Guidance and Advice for Orthoptists2020-07-16T15:12:23+01:00

Guidance and Advice for Orthoptists and Orthoptic Professionals

Below you will find guidance on working and keeping safe, as well as links to helpful resources and templates..

We hope you find this helpful but please do let us know if you have any specific concerns or enquiries.

The priority for BIOS in such a challenging time is, as always, the physical and mental health of our members.

Follow official guidance and organisational action plans which are changing daily – the most up to date details from each country can be found here:

If you do not feel well and have any of the symptoms described you should not attempt to go into work and should follow the guidance about self-isolation – this is to keep you and your work colleagues safe.

BIOS have put together some guidance on telephone consultations and social distancing.

Follow all infection control guidelines in line with the public health guidance and your own organisational policies.

The advice of your HR directors and advisors will support those staff currently off work and returning to work following self-isolation or absence, cancellation of holidays, school closure plans, and caring for relatives and dependents.

During the acute phase (lockdown) of the pandemic, cancellation of non-sight threatening appointments and surgical procedures along with strict social distancing has led to an unprecedented pressure on the NHS. It has resulted in decisions where the risk of delaying treatment have been balanced against the risks of continuing with assessment and treatment especially in:

  • The risk of the transmission of COVID, in the case of face-to-face assessment
  • The risk of mis-diagnosis in any form of remote assessment, particularly with a new patient

For orthoptic departments this had resulted in most of their booked patients being cancelled and / or safely deferred.

Whilst many services have resumed some clinical activity, seeing the medium risk patients and those who have been delayed, there is still large variation across services. It is expected that, where possible, low risk patients remain on virtual and remote consultations (See RCOphth’s interim guidance). However, patients in the medium risk categories who have been delayed may have moved into the high risk category and should be seen face to face during the recovery phase

BIOS have published updated guidance on the management of orthoptic patients during the recovery phase, available here.

[Updated 16 July 2020]

Please consider the following for all your clinical interactions with patients:

  1. Keep the examination as brief as possible and pertinent to the decision making required. Perform the necessary tests, which can be repeated on subsequent appointments in order to reach a diagnosis or a clinical impression. Where appointments are held jointly with another professional, consider jointly the minimum tests that are required for a safe clinical decision to be made and document this in the notes.
  2. Consider creating a COVID-19 temporary clinics standard operating procedure (SOP)
  3. Keep history taking for both medical and ophthalmic history to a minimum and don’t repeat it if it has already been taken in emergency eye clinic (for example)
  4. Consider a pre-appointment telephone call or a video consultation with the patient to ascertain as much information as you can (e.g. current treatment, concerns), and explain the changes to the clinical environment that you have in place to ensure the face to face consultation is safe e.g. social distancing, reduced footfall, PPE, face masks for patients and carers if applicable
  5. Keep more than 2 metres away from patients, except where the clinical examination requires it
  6. Limit the number of accompanying adults or siblings attending with the patient. Patients and carers should be advised of this prior to the appointment via pre appointment call, text or letter.
  7. Avoid touching the patient wherever possible
  8. Allow sufficient time between each appointment to maintain standards of hygiene and cleanliness including hand washing, cleaning of all equipment and clinical room used before and after patients, wiping all surfaces between consultations and of course bare below the elbow. Ensure that you follow the national recommendations on the use of PPE and that you are also familiar with your organisational guidelines, the manufacturers guidelines for cleaning specialist equipment, and local infection control guidelines.

[Updated 13 July 2020]

The latest government guidelines, relevant across the UK,  on infection control during the epidemic is available here, which includes:

Orthoptists, like other ophthalmic clinical professionals, are in prolonged close contact with patients when performing clinical assessments, and therefore may be at higher risk of infection than other specialities. The Royal College of Ophthalmologists have therefore adapted the PHE advice on infection protection, available here.

In England, the government issued guidance, as of 15 June, on the wearing of a facemask in all settings:

  • NHS Employers and NHS Trade Unions have produced a Communications Toolkit for Trusts following this government guidance, available to download here. Members should also refer to their organisational guidance, which will set out local operational arrangements.
  • An FAQ is available on these changes, here.

This is a useful leaflet detailing how to make a Children’s size surgical face mask.

Download our guidance document here.

There’s also published guidance from the RCOphth, available here.

NHS England have a guide to the management of remote consultations and remote working, available here.

We have developed advice with RCOphth on the sue of home vision testing apps as an adjunct to telemedicine, available here.

  • The BIOS CAGs have provided resources and useful links for use by patients, many of which may be helpful, available here.
    • We have a number of leaflets and links to further resources for use with patients following strokes and brain injuries here.
    • There are a number of resources linked to on the Low Vision CAG page.
  • There is a specific section on COVID-19, on the Sight Advice FAQ, which has advice on eye health and living with a sight condition.
  • The Starting Point leaflet is also available for download, giving advice to parents and carers of children with a visual impairment.

NHS: ‘Open For Business’

While many eye care appointments have understandably been deferred during the coronavirus pandemic, it is important that patients are reassured that urgent and emergency eyecare, the NHS remains open for business.

There is concern around people not attending emergency eyecare and not seeking help for potentially serious conditions in the case of loss of vision or the sudden onset of double vision.

The NHS has launched a campaign, Open For Business, to emphasise that people should still seek help for urgent and emergency medical conditions. We would encourage our members to spread the word about the importance of seeking helping if people are experiencing rapid changes in their vision and for urgent and emergency eye care to help to prevent hundreds of people unnecessarily losing vision.

Other Useful Links

For advice for healthcare professions in each country, follow the links below:

There is also a huge amount of regularly updated information available from the Royal College of Ophthalmologists –

The North West AHP Network produce a regular summary of resources for the AHP workforce, available from their website:

Letters and Statements

Joint letter on supporting AHPs and Support Workers during the COVID-19 epidemic –

Statement from UK’s Chief AHP Officers and the HCPC regarding returnees to the register –

Four-Nation statement from UK’s Chief AHP Officers on allied health professionals’ roles in rehabilitation during and after COVID-19 –