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General Optical Council (GOC) statement on supply of spectacles and contact lenses during COVID-19 emergency


GOC/COVID/02
Date of statement: 19 March 2020
General Optical Council (GOC) statement on supply of spectacles
and contact lenses during COVID-19 emergency
1. In these extraordinary times, we are fortunate that in all four countries of the
United Kingdom we have a group of exceptionally well qualified eye care
professionals on whom the general public and fellow healthcare professionals
can rely. Uncertain times mean that our registrants may be called upon to work
at the limits of their scope of practice and vary their practice for protracted
periods of time and in challenging circumstances.
2. In this statement we hope to reassure our registrants that when they act in
good conscience, for the public benefit, exercising professional judgement in all
of the circumstances that apply, the GOC will support them.
3. Along with all other healthcare regulators, the GOC has signed a joint
regulatory statement which acknowledges that registrants will need to act
differently and deliver care in different ways during the COVID-19 emergency in
line with Government and public health guidance. The GOC will take account of
this in fulfilling its regulatory functions along with the following statement in
response to a question regarding whether it is necessary to attend for a sight
test or contact lens fitting/check in order to be able to purchase spectacles
and/or contact lenses in the current environment.
4. The relevant legal requirements are set out below.
Issuing spectacles
5. There are no legal restrictions on the supply of spectacles by or under the
supervision of GOC registered optometrists and dispensing opticians, including
for users aged under 16 or registered sight-impaired / severely sight-impaired
(section 27 of Opticians Act). If there is no clinical need for a patient to attend
an optical practice, optical businesses should be considering posting or
delivering spectacles to the patient.
6. If there is a clinical need, then during the COVID-19 emergency period,
business registrants, optometrists and dispensing opticians should consider the
risk of requiring a patient to attend an optical practice and potentially
contracting or spreading coronavirus compared to any clinical risk of supplying
spectacles, and use their professional judgement to decide on the best course
of action.
Issuing contact lenses
7. In order to supply contact lenses, the patient must have an in-date contact lens
specification which has been issued following a contact lens fitting/check. The
contact lens fitting itself can only begin if the patient has had a sight test that

has been issued with a prescription in the last two years and before any re-
examination date specified in the prescription (section 25(1A(b) of the Opticians

Act). There is no requirement for how long a contact lens specification should
last, but good practice in the profession suggests up to two years. If the contact
lens specification has expired, this would ordinarily result in GOC registrants
and/or businesses withholding supply of contact lenses to patients until they
have attended the optical practice for a sight test and/or a contact lens
fitting/check.
8. If the contact lens specification is current and there is no clinical need to attend
an optical practice, optical businesses should be considering posting or
delivering contact lenses to the patient.
9. If there is a clinical need, or the specification has expired, then during the
COVID-19 emergency period, business registrants, optometrists and contact
lens opticians should consider the risk of requiring a patient to attend an optical
practice and potentially contracting or spreading coronavirus compared to any
clinical risk of supplying contact lenses on an expired specification, and use
their professional judgement to decide on the best course of action.
Exercising professional judgement
10. In making this judgement, registrants should take account of:

• public health advice at the time in question (some individuals may be self-
isolating and unable to attend, public transport may not be available, and

some domiciliary visits may no longer be possible for instance);
• patient vulnerability (Government definition available here:

https://www.gov.uk/government/publications/covid-19-guidance-on-social-
distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-
everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults);

• relevant clinical advice;
• how long it has been since the last sight test or contact lens fitting/check;
• whether the original expiration of the specification was less than two years;
• the nature of any specific clinical risks; and
• how quickly the business could see the patient following the emergency
period in order to minimise any risk.

Recording your decisions
11. Registrants should make a note of their decisions, and the reasons for their
decisions, in the patient records, including for the duration of any supply of
contact lenses and aftercare plans.
The GOC will keep this statement under review
12. Next routine review due: not later than 30 April 2020.

UCHW Cataracts referral information


Please can you forward this to all on your database and if possible add it to your website.

Due to the COVID-19 outbreak the government have asked us to review non-essential appointments and surgeries. Following this review, cataract surgeries and routine cataract assessments/follow-ups have been stepped down for the interim period at both UHCW NHS Trust and Rugby St Cross Hospital.

All patients who already have a cataract assessment appointment booked will be contacted by phone, and those that can manage in the medium term without intervention will be discharged with advice to get referred back for possible cataract surgery when hospital services resume normally.

Those who still wish to go ahead with cataract surgery will have their assessment appointment cancelled. They will be contacted with a new cataract assessment appointment when the service is up and running again. This may be in 12 weeks but is dependent on government advice.

In the short term, for those patient that have recently undergone cataract surgery and are waiting for a post-op follow-up, we will be implementing a telephone review

We wish to engage the local community optometrists for help with this group.

The outcome of the telephone reviews will be one of the following for each patient:

1) Those that are asymptomatic and not needing 2nd eye surgery or other follow up will be discharged to the community optometrist for a routine eye test.

2) Those that are asymptomatic but need 2nd eye surgery will be asked to go to community optometrist as above, but we will record those that need 2nd eye surgery and offer a fresh assessment appointment in hospital, when the service resumes. This is likely to be at least 12 weeks and then the

person would need to go on a waiting list for surgery. They may need glasses in this interim period with advice that the glasses may need changing after 2nd eye surgery. Many can be advised to use ready-made readers as a stop gap.

3) Those that are asymptomatic regarding the cataract but are under our care for other co pathology we will advise to go to the community optometrist for an eye exam but also their details will be forwarded onto their consultant for review so that they are not lost to follow up. However (just for information) many routine eye disease patients are having their routine hospital clinic appointment delayed by many months.

4) Those that are symptomatic will be brought into hospital for review

I realise that this is very short notice to ask the community optometrists to help out but it will only be for a few weeks.

Please be aware that these patients often have a drier eye than usual post op.

1) If after the eye examination the optometrist considers that the patient needs a hospital post op appointment please could they inform us via the cataract email in box as below? This will be monitored daily Monday-Friday.

2) Each patient will know from our contact whether we plan to list the 2nd eye or not. So if a patient has been advised that we are not planning to list 2nd eye when the service resumes but does required the 2nd eye surgery, please use the cataract inbox to refer the patient back rather than start the whole process again; Please limit this to only those where the 2nd eye is symptomatic and the patient is keen for surgery.

We highly value feedback on the patient’s VA and post op refraction. Please could this information be sent to the following email address:

uhcw.stcrosscataract@nhs.net

This cataract inbox is NOT available for other cataract referrals

Thanks in advance for your help in these difficult times.

Please circulate this information amongst your optometrist colleagues.

Jane Kempton (clinical lead for cataract services at UHCW and St Cross)

 

USEFUL LINKS AND INFORMATION


Dear All,

Please see some useful links below:

Useful Links

The College of Optometrists LINK

The AOP LINK

ABDO LINK

GOC LINK

The College have also produced a well worded joint statement with the Royal College of Ophthalmologists about Viral Conjunctivitis and Covid-19 : LINK

If you provide extended services through Primary Eyecare Services (PES) then please read their guidance here: LINK

The NHS England SOPs for Primary care (link) have not changed since 5th March but expect an update any time now.
The GOC has issued a couple of important statements:
1) A joint statement with the other healthcare regulators recognising that professionals may need to depart from their usual procedures at this time : LINK
2) Reassurance that using professional judgement we can supply spectacles and contact lenses without first requiring the patient to attend an optical practice : LINK

The main GOC Covid-19 page which references these and other statements is here : LINK

Optical Fees Negotiating Committee (OFNC) are working with NHSE on financial support and adjustment to contract requirements. Statement today : LINK.

This sector-specific advice sits on top of the Government advice to all citizens : LINK

This advises risk groups, those over 70 and those with underlying health conditions (details on the site) to follow social distancing measures.

Social distancing is explained here : LINK

It has been announced that Schools will provide childcare (not education) for children of health & social care workers so they can continue to work.

The guidance the schools are following is here : LINK

As yet there is no clarity on whether or not optical professionals are ‘essential workers’. For now I advise that if you can’t do without the childcare support in order to fulfil your healthcare role you should assert that you are a key worker, until we are provided with a clear position on this. The argument is especially strong if you provide MECS which we expect to be busier than usual. We are working on a model letter you can use to reply to schools which will come out via the optical representative organisations.

Kind regards

Dilesh

Viral Conjunctivitis and COVID19


Viral conjunctivitis and COVID-19 – a joint statement from The Royal College of Ophthalmologists and The College of Optometrists
Recent reports have suggested that COVID-19 may cause conjunctivitis, and it is known that viral particles can be found in tears, which has caused some concern amongst eye health professionals. It is recognised that any upper respiratory tract infection may result in viral conjunctivitis as a secondary complication, and this is also the case with COVID-19. However, it is unlikely that a person would present with viral conjunctivitis secondary to COVID-19 without other symptoms of fever or a continuous cough as conjunctivitis seems to be a late feature where is has occurred.

Viral conjunctivitis is not currently listed in the national case definition for COVID-19. As such practitioners should treat viral conjunctivitis in the absence of other symptoms as they would usually treat any presentation of viral conjunctivitis, including normal scrupulous levels of infection control, as we do for adenovirus which is very contagious. The optometric management of viral conjunctivitis can be found in the Clinical Management Guideline, it is a self-limiting condition and should not be referred to secondary care.

During the pandemic, we recommend that, for all patients, scrupulous infection control and hand hygiene measures are employed and that, where possible, time spent on slit lamp and other close examinations is kept to a minimum safe level.
The College of Optometrists

latest on Coronavirus (COVID-19) outbreak


The Department of Health & Social Care (DHSC) and Public Health England (PHE) are leading the UK government response to the Coronavirus (COVID-19) outbreak.

You can get up-to-date information about the situation in the UK and guidance for the public on the risk from Coronavirus on the government’s website.

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HSE is working closely with the DHSC, PHE and other government departments to provide support when it’s needed, including technical advice on the protection of workers. Check GOV.UK for the latest information from the UK government.