Introduction

An 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 are often detected in an eye examination.

The 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 or eye exercises.

The modern eye examination

The eye examination has developed enormously 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. There is controversy over whether two of the glaucoma tests (fields and pressures) are included in the NHS test, or whether a separate charge should be made for these. At Cole Martin Tregaskis Optometrists these tests are included in all NHS eye examinations that are carried out on people over the age of 40.

An NHS eye examination is available for children, people over 60, those on low income, and certain people with or at risk of glaucoma or diabetes. With the exception of Professor Evans and Miss Gow, all our optometrists see NHS patients, but Miss O’Leary do not see NHS patients on Saturdays. Mr Harris and Dr Rughani continue to see NHS patients on all the days they work, including clinics on most Saturdays.

The reasons why a growing number of optometrists are limiting the provision of NHS services relates to optometrists’ NHS contract, which dates back many decades. The NHS in Scotland and Wales have updated optometrists’ contract, but England is lagging behind. The main problem is that in England the NHS pays a fixed fee of £18.85 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 far 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. The NHS has recently reviewed primary eyecare services and we hope that this will lead to a fairer system that will allow us to expand rather than contract the range of NHS services that we can provide.

Follow-up tests and the NHS

Occasionally, an NHS eye examination may detect a problem which requires additional testing. The NHS does not allow us to claim for these follow-up tests. The appropriate private fee is shown below.

Fundus photography

We have recently purchased a sophisticated instrument for photographing the back of the eye. This improves our ability to detect and monitor diseases and is a recommended procedure for all patients. This additional procedure is not covered by the NHS fee and the charge is given below.

Items included in a private eye examination

All the tests listed above are included in our private eye examination. Where required, one fundus photograph of each eye is also included.

Professor Evans’ fees

Our principal optometrist, Professor Bruce Evans, has delivered over 250 lectures and has written 150 publications to educate optometrists, including four books. His fees are slightly higher than our standard fees, as shown below.

Professional fees and charges	Usual fee	Prof Evans
Private eye examination	32.00	42.00
Emergency appointment
Contact lens check
Children’s eye examinations	NHS or £24.00	31.50
Combined eye examination and contact lens check	62.00	75.00
Ocular photography (two photographs are included in the private examination fee)	13.00 per 2 photos
Follow-up appointment to repeat visual fields, pressures, or photos	16.00 plus charge per photo

Some of our staff provide specialist additional tests and treatments.

We have separate information leaflets on these procedures, which are listed below.

Additional professional fees and charges	£
Special investigation of visual factors that may be associated with school difficulties, migraine, or epilepsy (includes report)	75.00
Testing with MRC Intuitive Colorimeter & Precision Tints	45.00
Combined eye examination, Adult: special investigation, & colorimetry Child:	145.00 135.00
Detailed orthoptic assessment	62.50
Orthoptic eye exercises (includes 1 appt.)
Second opinion on complicated case
Assessment of dark adaptation per eye
Assessment of tear film function & collagen punctal occlusion	75.00
Silicone punctal occlusion	170.00
Tear duct wash out	37.50

June 2007

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 £16.00 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).

	Mon	Tues	Wed	Thur	Fri	Sat
Prof Evans	P	P		P	P	P
Miss Gow				P		P
Miss O’Leary	NHS & P	NHS & P	NHS & P	NHS & P	NHS & P	P (some weeks)
Mr Harris	NHS & P	NHS & P	NHS & P		NHS & P	NHS & P
Dr Rughani			NHS & P