The right to refract and prescribe glasses project is GO!
Orthoptists have been taught to refract for a long time, however, they do not have the right to write a prescription for glasses or test sight according to the Opticians Act 1989. As a profession we obviously do test sight but being unable to write a prescription does have ramifications for patient services. Recent developments in the profession including the rights to administer and supply medicines are changing the way in which orthoptists work. As autonomy has increased the ability to refract and prescribe glasses has been a notable omission in orthoptic practice. We can of course add Fresnel prisms and optical lenses to glasses to change their function, but being able to prescribe the final correct prescription would enable Orthoptists to do this autonomously and not via other professionals such as Ophthalmologists or Optometrists. This would have potential substantial benefits for patient care and service delivery.
What is the law regarding refraction?
The General Optical Council (GOC) was created by the first Opticians Act in 1958, and provides the current governing legislation for opticians/optometrists and dispensing opticians under the Opticians Act 1989 (“the Act”).
The Act gives the GOC powers to make rules and regulations in specific areas of eye care practice, subject to approval by the Privy Council. These include rules concerning the optical industry. The Act sets out the rules and laws governing sight testing and refraction. The Act originally gave opticians the right to prescribe glasses and conduct sight tests, something that only medical practitioners had been able to do before the act was formed in what had been a poorly regulated area of practice. The Act sets out the law with regard to spectacle prescribing, refraction, sight testing, sale and supply of glasses, conduct of optical businesses as well as regulation of the professionals registered by the GOC. Orthoptics as a profession is not included in this legislation even though we were a recognised profession as far back as 1937. Ophthalmic medical practitioners are mentioned within the Act as are optometry and medical students. We are now creating a business case to have an amendment made that would allow registered Orthoptists to conduct sight tests (refract and prescribe glasses in the hospital eye service) as part of the Opticians Act. Professional regulation would still be by the HCPC but the law would give us the right to write !!
Why now ?
Since its initial inception, there have been a number of amendments approved by the Privy Council with the largest update being made in 1989. Some further amendments were made in 2005 including the need for registered practitioners to do CPD. The GOC has intimated that they wish to make some further amendments to the act in light of some major changes in the Optometry profession and this has provided an opportunity for Orthoptics to be included in the Act as a profession eligible to conduct sight tests, refract and prescribe glasses. It is on this basis that BIOS are now working on this important right for our profession. These opportunities do not come along often and the last amendments to the Opticians Act was now over 18 years ago.
What do we need from you?
A survey has been launched and we would like to ask all members to fill in the survey so that we can monitor current practice with regards to refraction. Let us know how you use your ability to do retinoscopy and refract in practice and If you don’t already do it tell us why.
Perhaps you work in remote and rural areas and you feel that being able to prescribe glasses would be an additional enhancement to your clinical service and would negate the need for patients to travel long distances to the hospital for refraction by an ophthalmologist.
Perhaps you would like to issue a prescription with prisms for a patient with long-standing diplopia or prescribe prisms to help a patient with hemianopia? Would you want to be able to do this autonomously?
Perhaps you would like to prescribe bifocals for an accommodative esotropia you think may be able to control but there is a long waiting list for appointments?
Consider the obstacles to patient care that you currently have because you cannot prescribe and what benefits there would be if you could refract and prescribe glasses to your own patients.
Members will have other examples of how they already refract as part of their service delivery, how they are able to do this, for example by having the Ophthalmologist sign the prescription or indeed how they would utilise such a right in the event that we are successful in our case to the GOC.
I would welcome any comments and case studies that highlight how being able to prescribe glasses has benefited their patients, has led to significant efficiencies in service delivery and of course potential cost savings to the department and patient. Conversely, you may wish to share how not being able to prescribe impacts on your patient’s care and service delivery.
This project seeks to allow Orthoptists to carry out refraction, ophthalmic examination and prescribing of glasses within the hospital eye service. Competence will be achieved via post-graduate training for those already qualified. We will be pulling together evidence to ensure that the profession can meet the requirements needed for safe and effective practice when we put the case to the General Optical Council. This is an exciting and important opportunity for the profession that has not come along before and one BIOS does not want to miss. We are aiming to put together the case by the start of Autumn 2024 so don’t delay in contacting me or filling in the survey issued by the University of Sheffield.
If you would like to discuss this project with me or provide information please e-mail me at the following address: [email protected]
Regards
Dr Nadia Northway
Project Lead Refraction
