The following is a joint statement from the Optometric Fees Negotiating Committee (OFNC), Optometry Scotland, Optometry Wales and Optometry Northern Ireland.
The UK Government has now published further guidance clarifying that opticians are exempt from the general requirement for retail businesses and premises to close.
Optical practices may therefore continue to provide urgent and essential eye care to the extent that they can, including remote care, while managing COVID-19 risk to keep patients, staff and the public as safe as possible.
This is a key health service to meet urgent eye care needs during the crisis, especially for isolating elderly people and key workers, and to divert patients from GPs, A&E and hospital emergency eye departments.
Optical staff involved in offering urgent and essential eye care meet the Government definition of a key worker for the purpose of access to transport and schools. ABDO has published an ‘essential workers’ template letter for optical practices to help their staff demonstrate this to schools, and the sector is working on further resources covering transport etc. Key workers should only place children in school where absolutely necessary because they cannot safely be cared for at home.
Meaning of ‘urgent’ and ‘essential’ care
The Welsh, Scottish and Northern Ireland governments have all issued advice on the care that optical practices should continue to provide during the COVID-19 crisis. NHS England has yet to provide guidance but is expected to do so very soon.
On 23 March the College of Optometrists, OFNC and the UK optical bodies all issued statements advising optical practices to stop providing routine sight tests and care in the current circumstances. Optical practices should only remain open to provide urgent and essential care.
Our current view is that:
Urgent or emergency care would include urgent clinical advice or intervention eg for red eye, contact lens discomfort, foreign object, sudden change in vision, flashes and floaters which might suggest detachment etc.
Scottish Government guidance for practices in Scotland states that as is already the case, it is up to the professional judgement of an optometrist or ophthalmic medical practitioner to determine whether or not the circumstances in which a patient presents constitutes an emergency. Professional guidance already exists to help practitioners in this regard, such as the College of Optometrists Guidance for Professional Practice
Essential eye care would include appointments for patients who would not normally be considered to be emergencies, but where, in the practitioner’s professional judgement, a delay in an examination may be detrimental to a patient’s sight or wellbeing.
This definition is from the Scottish Government guidance for practices in Scotland. Optometry Scotland takes the view that a sight test is highly unlikely to meet the definition of essential care. In other parts of the UK, practices may consider a sight test as essential care if for instance a key worker needs a sight test and new spectacle prescription in order to continue to work. Other examples of essential care could include a visually impaired person or child who needs eye care where a delay in care may be detrimental.
Managing COVID-19 risk
Practices that remain open to provide urgent and essential care must have in place appropriate measures to manage COVID-19 risk. These should include:
- Displaying the College of Optometrists or equivalent poster at the entrance of the practice
- Using remote consultations wherever possible, closing for routine sight testing, and only admitting patients on appointment for essential and urgent eye care which cannot be provided by phone, video or email
- Keeping up to date with and following Public Health England guidance on limiting the spread of COVID-19 in workplaces, including:
- maintaining a distance of at least 2 metres from others where possible
- regular hand-washing and cleaning - ABDO has published an FAQ on the cleaning of practices, equipment and spectacles to manage COVID-19 risks.
Personal Protective Equipment (PPE)
The optical sector bodies are in constant contact with government, public health and NHS authorities about PPE. The situation is fast-moving and we recommend that you check the College of Optometrists website for regular updates using the link below.
The College has provided the following guidance (as of midday on 25 March) for optometrists providing urgent and essential care:
“We understand the growing concern about the potential for tears to lead to COVID-19 infection and are waiting for more information on this. In the meantime, optometrists should not put themselves at unnecessary risk and we are asking the UK governments to provide appropriate PPE for optometrists who are providing essential services. If you need to use personal protective equipment, it is important that you use the correct type and are trained in how to use it.
“Current guidance is that face masks are only needed for those who are dealing with patients with confirmed or suspected cases of COVID-19. The Royal College of Ophthalmologists advises that patients with no known risk, should be seen as normal - with the ophthalmologist using scrupulous standard infection control as for any patient (e.g. hand hygiene, clean instruments). They recommend that there is no known need for using face masks or gloves for every patient but that discretion is to be used. Ophthalmologists should use normal surgical masks for specific situations or patients, especially prolonged slit lamp exposure time or patients with watery, discharging eyes. They should balance mask use with the possibility of supplies running low if the pandemic is prolonged.
“We have guidance on how to adapt your practice to minimise prolonged close contact in our FAQ 'Should I continue with business as normal?”
If a practitioner has concerns about any procedure (especially aerosol effects) when carrying out urgent or essential care on an asymptomatic patient, they should apply their professional judgement when deciding whether to perform it. If they decide not to, they should inform the patient and note the reason in the patient record (annotating COVID-19) and where necessary rearranging care. In recent statements, the GOC has acknowledged that “registrants may be called upon to …vary their practice …. in challenging circumstances (and that) registrants should act in good conscience, for the public benefit, exercising professional judgement in all of the circumstances that apply”.