Consent at a glance

In law, everyone has the right to determine what happens to their bodies [1].

To be valid, consent must be:

• Voluntary
• Given by an appropriately informed person (usually the patient or parent/carer)
• Given by an adult authorised to act on the patient’s behalf if the patient lacks capacity.

In healthcare, informed consent must be obtained at the point of care and throughout treatment. A patient has the right to refuse or withdraw their consent at any point (even in the middle of a procedure).

These principles apply to sight testing, other eye care and the supply of optical appliances.

For community eye services, applying these criteria is largely a matter of common sense and professional judgement.

• Explicit consent is when a patient gives you specific permission to do something orally, in writing or by an affirmative sign or signal
• Implied consent can be assumed from a patient’s actions – e.g. placing their chin on a chin rest for a test they have been informed about or when a regular patient books and attends for a sight test, enters the consulting room and accepts an invitation to sit in the chair.

Note, consent cannot always be assumed, however. For instance, it may be the patient’s first sight test, even though they have attended the practice before, aspects of the sight test may have changed or they may have changed their mind about elements of the test since their last visit.

The more intimate or intrusive a procedure (e.g. moving close to a patient in a darkened room, instilling drops, pulling up eye lids, using a pupilometer, inserting a contact lens or removing a foreign object), the more important it is to check that explicit consent has been given.

Obtaining consent is part of an ongoing discussion and decision-making process between you and your patient. Various routine questions can be used as part of the sight test or other procedure to ascertain consent (with varying degrees of double check), for example:

• “I am just going to/need to [PROPOSED ACTION] in order to [PURPOSE].”
• “Would you mind sitting at this machine/putting your chin here so that I can [PURPOSE]?”
• “I am just going to dim the lights so that I can [PURPOSE].”
• “Would you/could you just look at the top of my left ear?”
• “And now please look to the right and up.”
• “Are you still comfortable?”
• “I am just going to/need to [PROPOSED ACTION] in order to [PURPOSE] – is that all right/do you mind?”

Special care should be taken with vulnerable patients such as children, people with learning disabilities, cognitive impairment, or in domiciliary situations. Using a colleague/chaperone to double-check may be useful in such circumstances.

When in any doubt, consent should always be re-checked and the record noted. This can be by ticking a printed checklist in the patient record. The record should also clearly record if consent is withdrawn, together with any reason the patient gives. The patient however does not have to give a reason.

Always check with your line manager, a senior colleague, FODO, the College of Optometrists, or the Association of British Dispensing Opticians, or take legal advice if you are in any doubt about what form of consent is acceptable or appropriate in any particular circumstance, or how consent should be ascertained in complex or difficult cases.

Read the General Optical Council guidance on Consent.

Read the College of Optometrists guidance on Consent.

Originally published: July 2018

Reviewed: January 2020

Next review date: September 2022

Info: January 2020 original Pdf factsheet converted into online version. Hyperlink updated for GOC guidance and new link added to College of Optometrists consent guidance.

The next review was originally planned for July 2021. This was changed due to prioritising work during the pandemic.

[1] There are some exceptions to this general rule but these do not apply in optics, except in cases of incapacity.