Sheffield Local Optometric Committee

Repeat IOP measurements in Enhanced services

As the principal provider of professional indemnity insurance to individual
optometrists, the AOP position on enhanced services that rely solely on repeating
intra-ocular pressure measurements is as follows:
1. Repeating the pressures at the time of the sight test on a practitioner’s own
patient and, where necessary, repeating the measurement a few days later is
safe practice and is of benefit to both patient and NHS. This approach is
recommended by the AOP.
2. Accepting a referral from another practitioner with a request and funding to
solely repeat pressures and make a decision on referral creates an
unnecessary risk for the 2nd practitioner. They have not personally observed
the optic nerve and they have no certainty that the visual fields were checked,
yet they may be asked to make a decision not to refer that patient purely on
the basis of pressure measurement. The AOP strongly advises that
practitioners should not accept such referrals.
3. Accepting a request from another practitioner or a referral centre to measure
the pressures and report back is acceptable. The referral decision is thus left
to the first practitioner or referral centre. However, the movement of patient
and reports increases the risk of information getting lost or patients not
attending. With this course of action there should be appropriate failsafe
procedures in place at the referral centre or 1st practitioner to ensure that
results are received and appropriate action taken. The 1st practitioner should
also note that the sight test will not be complete and a GOS1 should not be
submitted until the result of the pressure measurement is received and a
decision on the outcome of the sight test reached. The AOP advises that
practitioners should only participate in such an arrangement if they are
satisfied with the failsafe procedures and where the first practitioner has
systems to delay the final outcome of the sight test until the results are
received.
4. Accepting a referral from another practitioner with a request and funding to
repeat the pressures, check the optic nerve and, where appropriate, check
the visual fields is safe practice and is of benefit to both patient and NHS.
This approach is recommended by the AOP.
The advice of the AOP is that the approaches outlined in points 1 and 4 should be
used. If the majority of practices participate in repeat pressure measurements then
there will be few patients requiring the approach outlined in point 4.
Finally, the AOP wish to confirm that their members will be covered by
professional indemnity insurance in all the scenarios outlined above.
However, being covered by insurance does not mean that an action is
desirable, defensible or safe.

Next Meeting:

Copthorne Hotel
Bramall Lane
Sheffield
S2 4SU

at 7.00pm Monday 4th December

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