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NHS sight tests include unevaluated screening examinations that lead to waste

BMJ 2014; 348 doi: (Published 19 March 2014) Cite this as: BMJ 2014;348:g2084
  1. Michael Clarke, consultant ophthalmologist, Newcastle Eye Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, and reader, Institute of Neuroscience, Newcastle University
  1. m.p.clarke{at}

Eye healthcare is bad medicine, says Michael Clarke, because UK law leads to opticians making too many referrals to doctors

Ophthalmology receives more NHS outpatient referrals than any other specialty apart from trauma and orthopaedics.1 There are reasons why this should be the case: eye disease is a common accompaniment to old age and is associated with systemic diseases, such as diabetes, which are rising in prevalence. A more significant reason lies in the framework under which opticians operate and are regulated in the United Kingdom.

Under section 26 of the Opticians Act, revised in 1989,2 an optician carrying out an NHS sight test has “to perform such examinations of the eye for the purpose of detecting injury, disease or abnormality in the eye” and “immediately following the test to give the person whose sight he has tested a written statement—(i) that he has carried out the examinations that the regulations require, and (ii) that he is or (as the case may be) is not referring him to a registered medical practitioner.” …

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