Introduction

image003An eye examination has two important functions. The first is to assess the health of the eyes and to detect any general health problems that may be reflected in the eyes. For example, diabetes and high blood pressure can be detected in an eye examination. The picture on the right shows one of our optometrists, Dr Claire O’Leary, using a binocular microscope to examine the front of the eye under high magnification. We also have special equipment for scanning and photographing the back of the eye and this equipment is described below. For the pressure test, we use a modern instrument (pictured below) which measures the pressure without blowing a puff of air at the eye. Many of our patients tell us that this is the best investment in equipment that we have ever made!

i-care small fileThe second function of the eye examination is to assess how well the eyes see. If there is a problem with the visual or optical performance then we prescribe glasses, contact lenses, or eye exercises. During this part of the eye examination the optometrist typically asks lots of questions, such as ‘Which is clearer, lens one or lens two’. Patients are often concerned that they might answer the wrong question, but there is no need to worry about this. Each question the optometrist asks is repeated three or four times and the average response is recorded. This is not because the optometrist does not trust the patient, but rather because they know how difficult it is for the patient to be sure. By double-checking and treble-checking, the optometrist can be completely confident of the result obtained.

The assessment of the functioning of the eyes is not just about the optics of the eyes, or how well the eyes focus. Several of the tests that optometrists carry out are designed to assess how well the eyes work together as a team. This is sometimes called the binocular co-ordination, or orthoptic function. Our principal optometrist, Professor Bruce Evans, has specialised in this subject and has written several textbooks on this and designed a system of eye exercises.

 

Continued care

Although the practice has records for over 32,000 patients, we are committed to providing personalised care. When our patients return for an appointment, we are usually able to arrange this with the optometrist who they saw last time. Indeed, three of our optometrists have each worked at the practice for over 20 years.

One challenge with over 32,000 patients is keeping an accurate record of your eyes, spectacles, and contact lenses. We have had a computerised reminder system since 1996, but in 2006 we invested in a new state of the art system. This is produced by the leading company that specialises in software for optical practices and allows full integration of our eye examination records, reminder system, spectacle dispensing, contact lens ordering, and even the sketches, photographs, and scans that we take of your eyes. Of course, your details are password-protected for confidentiality and regular back-ups are made of all the data.

 

Children’s eyecare

Parents often ask at what age children should have their first eye examination. Usually, it is best to start eye examinations between the ages of about one and two years. A common mis-perception is that children have to be able to read before they can have an eye examination. This is not the case and all of our consulting rooms have state of the art computerised letter charts, which let us use a range of child-friendly targets including those illustrated in the right. These charts also allow the optometrist to randomise the order of the letters, so that children can now no longer memorise the optometrist’s letter chart! We use lots of tests, that are presented as interesting ‘games’, many of which do not require any participation from the child (other than being awake!).

squint from Google imagesOne problem that parents can watch for is a turning or wandering eye. This is illustrated in the photo on the left. An occasional ‘wandering eye’ in the first three or four months of life is quite common, but should cause concern if it is starts happening more frequently. After the age of about four months, any turning eye is an indication for an eye examination. All our optometrists are able to examine pre-school children, and most provide this care to eligible patients under the NHS (see below).

Most adults reading this will have had their vision screened regularly throughout their school years. Amazingly, this was stopped in the UK a few years ago and in most areas vision is no longer tested at school. This is despite the fact that many visual problems can develop during the school years and children often do not realise that their sight is gradually deteriorating. It is therefore important for school children to have regular eye examinations with an optometrist. Again, these eye examinations are available with most of our optometrists funded by the NHS. Even if a child’s vision has been tested at school the screening tests do not detect all the eye problems that could be detected in a full eye examination with an optometrist. This is one reason why it is recommended that all children have regular eye examinations.

One area of children’s community eyecare that is still not funded by the NHS is a comprehensive assessment of visual factors that may be associated with specific learning difficulties. Our principal optometrist, Professor Bruce Evans, is a world authority on this subject and the testing that these children require is described in more detail in the section on difficulties at school. It is not necessary for children to have received a diagnosis such as dyslexia in order to have these tests.

 

The modern eye examination

The eye examination has developed in sophistication over the years and new techniques have improved our ability to determine the correct spectacle prescription. But the greatest improvement has been in our ability to assess the health of the eyes.

There are over 50 tests that could be included in an eye examination today. Clearly, a large part of an optometrist’s skill is to determine which tests are appropriate.

 

The core eye examination

The basic core elements of an eye examination are listed below:

Visual acuity test (letter chart test)

Basic orthoptic tests (eye co-ordination)

Ophthalmoscopy (looking inside the eyes)

Distance refraction (for distance glasses)

Near refraction (for near glasses)

There are also many additional tests that can be carried out, when appropriate. Some of these are described below.

 

Items included in an NHS sight test

All the tests listed above are included in our NHS eye examination. At Cole Martin Tregaskis both the pressure test and the visual field screening test for glaucoma are included in all NHS sight tests for people over the age of 40. An NHS sight test is intended for determining whether a patient requires glasses and is available for children, people over 60, those on low income, and certain people with or at risk of glaucoma or with diabetes. The NHS HC11 form gives details of eligibility. The NHS sight test is not appropriate for emergency appointments.

We can examine children of any agesWith the exception of Professor Evans and Dr Gow, all our optometrists see NHS patients, but Dr O’Leary does not see NHS patients on Saturdays. Miss Rai and Mr Jiwa continue to see NHS patients on all the days they work, including Saturdays.

The reasons why a growing number of optometrists are limiting the provision of NHS services relates to optometrists’ NHS contract, which in England is very limited in scope and now has fallen behind the situation in Scotland and Wales. The main problem is that in England the NHS pays a fixed fee of about £20 per sight test, and does not pay anything extra for additional procedures. This fee covers less than half the cost of providing a modern, thorough, eye examination. Here at Cole Martin Tregaskis Optometrists our reputation means that we receive many referrals of patients with complex ocular problems. Consequently, we spend more time than average on an eye examination. Also, the NHS pays the same fee for a sight test by a newly qualified optometrist as they do for an optometrist with 20 or 30 years experience. Professor Evans and Dr Gow only see patients privately and this means that an NHS Optical Voucher for spectacles cannot be issued following one of these appointments.

 

Follow-up tests and the NHS

Occasionally, an NHS eye examination may detect a problem which requires additional testing. The NHS in England does not usually fund these follow-up tests and the appropriate private fee is shown below. In 2011 the NHS in Essex started funding a scheme involving optometrists with special interest (OpSIs) who have been engaged to see patients in community practices with certain conditions (e.g., suspected glaucoma) that would in the past have required referral to the hospital eye service. Cole Martin Tregaskis Optometrists has participated in this scheme since its inception. Our staff will advise on whether this is appropriate for you.

 

Optical coherence tomography and fundus photography

TOPCON NW6Technological developments in ocular photography have made it possible to detect eye diseases sooner and to monitor eye conditions with much greater accuracy. We were one of the first practices to invest in this new technology when we bought our first fundus camera in 1999. In 2007 we invested over £10,000 in a new state of the art 10 megapixel camera (pictured on the right).

In 2011 we became the first practice in the area to buy an Optical Coherence Tomography instrument (OCT; illustrated below). This state of the art equipment gives a 3-D scan of the structures inside the retina and more information is given our leaflet on OCT which can be downloaded here. Photography & OCT are not covered by the NHS sight test fee. We recommend that all adults have photos and OCT scans and the charges for NHS patients are given below. Please let reception know when you arrange the appointment if you would like OCT scans. OCT is not usually required for children.

 

Professional




Item

Fees (£)

Silver Eye Exam
(not Prof Evans or Miss Gow)

59.00

Gold Eye Exam

85.00

Contact lens check                  usual:

                                                        Prof Evans:

50.00

66.00

Combined eye exam       Silver Exam:

& contact lens check       Gold Exam:

                                        Prof Evans:

105.00

              129.00

              140.00

Children’s eye examinations   usual:

Prof Evans:

NHS or 42.00

59.00

Ocular photography

(included in Silver & Gold Eye Exams)

28.00

OCT (included in Gold Eye Exams)

48.00

OCT for external referral to us

70.00

Brief follow-up appointment

29.00

At risk of glaucoma follow-up exam (ARGE)

42.00

Emergency appointment

59.00

Orthoptic eye exercises (inc. 1 appt.)

67.00

 

 

Some of our staff provide specialist tests and treatments. We have separate information leaflets on these, which are listed below.

 

Additional professional fees

 

Dr O’Leary/ Mrs Shah

Prof Evans




Special investigation of visual factors that co-occur

with school difficulties, migraine, or epilepsy (includes gold exam & report).

                                                                                                                                       
                                                                                                                                                              

 

Adult:

Child:

 

160.00

122.00

 

195.00

172.00

Testing with MRC Intuitive Colorimeter & Precision Tints

Adult & child:

43.00

55.00

Combined exam, special investigation, & colorimetry

Adult:

Child:

195.00

159.00

231.00

209.00

Professor Evans second opinion on complicated cases (inc. exam)                                          

Or detailed orthoptic assessment (inc. exam)                                                                          

Adult:

Child:

 

180.00

159.00

Myopia control assessment (includes eye exam, but contact lens fitting & lenses extra)

 

 

85.00

 

Kindly note:

·     please allow about 45 minutes to 1 hour for an eye examination, and about 1¼ to 1½ hours for combined appointments

·     a fee of £29.00 is chargeable for appointments not kept without 24 hours notice being given

·     a deposit of 50% is requested upon ordering of spectacles. The balance is due at collection

 

Clinic staff & appointment availability

The table below shows the usual days that clinicians work, and whether NHS appointments are available (P indicates private). Exceptions sometimes occur (e.g., during holidays). Professor Evans has semi-retired from clinical practice to spend more time on research and writing. He is not taking on any new patients, but is happy to recommend one of his colleagues.

 

 

Mon

Tues

Wed

Thur

Fri

Sat

Prof Evans

 

P

 

 

P

 

 

Dr Gow

 

P (some weeks)

 

 

 

P (some weeks)

Dr O’Leary

 

NHS  & P

NHS & P

NHS & P

NHS & P

P (some weeks)

Mrs Shah

NHS

& P

 

 

 

NHS

& P

(some weeks)

P

(some weeks)

Miss Wyss

 

 

NHS & P

NHS & P

 

NHS & P

Pre-registration optometrist

NHS & P

NHS & P

NHS & P

 

NHS & P

 

 

Return to Cole Martin Tregaskis home page.

 

Updated February 2020