Providing spectacles and contact lenses to the adult patient with learning disabilities

    AE2.1 No-one can give or withhold consent to the provision of optical appliances on behalf of an adult patient without an appropriate court order. The practitioner must first assess the patient’s capacity to make an informed decision about the appliance. The practitioner must then assess whether the patient is able to make a decision about whether to have the appliance. If the patient lacks the capacity to decide, provided the patient complies with the process the practitioner may provide the appliance which s/he judges to be in the patient’s best interests. To have protection from liability regarding the provision, the practitioner must have a reasonable belief that the patient lacks capacity to make relevant decisions. It would be appropriate for the practitioner to make a note in the patient record of the reason.

    AE2.2 Where the practitioner considers a patient to be capable of giving consent to the provision of an optical appliance, s/he should carefully explain the implications. If the patient then withholds consent, s/he must not be provided with the spectacles or contact lenses.

    AE2.3. If spectacles are to be provided particular care should be paid to the dispensing. The patient may not be able to indicate when a spectacle frame is uncomfortable and irritating. Careful fitting and advice on care of spectacles is essential if they are to be of benefit to the patient..

    AE2.4. Patients should be treated with dignity and respect at all times.

  • [3] Model Chaperone Framework for Optometry and OpticiansOpen

    Explanatory notes

    AE3.1 This framework is adapted from the: “Guidance on the Role and Effective Use of Chaperones in Primary and Community Care Settings” Model Chaperone Framework, published by the NHS Clinical Governance Support Team in June 2004.

    Framework for optometrists and opticians

    AE3.2 The NHS framework relates closely to hospitals and NHS establishments where intimate examinations are being carried out. Sight Tests and other procedures carried out by optometrists and opticians are non-invasive and not intimate in nature.

    This framework has been written to address the particular circumstances relating to optometrists and opticians, and relates to chaperoning not the separate issues relating to child abuse.

    Guidance for optometrists and opticians

    AE3.3 Particular attention should be drawn to the following extract from Section 26.05 of the College of Optometrists Guidance:

    The practitioner should be aware of the need to protect him/herself against unfounded allegations of inappropriate conduct or assault that may result from the distress or discomfort of a patient at the close physical proximity and contact that is necessary in the conduct of a consultation. The unfamiliar environment of the consulting room may exacerbate feelings of distress or discomfort on the part of a child or vulnerable adult. The steps taken by an individual practitioner to overcome this will depend upon his/her own circumstances and must always take account of the need to preserve patient confidentiality. They may include:

    1. Ensuring the presence of a parent or other appropriate carer at all times, even outside the consulting room [note 26.03 When examining a child or vulnerable adult, a practitioner should normally allow any request for a parent or carer to accompany the patient in the consulting room. However, the practitioner should not allow such a request where it is contrary to the declared wishes of an adult patient or of a “Gillick competent” child.]

    2. An open-access policy – i.e. a policy which means that colleagues are able to simply knock and enter the consulting room at any time without having to wait to be invited in after knocking;

    3. Having windows in the consulting room, or keeping the door ajar to enable the parent or carer to hear the consultation if he is not in the consulting room;

    When a practice or corporate contractor publishes its policy, based on this guidance, the most up to date version of the relevant sections of the College of Optometrists guidance (Sections 1, 19, 24 and 26) and the relevant sections of the Association of British Dispensing Opticians guidance should be appended. These are available on: www.college-optometrists.org and www.abdo.org.uk

    The policy makes mention of a “Gillick-competent” child. The law regards young people aged 16 or 17 to be adults for the purposes of consent to treatment and right to confidentiality. Therefore if a 16 year old wishes a medical practitioner to keep the treatment confidential then that wish should be respected. For example, children under the age of 16 who have the capacity and understanding to take decisions about their own treatment are also entitled to decide whether personal information may be passed on and generally to have their confidence respected, for example if they were receiving counselling or treatment about something they did not wish their parent to know. Case law has established that such a child is known as ‘Gillick Competent’, i.e. where a child is under 16 but has sufficient understanding in relation to the proposed treatment to give, or withhold consent, consent or refusal should be respected. However, good practice dictates that the child should be encouraged to involve parents or other legal guardians in any treatment.

    Consent and request issues

    AE3.4 Consent for an NHS Sight Test is obtained by the patient signing the GOS 1 form. When a patient requests that the practitioner does not carry out any procedure, it may mean that a Sight Test cannot be completed. The requirements of the patient takes precedence, but if the practitioner judges that the Sight Test has not been completed, then the patient should be informed and the circumstances should be noted on the record card.

    Patient notification

    AE3.5 The Patient notification (which follows] is not designed as a notice to be displayed at the practice, but rather as a written guide which should be available to patients and their carers on request.

    For a sample CHAPERONE POLICY which can be personalised with your practice details, select this link Sample Chaperone Policy

  • [4] Guidance on sexual boundaries [CHRE]Open

    AE4.1 Practitioners are reminded that they are held in a position of trust by their patients and there may be a power imbalance between them and their patient even though this may not be explicit. On occasion practitioners may find themselves sexually attracted to their patients or their carers or vice versa. It is the practitioner’s responsibility not to act on these feelings and to recognise the harm that any such actions would cause.

    AE4.2 If a practitioner finds themselves attracted to a patient and is concerned that it may affect their professional relationship with them, they should ask for help and advice from a colleague or appropriate body in order to decide on the most professional course of action to take.

    AE4.3 If a patient displays sexualized behaviour towards a practitioner, the practitioner should seek advice from a colleague or their professional or representative body.

    AE4.4 If a practitioner becomes aware that another healthcare professional has breached sexual boundaries with a patient or carer, he or she has an ethical and professional duty to take action. Practitioners are strongly advised to contact their professional and/or representative body for advice in these circumstances.

    AE4.5 If a practitioner is asked for advice by a colleague who feels attracted to a patient or carer but has not acted inappropriately, they do not have a professional duty to inform anyone. However, if they feel that the colleague or patient may be at risk of harm, or they feel that they need helping advising their colleague, it is strongly recommended that they seek advice from their professional and/or representative body.

    For further information practitioners are referred to the paper ‘Clear sexual boundaries between healthcare professionals and patients: responsibilities of healthcare professionals’. This is available from the Council for Healthcare Regulatory Excellence www.chre.org.uk.

    AE4.6 Sexual relationships with any former patient, or the carer of a former patient, may be inappropriate however long ago the professional relationship ended. This is because the sexual relationship may be influenced by the previous professional relationship, which will often have involved an imbalance of power as described above.

    AE4.7 The possibility of a sexual relationship with a former patient may arise, for example through social contact. If a healthcare professional thinks that a relationship with a former patient might develop, he or she must seriously consider the possible future harm that could be caused and the potential impact on their own professional status. They must use their professional judgment and give careful consideration to the following:

    • When the professional relationship ended and how long it lasted;
    • The nature of the previous professional relationship and whether it involved a significant imbalance of power;
    • Whether the former patient was particularly vulnerable at the time of the professional relationship, and whether they might still be considered vulnerable;
    • Whether they would be exploiting any power imbalance, knowledge or influence obtained while they were the patient’s healthcare professional to develop or progress the relationship;
    • Whether they are, or in future are likely to be, treating other members of the former patient’s family.

    AE4.8 If a healthcare professional is not sure whether they are – or could be seen to be – abusing their professional position, they should seek advice from an appropriate professional body.

    AE4.9 However consensual a relationship appears to be, if a complaint is made the onus will always be on the healthcare professional to show that they have acted professionally by giving serious consideration to the points above in relation to the circumstances in question, and by seeking appropriate advice.

APPENDIX F

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  • [1] Occupational Visual StandardsOpen

    ABDO is indebted to the AOP for the following information.

    Full information on the following occupational visual standards is available from the AOP website www.assoc-optometrists.org. –

    Police
    Motor Vehicle Drivers
    Lift Truck
    Non –Destructive Testing
    Flying
    Motor Sport
    Teaching
    Electrical Engineering
    London Underground
    Railways
    Fire Officers
    Prisoners
    Prison Officers
    Offshore Oil and Gas Industry
    Lifeboat Crew members
    Seafarers and Coastguards
    Armed Forces

    Also information is available on visual standards for the following –

    VDU/DSE Guidance
    Blindness and Partial Sight
    Colour Vision
    Equivalent, Conversions, Near and Distance Vision

    Occupational optical appliances

    The visual standards sections in the AOP website also detail any specific requirements with respect to spectacles and contact lenses for the following occupations –

    Police
    Motor Vehicle Drivers
    Lift Truck
    Flying
    London Underground
    Railways
    Prisoners
    Prison Officers
    Offshore Oil and Gas Industry
    Lifeboat Crew members
    Seafarers and Coastguards
    Armed Forces

  • [2] British/CEN/ISO StandardsOpen

    Updated: 25/08/2011

    British, European and International Standards

    AF2.1 UK registered dispensing opticians may be placing themselves at risk in law if they do not supply lenses and frames that conform to the various Standards for appliances. (See Appendix F[2]). This applies to all finished spectacles. The Standards have been ‘registered’ with the Department of Trade and Industry under the Consumer Protection Act 1987. The Act makes provision with respect to the liability for damage caused by defective products. Consumer goods (and this includes optical appliances) will be deemed not to conform to general safety requirements unless they comply with British Standards in the case of spectacles.

    AF2.2 Existing ophthalmic standards are being further developed and British Standards have become based on European and International norms.

    For more information on British Standards contact the ABDO College Bookshop.

    Archived version(s) of this item - Click date to read:

    Archived version: 25/08/2011

    British , European and International Standards

    AF2.1 UK registered dispensing opticians may be placing themselves at risk in law if they do not supply lenses and frames that conform to the various Standards for appliances. (See Appendix F[2]). This applies to all finished spectacles. The Standards have been ‘registered’ with the Department of Trade and Industry under the Consumer Protection Act 1987. The Act makes provision with respect to the liability for damage caused by defective products. Consumer goods (and this includes optical appliances) will be deemed not to conform to general safety requirements unless they comply with British Standards in the case of spectacles.

    AF2.2 Existing ophthalmic standards are being further developed and British Standards have become based on European and International norms.

    The current standards are detailed on the British Standards website www.bsi-global.com: follow the links through – Standards / Standards & publications / Healthcare / Optics titles / Status / Current.

  • [3] Medical Devices DirectiveOpen

    The Medical Devices Directive (MDD) (93/42/EEC) covers a wide range of products. The Medical Devices Regulations (S1 1994 No. 3017), which implemented this Directive, came into force in the UK on 1 January 1995. From 14 June 1998 all devices placed on the market under the Regulations, with the exception of devices intended for clinical investigation and custom-made devices, must carry the CE mark. However, as regards ophthalmic devices, registration must occur in the following groups:

    1. lamps in ophthalmic examination
    2. fundus cameras, keratometers/slit lamp microscopes
    3. low vision aids
    4. ophthalmoscopes/retinoscopes
    5. spectacle lenses
    6. spectacle frames
    7. ready-made non-prescribed spectacles
    8. sight testing devices

    Further information is obtainable from The Medical Devices Agency, Department of Health, Hannibal House, Elephant & Castle, London SE1 6TQ Tel: 020 7972 8090/8300 (24 hours) Fax: 020 7972 8112. Website address: www.medical-devices.gov.uk

APPENDIX G

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APPENDIX H

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  • Form for the issuing of Pupillary DistanceOpen
    Updated: 27/05/2011
    Updated: 01/10/2012
    THE ISSUING OF INFORMATION REGARDING PUPILLARY DISTANCE
    Appendix H

    Name of patient…………………………………………………………………

    Address of patient……………………………………………………………….

    ……………………………………………………………………………………….

    Date of birth of patient………………………………………………………….
    (if under 16)

      • The following information has been taken from records held by this practice.
      • Measured at Patient’s request
      (delete as appropriate)

    Pupillary distance ………………………………………………………………

    measured by [print name]…………………………………………………… on

    [date]…………………

    The prescribing and dispensing of spectacles are very closely linked and it is in the best interests of the patient to have spectacles dispensed where the eyes were examined.

    It is always in the best interests of a patient to be accurately measured for pupillary distance when consideration of frame choice and lens design, usage and power can be taken into account at the same time.

    This practice can take no responsibility for any appliance that may be made by a third party using this information. You are strongly advised to ensure that relevant measurements are made at the same time you order new spectacles.

    Signed………………………………… Dated…………………………

    Name ………………………………… GOC No………………………

    Archived version(s) of this item - Click date to read:

    Archived version: 01/10/2012

     

    THE ISSUING OF INFORMATION REGARDING PUPILLARY DISTANCE
    Appendix H

    Name of patient…………………………………………………………………

    Address of patient……………………………………………………………….

    ……………………………………………………………………………………….

    Date of birth of patient………………………………………………………….
    (if under 16)

     

      • The following information has been taken from records held by this practice.
      • Measured at Patient’s request
      (delete as appropriate)

    Pupillary distance ………………………………………………………………

    measured by [print name]…………………………………………………… on

    [date]…………………

    The prescribing and dispensing of spectacles are very closely linked and it is in the best interests of the patient to have spectacles dispensed where the eyes were examined.

    It is always in the best interests of a patient to be accurately measured for pupillary distance when consideration of frame choice and lens design, usage and power can be taken into account at the same time.

    This practice can take no responsibility for any appliance that may be made by a third party using this information. You are strongly advised to ensure that relevant measurements are made at the same time you order new spectacles.

    Signed………………………………… Dated…………………………

    Name ………………………………… GOC No………………………

    Archived version: 27/05/2011

     

    THE ISSUING OF INFORMATION REGARDING PUPILLARY DISTANCE

    Appendix H

    Name of patient…………………………………………………………………

    Address of patient……………………………………………………………….

    ……………………………………………………………………………………….

    Date of birth of patient………………………………………………………….
    (if under 16)

    The following information has been taken from records held by this practice. Measured at Patient’s request
    (delete as appropriate)

    Pupillary distance ………………………………………………………….……

    measured by [print name]…………………….……………………………… on

    [date]…………………

    The prescribing and dispensing of spectacles are very closely linked and it is in the best interests of the patient to have spectacles dispensed where the eyes were examined.

    It is always in the best interests of a patient to be accurately measured for pupillary distance when consideration of frame choice and lens design, usage and power can be taken into account at the same time.

    This practice can take no responsibility for any appliance that may be made by a third party using this information and you are strongly advised to ensure that relevant measurements are made at the same time you order new spectacles.

    Signed………………………………….. Dated…………………………

    Name …………………………………… GOC No………………………

APPENDIX I

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APPENDIX J

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APPENDIX K

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The following documents can be downloaded :