- Immediately after carrying out an NHS or private sight test you must issue a prescription or a statement indicating that no prescription is necessary.
- If there is no clinically significant change in the prescription, you must issue the prescription and a statement saying that there is no clinical change.
- You must only prescribe, or recommend a change of, spectacles when it is in the patient’s best interests to do so.
- If you make a small change to an existing prescription, you must be clear about the benefit of the change and keep a record of the reason and any advice given.
- The pupillary distance measurement is not part of the prescription.
A329
This Guidance does not change what you must do under the law.
A330
Immediately after carrying out an NHS or private sight test you must issue:
- a prescription or
- a statement indicating that no prescription is necessary.121
A331
If there is no clinically significant change in the prescription, you must issue the prescription and a statement saying that there is no clinical change.
A332
You must include all the required information on the prescription as set out in the Sight Testing (Examination and Prescription) (No. 2) Regulations, paragraph 5.122
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You should write prescriptions according to British Standards.123
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You should clearly indicate on the prescription whether the spectacles are only for specific purposes.
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You should indicate on the prescription if the patient is registered as sight impaired or severely sight impaired. This is because a prescription you issue to a child under 16, or a person who is registered as sight impaired or severely sight impaired, can only legally be dispensed by, or under the supervision of, a registered:
- optometrist
- dispensing optician, or
- doctor.
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You remain responsible for any prescriptions you have issued, irrespective of where the patient chooses to buy their spectacles.
A337
When you give the patient their prescription, you should explain your findings and the type of lenses that you recommend.
A338
You should consider the patient’s risk of falling when advising on bifocal or varifocal use.124
A339
You should advise the patient if you think their prescription may change soon, for example if they are going to undergo cataract surgery. The patient can then decide whether they wish to have spectacles made in the meantime.
References
121 Opticians Act 1989 s26(2) [Accessed 1 Nov 2023]122 Sight Testing (Examination and Prescription) (No 2) Regulations 1989 SI 1230 [Accessed 1 Nov 2023]
123 British Standards (2004) Spectacle lenses - Specification for the presentation of prescriptions and prescription orders for ophthalmic lenses [Accessed 17 Nov 2023]
124 The College of Optometrists and British Geriatrics Society (2011) The Importance of Vision in Preventing Falls [Accessed 1 Nov 2023 ]
A340
You must only prescribe or recommend a change of spectacles when it is in the patient’s best interests to do so.125 NHS Counter Fraud Services have a remit to pursue cases where sight tests are carried out at inappropriate intervals and spectacles are supplied when they may not be clinically necessary.126, 127, 128
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You must make a professional judgement about whether a patient would benefit from a prescription for a low refractive error, for example small hypermetropic corrections in children. See section on Examining and managing patients with an anomaly of binocular vision.
A342
If you supply prescriptions of less than +0.75 R&L, to children for example, you must:
- be sure of the clinical need for the spectacles
- be able to explain the reason for prescribing them
- keep a record of the reason and any advice given.
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If you make a small change to an existing prescription you must:
- be clear about the benefit of the change
- keep a record of the reason and any advice given.
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If you are unable to provide the justifications in the above paragraphs, the Counter Fraud Services may consider you have been overprescribing and take action against you. See section on Information for small prescriptions, below.
Information on small prescriptions
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The following examples should assist you in deciding whether or not a prescription is likely to be beneficial:
- plus prescriptions of less than +0.75DS (binocularly) are unlikely to be of benefit to children under 16, unless there are clinical indications for giving such a low prescription or there are persuasive psychological reasons for doing so. Factors to consider include:
- a particularly low amplitude of accommodation
- ocular muscle balance problems at distance and/or near
- low fusional reserves
- poor health of a patient resulting in the need to correct low degrees of ametropia. If this is likely to be of short duration, you should consider whether the prescription will still be necessary when the patient’s health improves
- if a low prescription is found in one eye only, you should consider the points above and, in particular, whether the patient will benefit from such a low prescription in one eye only
- if you decide to prescribe a small prism (less than 1 prism horizontally or 0.5 prism vertically), you should take into account all the clinical factors including the patient’s ocular muscle status, and whether the use of the prism is appropriate. You should consider any presenting symptoms
- a small change in prescription (e.g. +0.25DS extra in both eyes) may be justifiable in some circumstances but not in others. For example, changing a +1.00DS reading prescription to a +1.25DS may well have significant benefits to the patient whereas changing a +8.00DS to +8.25DS is likely to have much less effect
- you should consider factors such as the patient’s visual acuity and ocular muscle balance. A small prescription change in a patient with poor visual acuity may not be as significant as one in a patient with good visual acuity
- in very high powers you should be aware that the manufacturing tolerances and/or the effect of very small changes in back vertex distance make 0.25DS changes meaningless.
References
125 General Optical Council (2016) Standards of Practice for Optometrists and Dispensing Opticians paragraph 7.6 [Accessed 1 Nov 2023]126 NHS Counter Fraud Authority [Accessed 1 Nov 2023]
127 Counter Fraud and Probity Services (CFPS) (Northern Ireland) [Accessed 1 Nov 2023]
128 NHS National Services Scotland- Counter Fraud Services [Accessed 1 Nov 2023]
A346
The PD is one of several facial measurements that are taken as part of the dispensing process. It is not part of the prescription.
The College of Optometrists: information and guidance on myopia management [Accessed 1 Nov 2023]
Elliott DB and Howell-Duffy C (2015). ‘Non-tolerances’ and the science of prescribing spectacles. Optometry in Practice;16:4:131-144 [Accessed 1 Nov 2023]
Leat SJ (2011). To prescribe or not to prescribe? Guidelines for spectacle prescribing in infants and children. Clin Exp Optom; 94:6:514-527 [Accessed 1 Nov 2023]
