17 April 2025
Orthoptists should be allowed to perform eye examinations to ease ophthalmology waiting lists, the British and Irish Orthoptic Society (BIOS) has said.
BIOS is urging the General Optical Council (GOC) to review regulations on who can perform a sight test and prescribe glasses, allowing orthoptists to be named within the Opticians Act.
This would “enhance patient care by making simpler care pathways with more streamlined clinical decision making” and “provide financial and cost savings for patients and hospital eye services,” BIOS said in its report.
The society notes that it would not expect this right to extend outside the hospital eye service (HES).
The report emphasises that ophthalmology services are continuing to experience long waiting lists for care.
This includes children waiting for routine refraction, delaying further treatment, BIOS said.
Although orthoptists regularly work with ophthalmologists and hospital optometrists in making decisions on spectacle prescription, especially for children and young adults with disabilities, they cannot prescriptions glasses due to not being mentioned in the Opticians Act.
Currently, post-graduate training is the preferred method to upskill orthoptists in refraction and ocular health checks. The proposals note that training to qualify for annotation to the Health and Care Professions Council (HCPC) register would include enhanced eye health training, with the register then including a notation of practitioners’ competency to sign off prescriptions for glasses.
The society described their proposed changes to the existing legislation that controls who can prescribe glasses in the hospital setting as ‘limited.’
The change would “be consistent with meeting the NHS workforce aims to offer care in the right place, at right time,” BIOS said.
Allowing orthoptists to perform eye examinations and prescribe glasses would improve productivity, build broad teams with more flexible skills, and deliver more trained staff in key areas where they are needed, the report added.
A “safe and highly beneficial” change
BIOS noted that the proposed change would relate to Part IV of the Opticians Act, which determines who can conduct refractions and prescribe glasses within a hospital or NHS setting.
Eye health is a large part of the orthoptics undergraduate degree and graduates have the skills and knowledge to carry out eye tests and make decisions on glasses prescriptions, BIOS said.
However, they noted that these skills can be lost after graduation if they are not used.
Additional training “would ensure the same competency standard as their ophthalmology colleagues,” BIOS said.
The change would be “safe and highly beneficial for patients” and would not “be a threat to the optometry profession” but would “allow a highly skilled, registered eye care profession to provide more efficient care benefiting patients within a specialised area of eye care within the NHS/HES setting,” they added.
Dr Peter Hampson, the AOP’s clinical and policy director, said: “It is important that we review the proposals put forward by BIOS carefully, taking on board the variety of views amongst AOP members – including, in particular, those who work in, or aspire to work in, a hospital setting. That is why as a first step we will be consulting with our Hospital Optometrists Committee members to help us fully understand the implications of the proposals.
"We will also be exploring the potential for the proposal to have a wider impact on members who work in other settings. Should a formal consultation be published, the AOP will engage fully with the consultation process and respond on behalf of all its members.”
BIOS consulted with GOC, the HCPC, the College of Ophthalmology, the College of Optometrists and NHS England on the proposed changes.
Comments (6)
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Anonymous24 April 2025
Why do orthoptics at uni if you want to be an optometrist?
Why be an optometrist if you want to be an ophthalmologist?
What next, a cleaner who feels he/she/they want to be a D.O. ?
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Don Williams22 April 2025
My personal view of BIOS Proposal for Orthoptists Performing Refractions and Prescribing Glasses
The proposal by the British and Irish Orthoptic Society (BIOS) to allow orthoptists to conduct eye examinations and prescribe spectacles within NHS hospital eye services (HES) aims to alleviate ophthalmology waiting lists and enhance patient care. The proposal requests that orthoptists be named explicitly within the Opticians Act, following appropriate postgraduate training and registration with the Health and Care Professions Council (HCPC). Every healthcare profession needs to evolve and adapt to changing healthcare demands and orthoptics is no exception.
Pros of the Proposal
1. Alleviating NHS Waiting Lists
Ophthalmology services in the UK currently face severe capacity issues and lengthy waiting lists, particularly affecting paediatric and vulnerable patient groups.
Empowering orthoptists to conduct eye exams and prescribe glasses can help accelerate patient throughput, reducing wait times significantly.
2. Leveraging Orthoptic Expertise
Orthoptists already perform complex diagnostic and therapeutic procedures, including anti-VEGF injections, glaucoma management, and laser procedures such as YAG capsulotomy and SLT.
Given this proven capability in advanced clinical tasks, extending their role to refraction appears both logical and consistent.
3. Enhanced Multidisciplinary Teamwork
Expanding the scope of orthoptic practice enhances a more flexible and comprehensive team, improving clinical efficiency.
Encouraging multi-skilled practitioners creates a versatile workforce capable of addressing diverse patient needs promptly and effectively.
4. Simplified Patient Care Pathways
Allowing orthoptists to prescribe spectacles directly within hospital settings streamlines clinical decision-making, eliminating unnecessary interprofessional referrals.
This integrated approach enhances patient convenience, reduces the risk of errors in communication and improves continuity of care.
5. Cost-Efficiency and NHS Resource Management
Reducing reliance on multiple professionals for straightforward refractions can lead to significant financial savings for the NHS.
Patients would benefit from fewer visits, and hospitals could redeploy resources more efficiently towards more complex ophthalmic cases.
6. Recognition and Retention of Clinical Skills
Orthoptic training already includes extensive eye-health education. Allowing orthoptists to prescribe glasses ensures that valuable skills acquired during training remain active, relevant and effectively utilised.
Cons of the Proposal
1. Concerns Over Professional Boundaries
Some optometrists might feel this move encroaches upon their traditional professional territory, potentially leading to friction or resistance within the eye care community.
Ensuring clear boundaries and respecting professional identities are essential to avoid undermining morale or creating inter-professional tension.
2. Training and Competency Assurance
There may be concerns about ensuring consistent standards of training and competency across orthoptists, particularly initially. It is essential that training pathways, accreditation, and competency frameworks are robust and transparent.
Adequate clinical governance structures must be put in place to ensure patient safety and high-quality outcomes which I'm sure the NHS will.
3. Limited to Hospital Settings
While BIOS explicitly proposes limiting these rights to hospital eye services, there might be pressure in the future to extend these privileges to community settings. This potential expansion would need careful evaluation and additional governance measures.
4. Risk of Diluting Clinical Expertise
There is a theoretical risk that orthoptists taking on additional duties in refraction could become overstretched, potentially reducing their capacity to manage more complex, specialist roles for which they are uniquely trained.
Ensuring adequate staffing and clear scope-of-practice guidelines would mitigate this risk.
5. Perceived Risk of Commercial Impact
Some optometrists may fear a long-term impact on their professional roles, especially if orthoptists eventually transition beyond hospital settings. This could lead to resistance from optical practices or unions concerned about their business models or professional security.
Personal Insight and Conclusion
Orthoptists have demonstrated high proficiency and reliability in performing advanced clinical procedures, including anti-VEGF injections, glaucoma management, and laser treatments. It is indeed compelling to ask: if orthoptists can manage complex ophthalmic procedures, why should refraction, a foundational skill often mastered at undergraduate levels remain out of reach?
I believe that this proposal represents the natural evolution of healthcare professions. It supports innovation, workforce flexibility, and ultimately benefits patients. However, it is vital that any implementation addresses concerns around competency standards, training, patient safety, and interprofessional collaboration transparently and robustly.
Encouraging open dialogue, clear competency frameworks, and collaborative governance can ensure that this innovative step is both safe and highly effective. In doing so, the NHS can move towards a future where each professional's full capabilities are optimally utilised, driving forward patient care and service efficiency.
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Nicholas Rumney10 May 2025
The other Con is that the regulatory framework would now spread across 3 regulators: GMC, GOC and HPC. There is already an issue that the very very few OMP's who are allowed to undertake GOS have no transparency or jurisdiction within the GOC and even within the GMC as the list is maintained by a Trade Union (the BMA). If this comes to pass with the orthoptists they should transfer regulator to the GOC.
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Anonymous18 April 2025
When can optometrist do Phaco?
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Anonymous17 April 2025
This doesn't make sense. Orthoptists do all sorts of eye examinations. They can't do Sight Tests and so are in same / similar position to DO's. If this is only intended within the HES then an appropriately qualified ophthalmologist (FRCOph Part 1) can sign off a refraction and the refraction that leads to an HES(P) Rx is not a Sight Test within the meaning of the Opticians Act is therefore no business of the GOC.
An alternative is for more HES patients needing refraction to be discharged out to optometrists, will even save money as the ST is under GOS and the vouchers also GOS3.
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Don Williams22 April 2025
You highlight an important consideration, discharging more patients needing refraction from the HES to community optometrists under the General Ophthalmic Services (GOS) scheme could indeed offer immediate financial savings for the NHS. However, while this may initially seem cost-effective due to the current GOS-funded sight tests and GOS3 vouchers, the prolonged freeze or limited increments in GOS voucher values may create longer-term sustainability issues for optometrists and optical businesses.
As NHS funding pressures continue, practices reliant on GOS may increasingly question the viability of providing services at the current remuneration rates, potentially prompting them to move away from the GOS model altogether. Some have already done so.
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