There is some confusion over what optical assistants (OAs) are allowed to do in the world of optics. I feel the confusion comes from practice staff potentially getting mixed up with company/practice procedures and laws we must follow. Below is a list of some of the most common dispenses that cause confusion:
- Patients under the age of 16 years,
- Patients registered Sight Impaired and Severely Sight Impaired
- Adult hospital prescriptions
- Complex lenses to adult patients (±10.00D)
- Prescriptions above ±5.00D, (these require a vertex distance to be specified on the prescription)
- Safety spectacles
As an OA, you can legally dispense all the above on your own except the first two, spectacles for patients under the age of 16 years, and patients registered Sight Impaired and Severely Sight Impaired. As an OA you can dispense these patients, but they must be supervised by a registered and qualified dispensing optician, optometrist or ophthalmic medical practitioner.
This in itself leads to some confusion, what does supervision mean? The supervising registrant has to be on the premises and be in a position to intervene. I feel that the registrant needs to be physically involved in both the dispense and especially the collection.
They are not just checking the prescription and optical centres, the registrant should also check the fit of the frame relevant to the child’s facial features, suitability of the frame, and that the lens material and form are appropriate.
A common mistake with those newer to optics is not selecting a smaller blank size for example for a child’s dispense for even a moderate plus prescription, just the action of choosing a smaller blank will reduce lens thickness and weight. Practice procedures are decisions your business makes for itself, the business owners may have decided that they would prefer qualified registrants to dispense the following prescriptions, but it is not a legal requirement.
Adult hospital prescriptions
A hospital prescription for an adult can be dispensed in the same way as a prescription issued from an optometrist in your practice.
Complex lenses to adult patients (±10.00D)
Complex prescriptions present several challenges, careful consideration of frame type and size as well as a knowledge of available lens materials and forms, for example higher index materials, lenticular and aspheric forms where both horizontal and vertical centring must be considered.
Prescriptions above ±5.00D
These require a vertex distance to be specified on the prescription, the distance from the apex of the cornea to the back surface of the lens. This is recorded on the prescription at the time of the sight test, if the dispensed vertex distance differs then this will affect the prescription experienced at the eye in the same way that contact lens prescriptions are often different to the spectacle lens.
If a frame fits at a different vertex distance to that prescribed then the higher the power, and the bigger the difference, the more likely compensation of the prescription will be required.
Safety spectacles
These again do not fall within a legal restricted category so an OA can dispense safety spectacles, but a knowledge of the relevant British Standards is important and the optical appliance must be suitable for the intended purpose, this is why many businesses within their company policy restrict these dispenses to qualified registrants.
Pre-screening
Most OAs will be involved in pre-screening, in fact when you are new to optics this is often one of the first areas of the practice that you will work in. But did you know pre-screening is a delegated task/function? That means that although you, as an OA, can carry out field tests, non-contact tonometry (NCT), retinal imaging, OCT, and auto-refraction the optometrist is still responsible for these tests being carried out, and carried out accurately.
So, if you as an OA do not carry out a pre-screening test accurately you may get in trouble with your manager but for the optometrists the situation is much worse, as there are specific standards of behaviour and performance expected by our regulator the General Optical Council (GOC) whose mission is, ‘to protect the public by upholding high standards in the optical profession’.
Hopefully this will explain why your optometrist colleagues appear overly concerned when any pre-tests are not correct. As an OA, if you understand this and aim to carry out accurate tests, pointing out any problems achieving accuracy or if you notice anything that looks strange you will be supporting optometry colleagues.
I spoke to a practice owner in the Wirral recently who told me his OA noticed something different when she was carrying out an OCT. She had a private word with the locum optometrist and said: ‘This looks like this patient has glaucoma.’ The optometrist was slightly taken aback but finished the eye examination and promptly referred the patient for suspected glaucoma. This practice owner was proud of his staff members understanding of the test and subsequent results.
Something I need to add that is really important, the above is a great example of how OAs can aid optometrists, but as an OA you must not try and interpret results even if asked by the patient. That could easily lead to unnecessary worry or inaccurate explanations. A reply I have used in this scenario is: ‘This field test is just one part of the jigsaw of the eye examination, when you go back into the test room the optometrist will talk through what they all mean.’
The law
The law that applies to the testing of sight and use of protected titles, for example optometrist and dispensing optician, is the Opticians Act 1989. Section 24 testing of sight states only a registered medical practitioner (registered with the General Medical Council) or registered optometrist (registered with the GOC) can test the sight of another person in other words carry out an eye examination.
There is an exemption to this rule: registered student optometrists under supervision. Section 25 registered optometrists, and dispensing opticians on the contact lens specialty register (contact lens opticians (CLO)) and medical practitioners can fit and check contact lenses.
Try to remember CLOs are checking what is happening at the front the anterior of the eye, while optometrists check both the front and back of the eye. Others that can fit and check contact lenses are student optometrists and contact lens opticians under supervision.
An essential part of contact lens wear for patients is learning how to insert, remove and care for their lenses.
Contact lens teaches for new contact lens wearers can be delegated by the optometrist or CLO. Remember this will be under the supervision of the qualified registrant. One way of justifying allowing OAs to do this, would be to make sure the OA has completed a recognised training course such as the level 3 OA apprenticeship course, so it can be demonstrated they are sufficiently qualified and experienced to undertake the task.
Section 28 you cannot call yourself an optometrist or dispensing optician if you are not qualified and registered with the GOC. So, for example a qualified optometrist who is not registered with the GOC and is working in optical practice is essentially an OA and cannot carry out eye examinations. Also, they cannot dispense to those that fall within a restricted category unless under the supervision of a qualified and registered member of staff.
Ready readers (ready-to-wear spectacles)
If an optical practice decides to sell readymade (ready-to-wear) reading spectacles it should ensure that all appliances sold conform to BS EN 14139:2010 Ophthalmic optics – Specifications for ready-to-wear spectacles. If your practice sells readymade reading spectacles you must consider the duty of care that you demonstrate to the patient.
What does this mean to an OA working in practice?
If someone buys ready readers from a supermarket for example, the individual can pick any of the powers on sale and see which feel right. In an optical practice we are required to demonstrate a duty of care to the customer, we must make sure the selected ready readers are suitable. If a copy of the prescription is available, we should look at it.
We should ask, are they to be worn on their own or on top of contact lenses? This will affect the prescription required and ensures the patient is aware these are for reading only (figure 1). If a prescription is mainly cylinder with a small sphere, explain the limited usefulness of ready readers. How long are you going to be wearing them? Why do we ask that? Ready readers are made up with preset optical centration, using them for long periods may cause problems, such as headaches.
Working distance, how far away is the task you wish to use them for? For example, a 40-year-old picking up a pair of +3.00D ready readers will be very restricted where they can read, alternatively the same 40-year-old may make models such as Airfix kits and the +3.00D may be ideal for small detail when very close to the model for short periods.
Why does an OA need to know the above?
You may find yourself as the most senior member of staff in your practice at some point in the future. You may have a locum optometrist come to your practice; I advise always checking the live GOC register to see if they are in fact registered.
My students’ reflections
‘I knew our opticians have to do the children’s dispenses but this lesson and following assignment has taught me that there is much more to it. The whole of my practice staff got involved in helping me with this assignment and we actually turned my findings into a staff training session.
‘My manager was happy that we were studying what an optical advisor can do, and he said that he had learnt a lot as well.’
As an OA, building up your own knowledge and abilities will really make you stand out in your practice, you will enjoy your job more. If you are then given extra responsibilities, look at it as a positive, it shows those abilities have been recognised. The more useful you are to the practice, the more likely your employers are to invest in your future development.
- Tony has designed, developed and managed the level 3 optical assistant apprenticeship course at Training 2000. He was also involved in the development and delivery of the bench-mark Btec level 4 certificate in optical dispensing, which started hundreds of students’ careers in optics, with around 70% of students going onto further study as a dispensing optician. Tony is also an experienced author and presenter of CPD lectures and discussion workshops with audiences of up to 500. He also previously worked as a part-time lecturer in ophthalmic dispensing at Anglia Ruskin University.