The National Health Service (General Ophthalmic Services) (Scotland) Amendment Regulations 2010

Regulation 3(12)

SCHEDULE 1

Regulation 2(1)

“SCHEDULE 3 PRIMARY EYE EXAMINATION

TABLE A

THE TESTS AND PROCEDURES SPECIFIED FOR THE PURPOSE OF THE DEFINITION OF PRIMARY EYE EXAMINATION IN REGULATION 2(1)

The taking of a detailed history and symptoms, including relevant medical, family, or ocular history

The recording of unaided vision, visual acuity or pinhole vision as appropriate

Sight test – appropriate to the presenting signs, symptoms, and aided / unaided acuity

A pupillary assessment including testing for relative size, shape, direct, consensual and near responses

An examination appropriate to the reason for referral from a medical practitioner or other carer

An eye health assessment appropriate to the patient’s needs and presenting signs and symptoms

An internal eye examination using direct ophthalmoscope and/or slit lamp / head mounted biomicroscopy

The external examination of the eyes using slit lamp biomicroscopy and appropriate diagnostic agents

A relevant assessment of extra ocular motor function; oculo-motor balance and ocular motility

A visual field assessment

The communication of the clinical findings, including preparation of a referral letter and clinical report (where appropriate), results and diagnosis to the patient, his or her carer (where appropriate), and other appropriate health professionals as agreed by the patient and/or his or her carer.

TABLE B

THE TESTS AND PROCEDURES SPECIFIED FOR THE PURPOSE OF THE DEFINITION OF PRIMARY EYE EXAMINATION IN REGULATION 2(1)

Column 1	Column 2
Children aged under 16 years (where the optician or ophthalmic medical practitioner which is carrying out the eye examination does not have access to or means to access the patient’s records)	On first appointment stereopsis and, where clinically appropriate, colour vision
Children aged under 16 years (where the optician or ophthalmic medical practitioner carrying out the eye examination does have access to or means to access the patient’s records)	Colour vision and stereopsis where clinically appropriate
Adults aged 40 and over	Intra ocular pressure measurement
Adults aged 40 years and over who have a close family history of Glaucoma	Intra ocular pressure measurement, automated suprathreshold visual field tests, and assessment of the optic nerve head
Adults aged 60 years and over ((i) where the optician or ophthalmic medical practitioner which is carrying out the eye examination does not have access to or means to access the patient’s records or (ii) where the optician or ophthalmic medical practitioner does have access or means to access the patient’s records and it is the patient’s first examination after having reached his or her 60th birthday)	(i)	Automated Supra-threshold fields
	(ii)	The performance of slit lamp / head mounted biomicroscopy with mydriasis
	(iii)	Digital Fundus imaging
Subject to the provisions of the row above, adults aged 61 years and over (where the optician or ophthalmic medical practitioner carrying out the eye examination does have access to or means to access the patient’s records)	(i)	Automated Supra-threshold fields as clinically indicated
	(ii)	The performance of slit lamp / head mounted biomicroscopy with mydriasis
	(iii)	Digital fundus imaging
Patients discharged from an ophthalmic hospital following a cataract operation	Postoperative cataract examination and sight test
Patients presenting with suspect vitreo retinal disorder aged 60 years and over	Vitreous examination and fundus assessment by dilated slit lamp biomicroscopy (with condensing lens) and/or indirect headset and/or gonio fundus lens
Patients with suspect glaucoma or ocular hypertensives	Intra ocular pressure measurement, automated supra-threshold visual field assessments, and assessment of the optic nerve head
Patients with suspect macular disorders aged 60 years and over	(i)	Internal Eye examination with mydriasis, using slit lamp biomicroscopy
	(ii)	Test to investigate sudden onset of visual distortion in one or both eyes
Patients with cataract aged 60 years and over	Internal Eye examination with mydriasis when a clear view of the fundus cannot be obtained without mydriasis, using slit lamp biomicroscopy or head mounted indirect ophthalmoscopy
Depending on the patient’s presenting signs and symptoms	(a)	Standard tests such as binocular function and stereopsis, amplitude of accommodation, colour vision, confrontation fields and other appropriate tests excluding the following tests and procedures when undertaken as part of a supplementary eye examination on the same day: cycloplegic refraction; dilated slit lamp biomicroscopy for patients aged under 60 with suspect cataracts, suspect macular disorders, suspect diabetic retinopathy, suspect vitreo retinal disorders, suspect glaucoma, suspect neurological symptoms, suspect tumour risk, small pupils measuring 2 mm or under
	(b)	Issue advice and instruction to patients prior to referral into a care pathway, shared care scheme or a level 2 optometric examination
	(c)	Direct referral, where clinically appropriate, to an ophthalmic hospital, to the patient’s General Practitioner, or to another Optometrist

THE FREQUENCY OF PRIMARY EYE EXAMINATIONS FOR THE PURPOSE OF REGULATION 22(3A) AND (3B)

TABLE C

Category of Patients	Maximum frequency at which primary eye examinations are to be carried out
Patients under 16 years	Annually
Patients aged between 16 years and 59 years	Biennially
Patients aged 60 years or over	Annually
Patients with glaucoma	Annually
Patients aged 40 years or over with a close family* history of glaucoma	Annually
*father, mother, brother, sister, son, daughter
Patients with ocular hypertension	Annually
Patients with diabetes	Annually”