Frequently Asked Questions

I have an older patient who is renewing his licence but has failed the vision standards for the driving test, he is dependent on his car, what do I do?
Advise that they don’t meet the standard for a full license but if you feel there is potential for a limited license subject to an On-Road Driving Assessment. You may refer a driver to have an assessment. If there is a progressive condition you may refer for ophthalmologists opinion. It should be pointed out that an ophthalmologist cannot ‘sign off’ a driver for a restricted licence where they do not meet the standards without a functional on-road assessment.

Can someone with a lazy eye apply for a group 2 licence?
Yes, once the VA in the amblyopic eye is not less than 6/60.

Can someone who has no vision in one eye apply for a Group 2 licence?
No, the VA in the weaker eye much reach 6/60 or better. Group 2 applicants are not permitted to apply for a restricted licence; no medical practitioner or consultant can sign off on such a driver (see ECJ vs Glatzel).

Can someone who is colour blind apply for a group 2 licence?

Yes, colour vision is not a requirement that needs to be examined for driver licence purposes.

Can someone with perfect vision in both eyes but no stereopsis have a group 2 licence?
Yes, once the Visual acuity meets the minimum requirement.

Can I use a confrontation test for group 1
Yes.

What is the best visual field test for group 2
A visual field test that goes 70 degrees out into periphery.

I have a lorry driver in to renew his group 2 licence but he fails to meet the standards, his GP passed him the last time, can I pass him as he has held the licence before?
No, the GP was wrong and there is no grandfather rule. If the driver does not pass today, he still does not pass regardless of previous history. An ophthalmologist cannot ‘pass’ such a driver (see ECJ vs Glatzel).

Click here for a link to ECJ (European Court of Justice) Judgement in the Glatzel case)

This is a message from Dr Peter Davison as per Members Update- you can watch the video of the interview and download a copy of the information for your records.

There appears to be some confusion among members about conditions for testing colour vision of apprentices.

At present there are 13 apprenticeships requiring normal colour vision. As members will know, the first step is for would-be apprentices in this category to take an Ishihara colour vision test with an optometrist or doctor. SOLAS specifically states on its Colour Vision Test Application Form that it: will not accept a Colour Vision Test Statement if coloured filters were needed in order to pass the colour vision test. Most colour vision deficient patients can pass the Ishihara test with the aid of a suitable red filter because they increase the contrast between red and green. However, filters do not correct colour vision and, depending on the colours to be recognized, will in some cases make colour vision even worse. Even in circumstances when they are helpful, will the apprentice or qualified electrician always use the filter at work?

Persons who fail the Ishihara test are entitled to appeal by taking further colour vision tests at the NOC.

I am available to answer any queries which members may have.

Dr Peter Davison

Head of Colour Vision Assessment Unit

National Optometry Centre (Designated Centre for colour vision appeals)

Technological University Dublin

peter.davison@tudublin.ie  086 301 7139

Your professional practice as an optometrist is governed by the Optical Registration Board Code of Conduct & Ethics. It is wise to consult this document whenever a question arises that touches on how you are asked to practice. Click here to open the CC&E.

Are we allowed to remove foreign bodies if we haven’t had training?
CORU states that a procedure can be carried out according to the limits of your training, experience and scope of practice. If you have had experience, then training is not mandatory unless you are removing a more complex foreign body whereby the use of certain instruments is required. The AOI recommends that foreign bodies should not be removed unless you feel competent and experienced to do so.

I completed the independent prescribing course in the UK, but I am told I cannot prescribe over here? Why is this?
An Irish registered optometrist is not regulated to prescribe any medication that is prescription only as listed under the HPRA. The HPRA does not allow optometrists access to prescribe medication and this supersedes scope of training and practice under CORU.

I have concerns about the behaviour/clinical practice/safety of a colleague? What can I do?
You should discuss you concerns with the colleague you may also bring your concerns to the attention of a manager or supervisor at work. You may also report the colleague to CORU if this is appropriate to their regulation (ie optom or optician).

I feel I am being bullied by my manager into what I feel are unsafe clinical practices, what can I do?
Under CORU, you are ethically responsible for clinical practice in your workplace and as such you are entitled to raise concerns with your manager or superior or employer. You may also report the situation to either CORU, HSE or HAS.

Can Irish Optometrists prescribe antibiotics for patients?

NO- nor can an optometrist issue an order to supply under the direction of a pharmacist. A pharmacist may only dispense a prescription for an antibiotic (including Chloromycetin) when the prescription has been issued by a medical practitioner.

I used tropicamide/proxymetacaine drops in my patient for the examination and today the patient phoned to say their vision is affected/worse/blurred. What should I do?

VA prior to instilling drops should have been recorded, along with all and any findings (anterior seg exam etc). Recall the patient and re-evaluate your findings, giving thorough attention to any structure which could have been affected by the use of drops and record all findings. In the event of noting an adverse event as a result of the drops, appropriate action should be taken. This may be asking the patient to return for monitoring or referral to ophthalmology. This is your clinical decision to make and will be specific to each circumstance.

Can I prescribe drops and treatment for dry eyes?

Provided the drops and treatment are OTC and not listed on the HPRA and provided the treatment prescribed is appropriate and within your scope of training and practice, this is permitted.

Page 1 of the most recent scale of fees from PCRS, this was taken from the 2019 PCRS Annual Report.

To view the full report you can click on the link here.

If someone has a medical card, do I have to do their eye test under the medical card or can I charge them privately?

Once your practice is registered under contract with the HSE to see patient with a medical card, you cannot refuse care or treatment to any patient presenting with a valid medical card who has had their application for an eye examination approved by the relevant HSE Office. Where a person presents with a valid medical card but no approval, they must get approval before examination. The contract expressly forbids charging the patient and issuing a refund once the approval is presented.

Can I charge for fields/fundus photo/OCT/repeat IOPs etc on top of medical card?

Medical card contract states all and any tests necessary but the argument exists that fundus photography, OCT and contact lens checks may not part of a routine eye examination and therefore could be chargeable- this is a grey area at best.

I don’t really see children, do I need a Children safety statement in my practice?

Even if you do not examine children, children may still enter your practice with a parent and this requires you to have a children’s first policy. If you do not examine children, your statement should reflect this and state how the child is still protected on entry to your premises.

Given that Optometrists can’t get Garda clearance, how do I manage when a parent cannot come into the testing room with their child? Is it ok for me to see a child alone in my testing room?

A third party must be present at all times when you are with a child. The only person allowed to be in the unaccompanied presence of a child, is one who has the appropriate Garda vetting clearance. Garda vetting for another organisation or role does not transfer to your practice.

Do I always have to do cyclo on all children?

Cyclo is recommended on all young children under age of 5 where the accommodative system is still active. Cyclo is appropriate in older children where signs and symptoms do not correlate with dry ret. If you are considering Myopia Management your should also use a cyclo refraction as your starting point.

An optician who is competition to me is seeing my patients for diabetic grading? Why can’t I do this?
This is outside the remit of the AOI. The competing optician has been recruited by the DRS provider to carry out the test. It may be either for fundus photography or for slit lamp grading.

A local optician who is seeing my patients for diabetic grading is calling the patients back for full eye tests. Are they allowed to do this?
No the optician is expressly not permitted to do this and it is outside the terms of their contract with the NCSS. Any optician behaving in this manner can be reported to the NCSS and is in danger of having their contract suspended. Proof of said transgression must be provided.

OI have clarified with the courts service that Optometrists would be excluded as a right from attending Jury service. They can’t list us as this would require a change to the original legislation (which simply isn’t going to happen). So our advice to you is that you apply to the local office and they will seek clarification from The Jury Office in the Criminal Courts of Justice. State that you are exempt as you are a registered designated as an Essential  Healthcare Professional (use the form that you received).
 
Those who are excused as of right for Jury Duty.

The following persons may be excused as of right from jury service:
» Persons aged 65 and upwards.
» Members of either House of the Oireachtas (the Irish Parliament), members of the Council of State, the Comptroller and Auditor General, the Clerks of Dáil Éireann and Seanad Éireann, a person in Holy Orders, a minister of any religious denomination or community, members of monasteries and convents, aircraft pilots, full-time students and ships’ masters.

» Those who provide an important community service including practising doctors, nurses, midwives, dentists, vets and chemists.
» The following persons if it is certified that their functions cannot be performed by another person or postponed; members of staff of either House of the Oireachtas, Heads of Government Departments, other civil servants, chief executive officers and employees of local authorities, health boards and harbour authorities, school teachers and university lecturers.
» Those who have served on a jury within the last three years or who have been excused by a judge at the conclusion of a previous period of service for a period that has not ended.

A detailed GDPR library is available in the Members Section, the following are the most frequent GDPR queries that we receive.

How much detail do I need to keep on patient records?
All details relevant to the patient’s general health history, ocular istory, family history and the examination you have performed. All tests carried out and the reults of these tests, all information and advice given, all visits to the practice. It is recommended that phone or video calls be logged on the file also. As per GDPR, you should have the patients signed permission to hold such details.

How far back do I keep patient records?
6 years or according to your GDR policy for record retention.

A patient has asked for a copy of his prescription to get glasses on line. He is insisting that I give him the PD, do I have to do this?
If the patient has never purchased glasses from you and therefore a PD has not been taken, no you are not required. If in the past the patient has purchased dispensed glasses from you, you should provide them with this finding under the proviso that the measurement is only relevant to the date of measurement.

A patient who is elderly has something wrong with their eyes but doesn’t want their son/daughter to know. I am worried about them, what should I do, the son/daughter is putting me under pressure to disclose?
Unless the next of kin has court assigned rights, you may not disclose any information to this person

A patient has asked for all of his records, do I give him the original or a photocopy?
A photocopy is acceptable. You must provide all records if this is what is requested.

Do my old patients have to sign data protection of they came to me before the legislation came in?
Existing patients returning to your practice are coming in under new legislation and thereby must still sign data protection agreement.

We encourage any members doing domiciliaries to do a risk analysis based on each specific situation

1. Is the optom fully vaccinated?
2. Is full PPE available (we recommend use of KN95/FFP2 masks)?
3. Is the patient/patients fully vaccinated and will they too use a FFP2/KN95 mask; this is appropriate from a health and safety perspective as you are going into a domicile situation over which you have no control, unlike your own practice
 
After that it is up to each member to determine how they personally feel in terms of risk to the patient and to themselves as to whether or not they are comfortable to provide the service.

Do I have to provide a prescription for a VDU eye test?

This depends on the contract with the company. If you are required only to screen to meet the EU health and safety regulations then there is no prescription generated from the examination, then there is no prescription  to be issued, However, if a refraction has been carried out, then the results of that refraction must be disclosed to the patient. However, if it is only a refraction and not a prescription, then this must be stated on the documentation.

What is a VDU prescription?

It is a prescription for the provision of vocational glasses specifically to use on the computer and for no other purpose. This includes, modified prescription only for intermediate/computer distance. According to Revenue guidance this should make up a very small percentage of those examined and Revenue retain the right to audit VDU prescribing habits.

I do VDU testing and the company wants to use the employees PRSI optical benefit to pay for it, can they do this?

No, PRSI/optical benefit may only be used privately by the patient and it is illegal for the employer to use this benefit to carry out he VDU examination The cost of such an examination must be borne by the employer.

What is the amount a company must pay for a pair of VDU glasses?

There is no lower or upper limit. It depends on the contract between the employer and the provider of the service (save for employees of Government Departments).

GUIDELINES AGREED BETWEEN THE DEPARTMENT OF FINANCE AND THE ASSOCIATION OF
OPTOMETRISTS, IRELAND, IN RELATION TO THE APPLICATION OF THE VDU DIRECTIVE TO
CIVIL SERVANTS

E.U. Council Directive 901270/EEC, Article 9 and Statutory Instrument No. 44 of 1993, Regulation 32,
provide for the protection of workers eyes and eyesight in the use of V.D.U.s.

These place an obligation on employers -including the State – to provide for “appropriate eye and eyesight tests” for those working with V.D.U.s.

(a) before commencing Display Screen work
(b) at regular intervals thereafter, and
(c) if they experience visual difficulties which may be due to Display Screen work.

Workers shall be entitled to an ophthalmological examination if the results of the above tests show that
it is necessary.

All those classified as “V.D.U. Users” are now being provided with these assessments – screening tests
in some cases and full examination in others.

The purpose in these notes is to emphasise the differences in benefits which may exist between
employees of the State, i.e. Civil Servants, and others.

An employer, other than the State, has freedom to provide payments and eye examinations and
prescribed spectacles on whatever basis s/he chooses, provided his decisions do not breach the
Regulations.

7 The State, as the employer of Civil Servants, does not have the same degree of freedom since it is
spending public money and must be publicly accountable for that spending. The State has been and will
be providing for appropriate eye examinations and it should be remembered that Civil Servants are not
entitled to Treatment Benefits from the Department of Social Welfare.

8 The State is therefore particularly concerned with the working of Art.9(3) of the Directive and Regulation
32 of S.1 44 of 1993.
Each of these states……… “And if normal corrective appliances cannot be used the employee concerned
must be provided with special corrective appliances appropriate to his work.”

9 Objective consideration of this Regulation must attempt to distinguish between “normal” and “special” in
this context. It follows, therefore, that those workers who are found to have refractive errors which may
cause difficulty when using V.D.U.s. but not in any other circumstances could be considered to require “
special corrections”. Where, perhaps because of age and of the accommodative and/or converging
capabilities of the person, a correction is required for the peculiar working distances involved, then such
corrections are more easily classed as “special”. Thus, where a presbyope requires an intermediate
correction for the working distance and would not otherwise have use of it, such could be deemed to be
“special”. Where such a person has need for an accompanying near correction, then Bifocals with
Intermediate upper portion and reading segment might be required.

It is not possible, other than in those general cases stated above, to be absolutely specific about
those whose corrections may be labelled “special”. Professional judgement must be allowed to assist a
decision and members of the Association of Optometrists of Ireland should be scrupulous in making their
decisions.

IN GENERAL, IT IS TO BE EXPECTED THAT BETWEEN 3% AND 5% OF A VDU WORKFORCE WILL
NEED SUCH SPECIAL CORRECTIONS, ALTHOUGH THIS CAN VARY DEPENDING ON THE
PERSONAL CHARACTERISTICS OF A PARTICULAR GROUP OF SUCH WORKERS.

11 Since these “special” corrections will be claimed to be solely for V.D.U. use and since, as with the
other hardware associated with V.D.U.s., the State will be paying for them, then it might reasonably be
required that the “special corrections” required for V.D.U. use be left with the keyboard at the end of a
working day.

12 Because the spending of and accounting for public monies is involved, the Department of Finance has
indicated that it must apply very rigid parameters in its approval or rejection of claims for payment for
spectacles provided under these Regulations.

13 In the case of Civil Servants, therefore, it is desirable that approval be obtained for spectacles to be
supplied at State expense before the patient is led to believe that s/he is so entitled.

14 The examination records supplied by the civil service department must be completed fully, accurately
and legibly, and contain no internal contradictions. If the record is unsatisfactory the department will
return it to you for completion, or request clarification.

15 The following guidelines should be taken into account when completing the form

a) Only one box of the first three points in the “Recommendation” section should be ticked, i.e. point 1 or
2 or point 3. If point 1 or 2 is ticked, a special recommendation cannot be recommended.

b) Where special corrective lenses are recommended, a reason must be given in the space provided.

c) Original Examination forms must be returned directly to the employing department or office, which will
give copies to the V.D.U. users examined.

Appendix 3
Explanatory Note

Refractive Errors:
The eye is a lens system and ‘film'( the retina at the back of the eye), rather like a camera. The process of
light passing through such a system is referred to as “refraction”. Defects in this lens system are therefore
known as “refractive errors” and are usually corrected with spectacle lenses.
The Accommodative and Converging Capabilities of the Person
The lens within the eye is supported by ligaments which allow it to change its shape to alter the focus of
the eye. This is known as ‘accommodation’ and is at its maximum when the person is young, allowing
them to focus on things which are very close to their eyes. As eyes become older, the lens also ages and
becomes less able to change focus. This usually becomes critical for persons in their mid forties requiring
reading glasses. The loss is gradual but continuous and so reading (or close work) glasses require
changing about every two to three years. A person in that category is said to be a ‘presbyope’ and to
suffer from ‘presbyopia’ (old sight). At a certain stage of this loss, the spectacles will confine clear vision
to a distance of about 15 to 20 inches, and looking at a VDU screen is difficult. They then need an
‘intermediate’ correction for that purpose but would also need their close work correction for the keyboard
and documents. They may thus need a special form of Bifocal, with an intermediate
correction in the top and a reading correction in the lower part- ‘normal’ bifocals would have a distance
correction in the top and a reading correction in the lower part.
When a person needs to look at a near object, he or she must change focus to that object. If they have
two working eyes, they must also point the two eyes at the near object and this operation is called
‘convergence’. The change of focus and the change of convergence are linked, so that activation of one
automatically activates the other, but not always adequately. The shortfall has to be provided for,
possibly by the use of lenses, Thus because of the special working distance of the VDU screen, a person
may be able to focus on it but have difficulty keeping both eyes pointed at it. The problems may be
exacerbated by tiredness, illness, lack of interest and aspects of the work station.

https://circulars.gov.ie/pdf/circular/finance/1999/16.pdf

Can I dispense on a prescription from another country/jurisdiction?

Providing the prescription is signed by a person registered in that jurisdiction and is within date.

A patient comes in complaining of vague blurred vision symptoms in one eye, she doesn’t have a cataract, her fundus in healthy, do I need to refer her or can I just call her back/do nothing?

Blurred vision is a symptom that requires resolution or reason and may be suggestive of a sight threatening. It is incumbent on the optometrist to find a reason for blurred vision and in the absence of identifying any reason for this blurred vision, the patient should be referred on.

I have a patient who is generally troublesome in the practice, can I refuse to test them?

Once you have reasonable grounds not to see a patient, you may refuse to test them. Reasonable grounds include non-payment of bills, aggressive or abusive or threatening behaviour towards you or any staff member. The patient must be made aware that they are no longer welcome in the practice under those grounds.

I have been asked to provide files for a legal case (not involving me), what do I have to provide?

You should provide all files as requested. You may provide a photocopy and you may provide written context on the details within those files to add clarity.

Do I need to record phone conversations with patients?

You may not record audio of a phone conversation without the patient’s express permission. However, you should record any phone or video calls made with a patient that are clinically relevant, noting number used, time of call, duration of call, content of call and action taken resulting from call.

The following has been taken directly from the Vat Treatment of Opticians – Document last reviewed June 2024

 Tax and Duty Manual VAT treatment of opticians

The information in this document is provided as a guide only and is not professional advice, including legal advice.  It should not be assumed that the guidance is comprehensive or that it provides a definitive answer in every case.

1  VAT treatment of opticians
This document should be read in conjunction with paragraph 2(5) of Schedule 1 of the VAT Consolidation Act 2010 as amended Document last reviewed June 2024.
Tax and Duty Manual VAT treatment of opticians

2  Introduction
This guidance sets out the VAT treatment of supplies of goods and services made by opticians and how VAT can be reclaimed. Generally, optical services are exempt from VAT. However, the supply of goods, such as spectacles, is taxable. Opticians typically make mixed supplies of exempt services and taxable goods. As such, there are rules on how they charge VAT and on the amount of VAT they can reclaim.

1 Eye testing fees
Eye testing fees are optical services and are exempt from VAT. Such fees should be separately identified if supplied with other taxable supplies of services / goods.

2 Supplies of corrective spectacles and contact lenses
The supply by an optician of corrective spectacles and contact lenses constitutes two supplies, namely:

• a supply of goods,
• a dispensing service

The supply of the corrective spectacles and contact lenses are subject to VAT at the standard rate.

The dispensing services are a supply of professional optical services and are exempt from VAT.

These supplies are typically made for a single consideration. As such, opticians should apportion the total consideration received for the supply of corrective spectacles and contact lenses between the exempt dispensing service and the taxable supply of goods in accordance with Revenue guidance on mixed supplies, unless they apply the 50 / 50 apportionment for opticians.

2.1 The 50 / 50 apportionment for opticians
Revenue are prepared to accept an apportionment of the total consideration which shows up to 50% of the price charged as being appropriate to the exempt service.  Any claims for a higher percentage will be examined to ensure that the optician can justify the percentage claimed.

Tax and Duty Manual VAT treatment of opticians

2.1.1 What if other supplies are made?

Where other types of goods or services are supplied, the income from those supplies should be deducted from the gross income from sales of corrective spectacles and contact lenses in the VAT period. The balance may then be split on a 50/50 basis as representing the exempt dispensing service and the taxable supply of goods, and VAT should be accounted for accordingly.

2.2 Purchases funded by DSP1 or GMS2

Where the purchase of spectacles or contact lenses is entirely funded by payments from the DSP, or covered for medical-card holders by the GMS, only the dispensing fee agreed between these bodies and the opticians’ professional bodies should be treated as exempt from VAT.

The balance of the payment made is liable at the standard rate.

          2.2.1 What if the customer supplements the DSP or GMS payment?

Where an individual customer supplements the DSP or GMS allowance / benefit, the 50 / 50 spilt referred to in paragraph 2.1 above may be applied only in relation to the amount paid by that customer that is in excess of the DSP or GMS allowance /benefit. The portion of the price represented by the DSP or GMS allowance / benefit must be accounted for as set out in paragraph 2.2.

3 Repeat or replacement contact lenses

Where a repeat or replacement contact lenses is supplied with no dispensing service, VAT at the standard rate should be charged on the full consideration.

4 Repair services

Generally, repair services are subject to the reduced rate.

Where there is no dispensing service supplied with the repair service, VAT at the reduced rate should be charged on the full consideration.

1 Department of Social Protection
2 General Medical Services

Tax and Duty Manual VAT treatment of opticians

5 Ancillary items and accessories

Most ancillary items and accessories are subject to the standard rate, such as:

• cases
• chains for spectacles
• coloured lenses
• cleansing solutions
• cloths for spectacles
• non-prescription sunglasses.

These goods should be separately identified and VAT at the appropriate rate should be accounted for.

6 What VAT can be reclaimed?

Opticians may reclaim VAT incurred on the purchase of goods for resale.

However, to take account of the exemption for dispensing fees, there is no entitlement to recover VAT incurred directly with dispensing services. Neither is there an entitlement to reclaim VAT on costs incurred directly for other exempt optical services.

Where a cost relates both to the taxable supplies and the exempt supplies, the optician can only reclaim the VAT for the taxable supplies (i.e. dual use inputs).

7 Intra-Community acquisition / import of optometric or other equipment used for eye-testing

VAT registered opticians must account for VAT in respect of intra-community acquisitions of such equipment.

An optician cannot reclaim the VAT incurred (ICA or imported) on equipment for the provision of exempt supplies only (professional services of an optical nature e.g. eye testing).

The information below has been copied directly from Revenues website

Great Britain (GB) and Northern Ireland (NI) are formally no longer Member States of the European Union (EU).

A Trade and Cooperation Agreement between the EU and the UK has been agreed and was provisionally implemented from 01 January 2021. Following consent by the European Parliament, the Agreement entered into force on 01 May 2021.

The rules of trade with a non-EU country now apply when you trade with GB. You should complete the appropriate customs declarations to allow you to move goods to, from or through GB.

For more information see New to customs.

Department of Transport announced that the mandatory provision of a medical report when renewing a driving licence will increase from 70 to 75 years of age from Monday 21 February 2022.

The National Office for Traffic Medicine supports this change.

The press release from the Department of Transport can be accessed here: https://www.gov.ie/en/press-release/48d1a-increase-to-75-years-of-age-for-the-mandatory-provision-of-a-medical-report-when-applying-for-or-renewing-a-learner-permit-or-driving-licence/#

The announcement also features on Twitter: https://twitter.com/Dept_Transport/status/1494614067956359202?s=20&t=g8W_xb2QcTSet5Row2mD7g

CPD Audit and CPD for Optometrists

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