Our response to the GOC consultation on the verification of contact lens specifications and definition of aftercare statement

This consultation has focused on GOC's view that verification of the a copy of contract lenses specification is no longer necessary (provided that the specification is clear) and there are no errors or signs of being tampered with. Additionally, a definition of "aftercare" be provided to ensure public safety. Both factors that form Section 27 of the Opticians Act 1989. 

AOP has broadly welcomed the consultations given that it directly responds to feedback we expressed as part of the GOC’s Call for Evidence (CfE) on the Opticians Act 1989 (‘the Act’) last year. However, we feel the proposals could be strengthened with additional safeguards to enhance patient safety. 

Our response

Q5. To what extent do you agree with the content of the draft verification and aftercare statement?

AOP response: Agree

We broadly welcome this consultation particularly given that it directly responds to feedback we expressed as part of the GOC’s Call for Evidence (CfE) on the Opticians Act 1989 (‘the Act’) last year.

It is clearly in the public interest that the core parts of Section 27 of the Act, namely contact lens prescribing and fitting and in-date requirements, will remain unchanged.

However, we feel the proposals could be strengthened with additional safeguards to enhance patient safety as we explain in our answer below.

Q6. Is there anything unclear or missing in the draft verification and aftercare statement?

AOP response: Yes

Verification

We feel that the draft statement on relaxing contact lens verification reflects the technological changes since the Opticians Act 1989, particularly the common use of online and mobile devices in practice settings. We agree with the points regarding the possible burden on the original provider to verify a copy of the specification and the accompanying likelihood of delays and costs to patients.

Where a copy of the specification is provided, in our view a photograph or similar image is acceptable and as per our CfE submission, as long as it hasn’t obviously been tampered with, we are content that verification is not required. Where only the particulars of a specification are provided, most likely into an online form, we agree that verification should still be a requirement.

We also support the proposed caveat to the proposal that:

• The specification or copy of the specification must be clear, does not contain any obvious errors and has not been tampered with

However, where this is the case, in these situations we would like to see the verification statement clarify the requirement to contact the original prescriber. As it stands, it is not clear what the course of action should be in the event of a tampered/erred etc specification. Original suppliers can either provide a copy of the original specification to the patient or gain the patient’s permission to send a copy directly to the supplier.

We note the requirement (5) ‘We continue to expect our registrants to co-operate with all requests for verification.’ However, we also feel the proposals as they stand require greater emphasis on the importance of online suppliers in particular meeting this expectation. As we said in our response to last year’s Call for Evidence (CfE) response on proposals to amend the Opticians Act, it is essential that contact lens suppliers ensure that lenses meet the specification.

Contact lens wear carries various risks of infection and corneal damage (Wolffsohn, J. S., Dumbleton, K., Huntjens, B., Kandel, H., Koh, S., Kunnen, C. M., ... & Stapleton, F. (2021). BCLA CLEAR-Evidence-based contact lens practice. Contact Lens and Anterior Eye, 44(2), 368-397). There are several risks of harm to patients from being supplied with lenses that do not match their specification which can result from a failure to verify contact lens particulars or inappropriate contact lens substitution. These include risks of corneal damage, eye infection, eye discomfort, and poorer visual acuity particularly a risk of failing to meet vision standards for driving.

Our concern is that online suppliers of contact lenses, unlike optical practice suppliers, are not in a position to monitor such patient risks. Therefore, it is important that the verification statement emphasises the particular importance of online suppliers ensuring that specifications are suitable as per the GOC’s proposed verification statement prior to sale.

Aftercare

In our CfE response last year we called for a specific definition of aftercare as mandated by the Act. Therefore, we are pleased that the GOC has accepted the importance of this by consulting on a proposed statement.

We note the GOC’s proposed aftercare definition includes:

• Instructions and information on the inserting, wearing and removing of the contact lenses
• Instructions and information on the cleaning and storing of the contact lenses
• Signs or symptoms the patient should look out for
• Details of who the patient should contact if they have problems with the contact lenses
• The importance of having regular contact lens check-ups

These are all appropriate but we ask that the first point be expanded with a focus on hygiene and care as well as insertion, wearing and removing.

In our view the second point ‘instructions and information on the cleaning and storing of the contacts lenses’ is not sufficiently comprehensive. Without appropriate advice about how to care for, clean, and store their lenses, there is a significant risk that patients develop unsafe contact lens habits. This may increase the risk of developing sight loss-causing infections (Stapleton, F., Keay, L., Jalbert, I., & Cole, N. (2007). The epidemiology of contact lens related infiltrates. Optometry and vision science, 84(4), 257-272). Specifically, acanthamoeba keratitis is a rare but severe corneal infection that affects mainly contact lens wearers in Western countries (Carnt, N., & Stapleton, F. (2016). Strategies for the prevention of contact lens‐related Acanthamoeba keratitis: a review. Ophthalmic and physiological optics, 36(2), 77-92). It can lead to visual impairment and blindness, and it can develop as a result of poor contact lens hygiene and exposure to tap water. This is why regulations that ensure the patient has had a recent contact lens fitting with instruction on hygiene and care and provision of aftercare are essential.

Therefore, it is important that sellers explain the need for correct lens care particularly with regard to exposure to tap water. This is even more important when we consider that whereas in the past patients would habitually purchase their lenses from the initial lens fitter, this is no longer the case.

Our view remains that the severity of the risks of poor contact lens care means patient safety is best served by purchasing their lenses from an appropriately qualified registered professional following a fitting by a similar professional. We also argue that if lens substitution is indicated, patient safety is best served by this also being overseen and authorised by such a professional.

Q7. Are there any unintended consequences of the draft verification and aftercare statement or risks that cannot be mitigated against that the GOC should consider?

AOP response: Yes

The main unintended consequence that may arise from the proposed statement is that it could be read as allowing too much scope for online suppliers who will not be in a position to perform the clinical oversight of optical practice professionals.

In terms of risks that cannot be mitigated against, the prime risk is non-UK supply of lenses. We recognise that such suppliers are by definition outside of the regulatory powers granted to the GOC by the Act.

However, the GOC should work with the UK professional bodies and workforce to help educate the public about the significant risks from unsuitable lens purchases from non-UK regulated suppliers.

This is why we call for an enhanced statement to make specific reference to the duties of online suppliers where the GOC can exercise its authority.

Q8. Are there any aspects of the draft verification and aftercare statement that could discriminate against stakeholders with specific characteristics?

(Please consider age, sex, race, religion or belief, disability, sexual orientation, gender reassignment, gender identity, gender expression, pregnancy or maternity, caring responsibilities or any other characteristics.)

AOP response: No

Q9. Are there any aspects of the draft verification and aftercare statement that could have a positive impact on stakeholders with specific characteristics?

(Please consider age, sex, race, religion or belief, disability, sexual orientation, gender reassignment, gender identity, gender expression, pregnancy or maternity, caring responsibilities or any other characteristics.)

AOP response: No

Q10. Are there any other impacts (including financial) of the draft verification and aftercare statement that you would like to tell us about?

AOP response: No

Please see our responses to Questions 7 and 8.

Q11. Are there any unintended consequences of removing our 2006 statement on the sale and supply of optical appliances?

AOP response: No