Five steps to dealing with… a declined test

The AOP’s Farah Topia shares her five steps for practitioners to follow if a patient declines a test

5 min read

Optician with man sitting in testing room consulting about vision

Getty/LaylaBird

20 June 2026

Members often contact the AOP’s legal and regulatory team to discuss patients who have refused a certain element of the sight test, for one reason or another. Members are faced with having to make difficult clinical decisions.

Optometrist and AOP clinical adviser Farah Topia, outlines the five steps optometrists should consider to help them navigate what can be a tricky situation.

1 Consider the patient’s reason for refusal

Patients might refuse a certain test for a number of reasons. It could be that they just do not like it, it could be a fear of the test itself, or of what the results might mean for them.

It is important for optometrists to try and understand the underlying reason for refusal, to help shape discussions with the patient. In many cases, it may be possible to help patients overcome this whilst still balancing the need to respect patients’ wishes and their right to refuse a test. For example, if the patient does not like non-contact tonometry, can you offer a different method of checking the intraocular pressure (IOP)?

You should consider whether the test that is being refused will actually affect your clinical decision making

2 Consider the importance and significance of the declined test

Is the patient refusing a test that you consider to be clinically necessary, or something which is only being done in line with practice protocols? You should consider whether the test that is being refused will actually affect your clinical decision making.

If you consider that the test is not essential, for example, routine IOPs in an asymptomatic patient under the age of 30, refusal is not likely to be an issue.

If you consider that the test is clinically necessary, you should try and explain the importance of this to the patient, so they can make an informed decision having considered the risks of not having the test done.

Using IOPs as an example, you can explain that without the test – for instance, checking the pressure of the eye – it is harder to detect signs of eye disease and this could mean that a condition such as glaucoma goes undetected and untreated, leading to permanent sight loss.

Ensuring the patient understands the possible consequences of not having the test is important in allowing the patient to reach an informed decision about their care.

If the patient is refusing an essential part of the sight test such as ophthalmoscopy, you should consider the reasons for refusal carefully and exercise your professional judgment, before deciding whether to continue with the examination.

If the check is being declined without a good reason, perhaps because the patient is in a hurry and just wants a refraction, it would not be in their best interests to provide a sight test, and you should refuse to do so. As an optometrist you have more insight than the patient into the possible consequences of not performing health checks as part of a sight test, and you could be criticised for agreeing to do so without a good reason. External and internal examinations are basic requirements of a sight test as defined by the Opticians Act, so if choose to exercise your professional judgement by omitting them, you must be able to justify your decision, should this ever be questioned.

3 Write a letter to the patient following the sight test

If the patient declines an important test or follow-up, and you feel this is likely to lead to harm, you should consider putting your advice in writing and sending this to the patient, so they can reach an informed decision in their own time.

You should explain the need for the extra test, what the potential consequences might be if they do not have this done and invite the patient to return if they change their mind, or seek medical attention elsewhere.

If you have been unable to conduct an important test, it may be necessary to reach a clinical decision based on the available information

4 Consider if you need to make a referral

If you have been unable to conduct an important test, it may be necessary to reach a clinical decision based on the available information. For example, if the patient has refused visual fields, but their optic discs are suspicious, you might still want to refer them for suspect glaucoma. You should outline in your referral that visual fields were not done because this was refused by the patient. You still need the patient’s consent for referral, and if a patient refuses, we have some guidance on how to manage this situation: Five steps to dealing with… a referral refusal.

If the patient is a child or a vulnerable adult where the refusal has been given by the carer, you should consider whether you might need to contact the local safeguarding team for further advice.

5 Is the sight test considered complete, and can you claim a GOS fee?

NHS England has previously confirmed that a General Ophthalmic Services (GOS) sight test fee can be claimed as long as a reasonable attempt has been made to examine the patient, appropriate records are kept and any legal obligations are met.

If you are not sure whether it is appropriate to submit a GOS claim, you should contact your local NHS team, explain the situation and ask them to authorise the claim, noting the name of the individual giving authorisation and the date clearly on the GOS forms and clinical records.

These situations can be quite complex and difficult to manage. The AOP’s clinical and regulatory team is well placed to offer advice on scenarios such as this, so please get in touch if you need any advice or assistance.