Optometry Scotland provides a list of recommended equipment to assist Scottish practitioners in complying with the new GOS contract that will start on April 1.
It is not totally exhaustive or prescriptive, but should be seen as guidance. These are recommendations and should be used with your clinical judgment to provide a standardised service.
There may be local variations in preferred equipment due to shared care schemes, or other agreements between optometry and ophthalmology. These arrangements should be notified to your local area optometric committee.
The list will be updated as new equipment is launched and has been accepted by Optometry Scotland.
Condensing lens
These lenses should be used with a good quality slit lamp biomicroscope capable of more than one level of magnification.
For general undilated indirect ophthalmoscopy:
A super-vitreo fundus lens / superfield 90 dioptre or similar condensing lens can be used.
For dilated indirect ophthalmoscopy:
A condensing lens 90 dioptres / superfield type full field 78dioptres or similar, and a 60 dioptre (x1) or 66 dioptre lens. The higher dioptre will give you a wider field of view, the 60 dioptre (x1) is excellent for assessing optics disc, and the 66 dioptre stereo lens has excellent stereopsis characteristics.
For domiciliary purposes:
It is accepted that slit-lamp bio microscsopy is difficult in a home setting, and practitioners must exercise their clinical judgement accordingly when carrying out an internal examination of the eye.
There are indirect handheld ophthalmoscopes such as those made by Welch Alyn or Keeler that could be used, but even a direct ophthalmoscope with good dilation would be acceptable.
Despite the popularity with some optometrists, head-mounted biomicroscopy is not on the recommended list. Although it gives a wide field of view, it has been agreed between Optometry Scotland and the Scottish Executive that slit lamp bio with a condensing lens is the preferred standard.
Contact applanation tononmetry
For screening purpose you may use a Non-contact tonometer, Tono-Pen, Goldman, or other tonometer design, but for diagnostic, repeat pressures and referral refinement you must use:
- Goldman design slit lamp mounted contact tonometer,
- Perkins hand held contact tonometer
In a domiciliary setting the Perkins is most appropriate.
Visual field testing
The visual field testing apparatus must offer a minimum central 30 degrees full threshold capability.
Obviously a bowl perimeter that offers additional full field assessment will be more advantageous to the practice and allow a more detailed assessment of the patient’s visual field.
Equipment that meets these requirements are:
- Any Humphrey model as above
- Henson 3000*, 3200*, 4000, 5000
- Dicon 400
- Octopus
- Oculus Easyfield
- Medmont Ld400 and TKS500
* The 3000 and 3200 may not be suitable - to be advised.
There are some portable field screeners that might be suitable in a domiciliary environment, such as the Henson 6000, but it is accepted that visual field testing in the home setting is difficult.
It is expected that practitioners will do what can be done in a particular set of circumstances, and exercise their professional judgment for the benefit of the patient.
This article is based on information provided on the Optometry Scotland web site.