The National Health Service (General Ophthalmic Services) (Scotland) Regulations 2006

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

An assessment of current spectacle correction and their appropriateness to the patient’s current needs by focimetry and identification of lens and frame type

A pupillary assessment including testing for Relative Afferent Pupillary Defects

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

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, with mydriasis where appropriate, using direct ophthalmoscope and/or slit lamp 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

The examination and checking for co-existing ocular disorders

The communication of the clinical findings, results and diagnosis to the patient, their carer (where appropriate), and other appropriate health professionals as agreed by the patient and their 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	Tests appropriate to the age of a child to determine vision, refractive state, stereopsis, extra ocular motor function (muscle balance motility) and ocular health
Adults aged 40 years and over who have a family history of Glaucoma	Intra ocular pressure measurement, visual field tests, and assessment of the optic nerve head by slit lamp biomicroscopy, should be performed on a screening basis. This will consist of Non contact tonometry, suprathreshold visual fields and slit lamp biomicroscopy
Adults aged 60 years and over	(i) Supra-threshold fields on a screening basis (ii) Amsler Test if the macula is suspect (iii) The consideration of slit lamp biomicroscopy with mydriasis
Adults aged 70 and over	The performance of slit lamp biomicroscopy with mydriasis
Patients referred from an ophthalmic hospital	Postoperative cataract examination, refraction and report
Refractive Abnormality	(i) Refraction, muscle balance, and other tests as required (ii) Spectacle dispensing advice
Patient’s presenting with sudden onset ‘flashes and floaters’ or sudden vision loss	Vitreous examination and fundus assessment by dilated slit lamp biomicroscopy
Patients with suspect glaucoma or ocular hypertensives	Intra ocular pressure measurement , visual field tests, and assessment of the optic nerve head by slit lamp biomicroscopy, should be performed on a screening basis. This will consist of Non contact tonometry, suprathreshold visual fields and slit lamp biomicroscopy
Patients with macular disorders	(i) Internal Eye examination must be with mydriasis, using slit lamp biomicroscopy (ii) Amsler chart test
Patients with cataract	Internal Eye examination must be with mydriasis when a clear view of the fundus cannot be obtained without mydriasis, using slit lamp biomicroscopy or head mounted indirect ophthalmoscopy
Patients with diabetes	Internal Eye examination must be with 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 (b) Advice regarding the dispensing of the prescription, and discussion of an appropriate dispensing solution to the current needs of the patient (c) Issue advice and instruction to patients prior to referral into a care pathway, shared care scheme or a level 2 optometric examination (d) Direct referral to an ophthalmic hospital (e) Completing a clinical report for another health care professional or referral letter if required.