Case Study #1
An eligible client
Your client is looking for a pair of eyeglasses but doesn’t have an updated prescription. They have not had an eye examination in two years. The client sees the “Sight Test” infographic posted in your store and asks if they can have a sight test to ensure their new eyeglasses will have the correct visual requirements.
As a Licensed Optician certified to perform independent automated refractions, you explain to your client that you can perform a sight test. You also advise them that is this is not the same as an eye health examination. You review your business’s fees for sight testing with your client and explain that no fees will be charged for the service if any issues arise that indicate a need for an eye health examination. You also explain that you cannot charge for a copy of the assessment record, which is the record you will produce outlining the sight test results.
Next, your client must review and complete the mandatory paperwork. The first document you provide to the client is the Client Information Sheet, Form 1A. The information sheet explains what a sight test is and what it does and does not include. You review the information sheet with your client to help them understand the scope of the service and address any questions or concerns they may have. Then, you ask the client to complete Form 1B: Client History & Eligibility. Forms 1A and 1B must be reviewed/completed by the client before the sight test is performed.
Here’s what you now know about your client:
- They are a 45-year-old with no known medical or ocular conditions.
- They have no family history of medical or ocular conditions.
- Their most recent eye exam was completed by an optometrist 2 years ago.
You double-check the Eligibility Checklist or Eligibility Flow Chart to ensure that your client is eligible for a sight test. You determine that they are eligible because of the date of their most recent eye health examination (which happened since they turned 40).
You complete the sight test and produce an assessment record, which contains the results of the independent automated refraction, as well as the client’s pupillary distance. You provide a copy of the assessment record to your client and charge them the agreed-upon fee for the sight test. You then assist your client in picking lenses and frames to fit their vision needs.
Requirements for conducting an independent automated refraction
You must help your client to understand the difference between a sight test and an eye examination. Remember that your client must review Form 1A and complete Form 1B before you can proceed with a sight test. Of course, you must also ensure that the client is eligible for a sight test—and if they are not eligible, you must be prepared to explain the reasons.
Keep clear and well-documented records in the client record, as per the Record Keeping Checklist. Importantly, ensure that the client record contains their assessment record, which details the results of their independent automated refraction as well as their pupillary distance.
The client must be provided with a copy of the assessment record after the service is completed, whether they request it or not. You cannot charge the client for this first copy of the assessment record; however, you can charge for duplicate copies. You can also charge a fee for the sight testing service itself, in accordance with your business’s policies.
These requirements come from the Opticians Regulation and are not optional.
Case Study #2
A client referred by a prescriber
A 65-year-old diabetic client has just had their second cataract surgery and now needs a new pair of eyeglasses. Due to their age and medical conditions, they are only eligible for an independent automated refraction if their ophthalmologist or optometrist, who has already performed an eye health examination, requests one.
This client had an eye examination performed by their ophthalmologist recently. Their ophthalmologist has referred them to you to complete a sight test and dispense new eyeglasses. Since the client was referred to you, you are not required to provide Form 1A or have the client complete Form 1B. However, because you are not using Form 1B, you make a point of collecting and documenting all of the necessary personal information separately.
You are still obligated to obtain informed consent from the client before and during the sight test. Once the sight test is complete, you provide the client with their assessment record and update the client record—being sure to include a copy of the referral letter.
Requirements for performing an independent automated refraction on a referred client
A client who does not otherwise meet the criteria for an independent automated refraction with an optician may be eligible if referred to the optician by a prescriber.
Under these circumstances, it is essential to document the details of the independent automated refraction, including the fact that the client has been referred by a prescriber who has already completed an eye health examination on the client. Be sure to keep a copy of the referral letter.
Certain aspects of the process will be just the same as they would be with any other client. You must always ensure that your client provides informed consent for a sight test, and you must always communicate the cost of the sight test prior to service. Additionally, the obligation to provide a copy of the assessment record to the client, including pupillary distance, remains the same. You should obtain the client’s verbal and/or written consent before sending a copy of the assessment record to the referring prescriber.
Case Study #3
A 41-year-old client
A 41-year-old client has been noticing some difficulties with reading lately, so she has come in to get her very first pair of eyeglasses. The client has found a frame she likes, but she does not have a prescription. As a Licensed Optician with a certification authorizing you to perform independent automated refractions, you provide the Sight Testing Client Information Sheet (Form 1A) to the client. While reviewing the information sheet, the client advises you that she has not had an “eye test” since turning 40. You realize that she is not eligible for a sight test.
You help your client to understand why she is not eligible for the independent automated refraction: because provincial law dictates that an individual who is 40 or older cannot have a sight text if they have not had an eye health examination since turning 40. You recommend a nearby optometrist that the client can see for her eye examination. You offer to assist her with her eyeglass selection once she has received a prescription.
Best practices with clients who may not be eligible for sight testing
Determining eligibility is an essential first step with any client who expresses interest in a sight test. Use the resources in the Automated Refracting Toolkit and be sure to ask your client plenty of clarifying questions. In this example, you could ask the client if they remember the year in which they had their last eye examination as a response to their comment about the “eye test.” Be prepared to respond to any questions or concerns that may arise when you advise the client that they are not eligible for a sight test. You can use the guidance documents prepared by COBC to assist with these conversations.
According to the Opticians Regulation, you must recommend an eye health examination when a client is deemed ineligible for sight testing. Best practice would be to assist your client in finding an optometrist and/or booking an appointment.
Some client interactions end without any products or services being offered to the client; this is likely to be the case when the client is seeking a sight test that they are not eligible to receive. Nonetheless, best practice is to keep a client record and document the interaction, including the reasons for ineligibility and the recommendations provided.
Case Study #4
A change in dioptres
A loyal client has returned for a sight test and a new pair of eyeglasses. You have previously performed independent automated refractions on this client on two separate occasions, but you nonetheless begin the process by going over the Sight Testing Client Information Sheet (Form 1A) with them, to ensure they still understand the purpose and the process of sight testing. You also check in to see if they have recently had an eye examination to evaluate the overall health of their eyes. After addressing their questions and concerns, you ask the client to complete the Client History & Eligibility form (Form 1B). You review the form and determine that, based on the information provided, they are eligible for a sight test.
You perform the independent automated refraction. Since this client has had sight tests with you before, you check the client record for their previous assessment results. Comparing the new results to the previous one, you notice a 2.25-dioptre increase in the right eye. You inform the client of the change and let them know that they will need to have an eye health examination before you can dispense new eyeglasses to them. You do not charge them for the service.
Considerations based on certain sight testing results
The Opticians Regulation dictates certain situations in which you cannot charge for an independent automated refraction or dispense eyewear based on the results. In this scenario, the 2.25-dioptre change in the client’s right eye is significant enough that the client will need to have an eye health examination before you can dispense new eyeglasses. The Opticians Regulation also states that you cannot charge the client for the independent automated refraction in this scenario.
You may wish to use the Post-Assessment Information sheet (contained in the toolkit) to assist in explaining this to your client. Be prepared to respond to their questions, concerns, and frustrations.
Noting that the client will need to have an eye health examination, it is best practice to assist them in finding an optometrist and/or booking an appointment.
Even if an assessment record cannot be produced and eyewear cannot be dispensed, it is important to document the results of an independent automated refraction, along with the information and recommendations provided to the client.
What criteria from Standard 9: Independent Automated Refraction were considered in the above case studies?
9.1 Be certified by COBC to conduct independent automated refractions.
9.2 Comply with the Opticians Regulation when conducting independent automated refractions.
9.3 Have access to the appropriate equipment to perform independent automated refractions, including one or more computerized components.
9.4 Before conducting an independent automated refraction, work with the client to complete the client notice forms required by the bylaws and obtain informed consent (Form 1A).
9.5 Document any referral or request to provide an independent automated refraction from a prescriber in the client record.
9.6 Communicate the fee for the independent automated refraction to the client prior to providing the service.
9.7 Ensure that all assessment records generated for use in preparing vision appliances are signed by an optician who is certified to perform independent automated refractions and retained in the client record.
9.8 Recommend that the client see a relevant regulated health care professional regarding any indications or complications in the client’s visual or general health as observed during the independent automated refraction.
9.9 After completion of service, provide the client with a copy of the assessment record that:
a. Includes the pupillary distance.
b. Is free of charge.
9.10 Maintain the client record in accordance with Standard 14 and the Opticians Regulation.
For more information on the standards, please review our new Standards of Practice page on our website.