A query arose the other day, which I hadn’t encountered before. A member asked if she might supply a frosted, plano lens to a severely sight impaired (SSI) patient without a prescription. There are lots of things going on in this query and perhaps they are most usefully addressed from the beginning.
The patient was 17 years old; she had been seen in the practice with other members of the family over many years. She had been referred to the Hosptial Eye Service 10 years previously with poor acuity of unknown origin. Over the years, other family members had been into the practice for their own spectacles and reported that the patient was being referred to a neurological consultant and that she had been registered as sight impaired. So, our member had some background on the patient when she arrived at the practice, with her mother, requesting a frosted lens. The situation was quite delicate. They had come straight from the London hospital where the patient was registered, and where she was having yearly assessments for an array of problems.
The problem that day was double vision. The neurologist had suggested a pair of spectacles; no power just a frosted lens over the right eye. The patient was very keen to have a trendy pair of specs although she was less clear when double vision actually occurred.
What to do? There was no prescription, no written instruction from the hospital just an excited young girl and a Mum desperate to help her daughter. What could our member do to help?
The law was not particularly helpful in this case: plano lenses are not covered by the Opticians Act although sight impaired and SSI patients may only be treated by a registered practitioner, so our member could legally proceed.
Professionally, it was slightly irregular with no prescription but our member had a long history of care for the patient and family. I felt the situation was much the same as supplying filter lenses to an SSI patient; not to improve sight but to relieve distressing symptoms.
The advice was to proceed with the usual caveat of full and contemporaneous record keeping describing the circumstances, naming the hospital and the consultant involved and the debate as what was in the patient’s best interest.
I later learned from our member that the patient had been delighted with her frosted lens.