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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: Red Flags in Practice

Scenario 5: Retinal Detachment Symptoms

Scenario

You are in clinic when a 58-year-old patient with high myopia presents, anxious and reporting new flashes of light and a curtain-like shadow affecting the temporal field of the left eye that began last night. They are worried about sudden visual change and ask what should happen next.

What pathway should you follow?

Treat as urgent. ^[3]^[2]
Record onset, progression, and any history of recent trauma or ocular surgery; check visual acuity and pupils. ^[1]^[6]
If you are competent and have time, perform a dilated fundus examination, but do not delay referral to complete non-essential tests. ^[1]^[3]
Arrange same-day assessment by the retinal service; advise detachment precautions and document the discussion and exact timings. ^[2]^[1]

Scenario 6: Headache with Blurred Vision

Scenario

A 45-year-old attends with a severe new headache, intermittent visual blurring, and nausea. On examination there is concern for disc swelling. The patient is distressed and seeking urgent assessment given the potential for a serious intracranial or systemic cause.

How do you escalate?

Prioritise systemic risk. ^[4]
Screen for focal neurological deficit, sudden thunderclap onset, and systemic symptoms; avoid mydriasis if it will delay urgent neuroimaging. ^[4]^[6]
Refer immediately via the ED or neurology urgent pathway with a concise clinical summary and your contact details. ^[3]^[4]
Provide written advice to the patient; document the patient's capacity, understanding, and the exact time of escalation. ^[4]

References (numbered in text)

Examining patients who present with flashes and floaters - The College of Optometrists Find (opens in a new tab)
Detached retina (retinal detachment) - NHS Find (opens in a new tab)
Annex 4: Urgency of referrals table - The College of Optometrists Find (opens in a new tab)
Headaches in over 12s: diagnosis and management (Clinical guideline CG150) - National Institute for Health and Care Excellence. 2012 Find (opens in a new tab)
Association of Myopia and Intraocular Pressure With Retinal Detachment in European Descent Participants of the UK Biobank Cohort: A Mendelian Randomization Study — Xikun Han, Jue-Sheng Ong, Jiyuan An, Jamie E Craig, Puya Gharahkhani, Alex W Hewitt, Stuart MacGregor. JAMA Ophthalmology. 2020 Find (opens in a new tab)
Idiopathic intracranial hypertension: consensus guidelines on management — Susan P Mollan et al. Journal of Neurology, Neurosurgery & Psychiatry. 2018 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):

Treat suspected retinal detachment as an urgent same-day pathway.
Record onset, progression, trauma/surgery history and document timings.
Check visual acuity and pupils; perform dilated fundus exam if competent and it will not delay referral.
Do not delay referral to complete non-essential tests; arrange same-day retinal service assessment.
Provide clear detachment precautions and written patient advice; document discussions and understanding.
For severe headache with blurred vision prioritise systemic/neurologic risk and screen for thunderclap onset or focal deficits.
Avoid mydriasis if it will delay urgent neuroimaging; escalate immediately via ED/neurology with concise clinical summary and contact details.
Document capacity, consent, the exact time of escalation and any safety-netting given.

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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 3: Red Flags in Practice’. Mecourse Lifelong Learning [Online]. Available at: https://www.mecourse.com/scenario-page-3-red-flags-in-practice [Accessed 12 May 2026].

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Mecourse Lifelong Learning. Scenario Page 3: Red Flags in Practice [Internet]. Mecourse Lifelong Learning; 2025 Aug 22 [cited 2026 May 12]. Available from: https://www.mecourse.com/scenario-page-3-red-flags-in-practice.

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Mecourse Lifelong Learning. “Scenario Page 3: Red Flags in Practice.” 2025. https://www.mecourse.com/scenario-page-3-red-flags-in-practice. Accessed May 12, 2026.

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Mecourse Lifelong Learning. (2025, August 22). Scenario Page 3: Red Flags in Practice. https://www.mecourse.com/scenario-page-3-red-flags-in-practice

IEEE

Mecourse Lifelong Learning, “Scenario Page 3: Red Flags in Practice.” Mecourse Lifelong Learning. https://www.mecourse.com/scenario-page-3-red-flags-in-practice (Accessed: May 12, 2026).

AMA

Mecourse Lifelong Learning. Scenario Page 3: Red Flags in Practice. Mecourse Lifelong Learning. Published August 22, 2025. Accessed May 12, 2026. https://www.mecourse.com/scenario-page-3-red-flags-in-practice.

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Scenarios: Red Flags in Practice

Scenario 5: Retinal Detachment Symptoms

Scenario 6: Headache with Blurred Vision

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