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GOC Standard 7: Conducting Appropriate Assessments and Referrals in Optical Practice

Providing Safe, Effective, and Timely Patient Care

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GOC Standard 7: Assessments
Appropriate Clinical Care
Patient Assessment & History
History Taking Challenges
Clinical Examination
Adapting Examinations
Red Flags & Risk Factors
Red Flags in Practice
Treatment Within Scope
Referral Best Practice
Referral Decisions
Documenting Assessments
Reflection & Continuous Improvement
Exam Pass Notes - GOC Standard 7
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Scenarios: Adapting Examinations

Scenario 3: Child with Attention Difficulties

Scenario

A 6-year-old in clinic becomes restless and unable to sustain attention during acuity testing and retinoscopy. Multiple attempts at a full subjective refraction are unsuccessful as the child frequently loses focus and disengages.

How can you obtain usable clinical information without distress?

Shift to brief, developmentally appropriate measures and split tasks into short blocks. ^[1]
Use crowded picture acuity or Cardiff cards; employ dynamic retinoscopy or a spot autorefractor as objective baselines. ^[3] ^[4] ^[5] ^[1]
Confirm endpoints with simple binocular balance and plus/minus acceptance rather than lengthy duochrome or extended subjective routines. ^[1]
Document test reliability, note any adaptations used, and arrange a short follow-up when the child is rested. ^[1]
Engage parents with clear, simple goals (comfort, classroom function) and brief home/ school observation advice. ^[1]

Scenario 4: Patient with Severe Vision Impairment Requiring Assessment

Scenario

A patient attends reporting new "misty" vision but cannot see standard acuity charts. Examination must be adapted to provide useful clinical data while maintaining the patient's dignity and minimising fatigue.

How do you adapt while preserving dignity and clinical value?

Replace standard chart-based acuity with functional and objective assessments. ^[2]
Assess pupils, confrontational fields, anterior segment and intraocular pressure; consider OCT or B-scan ultrasound if indicated by history or signs. ^[2] ^[6]
Provide clear orientation, tactile guidance and obtain verbal consent for close-contact tests; avoid low-yield tasks that increase fatigue or distress. ^[1]
Record functional status (navigation, reading, activities of daily living), compare with prior baselines, and escalate promptly if new pathology is suspected. ^[2]

References (numbered in text)

Examining patients with learning disabilities — The College of Optometrists Find (opens in a new tab)
Assessing and managing patients with low vision — The College of Optometrists Find (opens in a new tab)
Crowded letter and crowded picture logMAR acuity in children with amblyopia: a quantitative comparison — Cathy O'Boyle; Sean I Chen; Julie-Anne Little. Br J Ophthalmol, 2016 Find (opens in a new tab)
Screening for visual impairment in older people: validation of the Cardiff Acuity Test — Antony Johansen; Susan White; Pervais Waraisch. Arch Gerontol Geriatr, 2003 Find (opens in a new tab)
Automated screening devices for vision screening in preschool children: A comparison of the PlusoptiX S12C photoscreener and retinomax K+3 autorefractor — Stephen C Hunter; Donny W Suh; Iliana Molina; Jennifer Espinoza. Frontiers in Ophthalmology (Front Ophthalmol), 2022 Find (opens in a new tab)
Update of the ophthalmic imaging guidance — The Royal College of Ophthalmologists, 2021 Find (opens in a new tab)

Key Points

Please take a moment to review these points, reflect on their significance and consider how they apply to your own experiences.

Tick to confirm (optional):

Use brief, developmentally appropriate measures for children (crowded picture acuity, Cardiff cards).
Obtain objective baselines for uncooperative children (dynamic retinoscopy, spot autorefractor).
Confirm endpoints with simple binocular balance or plus/minus acceptance rather than lengthy subjective routines.
Document reliability, note adaptations and plan short follow-up appointments.
Replace standard charts for severe vision impairment with functional and objective assessments.
Assess pupils, confrontational fields, anterior segment and IOP; escalate imaging (OCT, B-scan) if indicated.
Provide clear orientation, tactile guidance and obtain verbal consent to preserve dignity.
Record functional status (navigation, reading), compare with baseline and escalate if new pathology suspected.

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Course Snapshot

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Length: 60 minutes CPD (1.00 CE Credits)
Appropriate for: Optometrists, Dispensing Opticians, Optical trainees, Clinical leads in community eye care, Primary care clinicians involved in eye-care triage.
Course Price: Free
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Harvard

Mecourse Lifelong Learning (2025) ‘Scenario Page 2: Adapting Examinations’. Mecourse Lifelong Learning [Online]. Available at: https://www.mecourse.com/scenario-page-2-adapting-examinations [Accessed 12 May 2026].

Vancouver

Mecourse Lifelong Learning. Scenario Page 2: Adapting Examinations [Internet]. Mecourse Lifelong Learning; 2025 Aug 22 [cited 2026 May 12]. Available from: https://www.mecourse.com/scenario-page-2-adapting-examinations.

Chicago

Mecourse Lifelong Learning. “Scenario Page 2: Adapting Examinations.” 2025. https://www.mecourse.com/scenario-page-2-adapting-examinations. Accessed May 12, 2026.

APA

Mecourse Lifelong Learning. (2025, August 22). Scenario Page 2: Adapting Examinations. https://www.mecourse.com/scenario-page-2-adapting-examinations

IEEE

Mecourse Lifelong Learning, “Scenario Page 2: Adapting Examinations.” Mecourse Lifelong Learning. https://www.mecourse.com/scenario-page-2-adapting-examinations (Accessed: May 12, 2026).

AMA

Mecourse Lifelong Learning. Scenario Page 2: Adapting Examinations. Mecourse Lifelong Learning. Published August 22, 2025. Accessed May 12, 2026. https://www.mecourse.com/scenario-page-2-adapting-examinations.

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GOC Standard 7: Conducting Appropriate Assessments and Referrals in Optical Practice

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Scenarios: Adapting Examinations

Scenario 3: Child with Attention Difficulties

Scenario 4: Patient with Severe Vision Impairment Requiring Assessment

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