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”

Regulation 3(13)

SCHEDULE 2

Regulation 2(1)

“SCHEDULE 4 SUPPLEMENTARY EYE EXAMINATION

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

1.   The patient’s relevant medical, family or ocular history should be updated and the reason for and date of visit should be recorded.

2.   Where clinically appropriate, a patient should be referred directly to an ophthalmic hospital, to the patient’s General Practitioner, or to another Optometrist.

TABLE

Column 1	Column 2
Following routine sight test;	Cycloplegic sight test
Paediatric follow up within six months of the previous examination	A sight test;
	Oculo-motor balance; and
	Stereopsis
Referral refinement / Repeat or follow-up procedures	To include, as required:
	A sight test where this could not be undertaken as part of the primary eye examination due to eye infection, disease or injury
	Repeat of automated visual field assessment by full threshold visual fields;
	Repeat tonometry using applanation tonometry;
	Slit lamp biomicroscopy, which may include mydriasis, and / or digital retinal photography;
	Also to include where referring: general referral advice and counselling specific to the referral reason
Suspect glaucoma, unusual optic disc	To include, as required:
appearance, or where other retinal or
choroidal abnormalities have been detected during the primary eye examination	Repeat of automated visual field assessment by full threshold visual fields;
	Repeat tonometry using applanation tonometry;
	Slit lamp biomicroscopy which may include mydriasis
Patient aged under 60 with suspect cataracts, suspect macular disorder, suspect diabetic retinopathy, suspect vitreo retinal disorders, suspect glaucoma, suspect neurological symptoms, suspect tumour risk, small pupils measuring 2 mm or under.	Dilated slit lamp biomicroscopy, and any other tests and procedures appropriate to the patients’ symptoms
Suspect or diagnosed anterior segment disorders, damage or infections, as detailed in the patient’s record, including corneal abrasion, foreign body, dry eye, conjunctivitis, red eye, scleritis, episcleritis, iritis, or uveitis	External eye assessment using slit lamp and relevant diagnostic agents
Children aged under 16 years on referral by an ophthalmic hospital	Cycloplegic sight test
Patients discharged from an ophthalmic hospital following a cataract operation	Postoperative cataract examination and sight test
Patient presenting with reduced visual acuity, sudden vision loss, sudden onset flashes and floaters, or neurological symptoms	sight test, macular assessment tests, slit lamp biomicroscopy which may include mydriasis, and any other tests and procedures appropriate to the patient’s signs and symptoms”

Regulation 3(14)

SCHEDULE 3

Regulation 2(1)

“SCHEDULE 5 RECORDS

1.   An ophthalmic medical practitioner or optician shall keep the following data in records (this data is a record of patient details, symptoms, tests performed and results thereof):—

Personal Patient Data (primary eye examination)	Name, title, address, telephone number, Date of Birth, General Practitioner’s details, Community Health Index number (where available), occupation, driver Yes/No, relevant interests, date of examination
Symptoms & History (primary eye examination)	Presenting signs & symptoms and reason for visit, past ocular history, past medical history, family ocular and patient’s own medical history, medication, reason for referral to or from the ophthalmic medical practitioner or optician, smoker yes/no (if relevant), if family history, or symptoms of age related macular degeneration.
Personal Patient Data (supplementary eye examination)	Update of Name, title, address, telephone number, General Practitioner’s details, occupation and date of examination
Symptoms & History (supplementary eye examination)	Presenting signs & symptoms, reason for visit or for referral to or from the ophthalmic medical practitioner or optician, update of ocular and medical history and medication
For all eye examinations:
Diagnosis / Findings	Record of all findings and any diagnosis or outcomes. Record of reason why any specified/expected procedure or test was not carried out. Where digital fundus photographs have been taken, the photographs should be retained either in electronic form or in hard copy and backed up either in electronic form or hard copy. Where a drug has been issued to a patient, a record of the batch number of that drug, the expiry date and the date when that drug was administered to the patient should be kept, either in the patient record or in a register held at the practice for the specific purpose of recording the drugs which have been administered.
Communication	Note any advice, statements, reports or referrals issued to the patient or made on behalf of the patient
Data to be recorded where appropriate for tests and procedures specified in the Tables A and B in Schedule 3 and the Table in Schedule 4:
External Examination	A record of all relevant findings, technique and apparatus used
Internal Examination	A record of whether this was with or without mydriasis, the technique, apparatus and diagnostic agents used and a full description of the ocular media, fundus, blood vessels, optic disc and macula
Neurological Assessment	All relevant tests undertaken, which may include pupil assessment – relative size, shape, direct, consensual and near responses
Oculo-Motor Function	All relevant tests undertaken which may include cover test, convergence, muscle balance, motility, stereopsis, amplitude of accommodation
Visual Fields	Record findings, technique and apparatus used
Intra Ocular Pressure	Intra ocular pressure measurement, type of tonometer and time of measurement
Sight test	Objective/subjective findings, unaided vision, pinhole acuity, visual acuity, back vertex distance (over 5D), prescription issued, dispensing details
Colour Vision	Record findings and test procedure
Imaging	Record reference to any electronic images taken. Where any electronic images have been taken, the image should be retained either in electronic form or in hard copy and backed up either in electronic form or hard copy.”