NHS Optical Benefits in the UK

In the United Kingdom, state benefits in the form of optical vouchers are used for about one third of all dispensing.

Introduction

In the United Kingdom the Department of Health delivers optical benefits for those on a low income. Most opticians participate. The benefits include free sight-testing and vouchers toward the cost of spectacles.

Many in the UK wear spectacles or contact lenses, and the figures are perhaps surprising. About 68% of adults over the age of 16 wear either spectacles or contact lenses; 65% of men and 71% of women.

A large proportion of those who wear spectacles pay for them, in full or in part, with vouchers. Vouchers are used in 31% of all spectacle dispensing in the UK.

In the year to 31 March 2010 there were 11.8 million free eye tests carried out in England for the National Health Service (NHS), and this represents about 23% of the English population. Of this figure, about 40% were for persons over the age of 60 years. Each optometrist in England, on average, conducted about 1200 such tests in the year.

There were also 4.4 million optical vouchers processed for payment at a cost of £192 million. (About $311 million). It is estimated that vouchers were used by about 8.5 percent of the English population. These and other statistics for such optical services can be found by reference to GOS Activity Statistics 2010

Despite the UK public's involvement with the voucher system, the knowledge needed to determine the amount of voucher benefits lies with the optometrist. It is assumed that the process is considered too complex for the general public. As far as is known, there is no simple brochure for the public that explains how to work out the values.

Purpose

The page does not intend to describe the full range of general optical services (GOS), for which the optician's practice is the best port of call. Nor is this page intended to replace professional advice in any regard. You should know that your optician and optometrist are the best sources of advice on all optical matters. In particular, only they can advise on the entire range of benefit services, and conduct any eye tests that are needed.

This text explains how to estimate optical voucher values from eye prescriptions.

Health Benefit Entitlements

The various groups that can receive free NHS optical benefits are listed on the page NHS Eye Care Entitlements 2012 , as they existed for the year 2012. Entitlement rules change from time to time so be sure to refer to up to date entitlement information for the current year. Up to date information on optical entitlements is available from opticians' outlets in the UK, and dentists can advise on 'their' benefit products. Information leaflets can also be obtained from benefits offices, and from the Health Benefits section of the Department of Health.

The main entitlement points are these:

These benefits, and nearly all other benefits in the UK require that a claimant be ordinarily resident. If there is some doubt, a so-called Habitual Residence Test, an interview, can be conducted to determine this.
At the most general level optical (and dental) benefits are given to those claimants who can show that they have a low income.
Claimants who already receive a means-tested benefit, or who would have if they applied, (underlying entitlement), will usually get full voucher values.
Claimants without means-tested benefits may still receive partial assistance, depending on their income and savings. A tapered calculation applies.
To demonstrate an entitlement to health benefits for a dentist or optician, those with means- tested benefits show a recent entitlement letter, and those without benefits provide a form from the Health Benefits Section of the Department of Health, based on a satisfactory means-testing questionnaire.

Those claimant groups with typical entitlements to optical (and dental) benefits are listed in the drop-box below, though for up-to-date official listings, interested parties should refer to current benefits brochures.

Typical Entitlement Groups for Optical Benefits

UK Entitlements to Sight Tests and Spectacle Vouchers

In the United Kingdom (UK), some individuals are entitled to free sight tests and some others to vouchers toward the cost of spectacles. A description of the health benefit entitlements can be found in the brochure HC11.

The following is a sample of entitlement groups as it relates to the subject material in the main page.

NHS SIGHT TESTS:

UK residents, (those who are ordinarily resident), can get free sights tests if they:

are under 16
are aged 16,17 or 18 in full-time education
are aged 60 or over
are a diagnosed glaucoma patient
have been advised by an ophthalmologist that you are at risk of glaucoma
are aged 40 or over and are a parent, brother, sister, son or daughter of a diagnosed glaucoma patient
have been diagnosed as diabetic
are registered as severely sight-impaired/ blind or sight-impaired/ partially sighted
need complex lenses.
are someone whose sight test is carried out through the hospital eye department as part of the management of your eye condition
are getting, or your partner gets:
– Income Support
– Income-based Jobseeker’s Allowance
– Pension Credit - Guarantee
Incapacity Benefit or Disability Living Allowance do not in themselves count as they are not income-related
are entitled to, or named on, a valid NHS tax credit exemption certificate
are named on a valid HC2 certificate.
Partial help. if named on a valid HC3 certificate because they have a low income, (see HC11 brochure), there might still be some help towards the cost of a private sight test.

NHS OPTICAL VOUCHERS:

UK residents, (those who are ordinarily resident), can get vouchers towards the costs of glasses or contact lenses if they:

are under 16
are aged 16, 17 or 18 in full-time education
need complex lenses. (not necessarily the full voucher, but at least a complex lens increment.)
are getting, or your partner gets:
– Income Support
– Income-based Jobseeker’s Allowance
– Pension Credit - Guarantee
Incapacity Benefit, or Disability Living Allowance do not in themselves count as they are not income-related
are entitled to, or named on, a valid NHS tax credit exemption certificate
are named on a valid HC2 certificate.
Partial help: if named on a valid HC3 certificate because they have a low income, (see HC11 brochure), there might still be some help.

Prescription Terminology

This section introduces some of the terms found on eye prescription forms and gives a little information on their meaning. An understanding of this terminology is not strictly necessary, but some may find it of general interest.

**Table 1**. The format for the voucher table.
Typical eye prescription extract for Mr. A. Person in highest spherical power notation.
	Distance.	Sphere	Cylinder	Axis
	Right eye, (O.D)	+6.5	-1.5	95
	Left eye, (O.S.)	+5.5	-1	85

	Intermediate.	Add
	Right eye, (O.D)	+1
	Left eye, (O.S.)	+1.25

	Near	Add
	Right eye, (O.D)	+1.5
	Left eye, (O.S.)	+1.75

Two fictitious prescriptions have been produced in Tables 1 and 2. These make glasses that are identical, though they look quite different in their number content. They are typical of formats used throughout the world, though in the UK the version in Table 1 is by far the most common. Notice that both lenses in the prescription in Table 1 have higher Sphere values that the ones in Table 2. This format with the higher set of sphere powers is the one that is needed for looking up the NHS voucher values, and it is perhaps this factor that has directed the UK's choice of format.

When an optician encounters a prescription that is not in the format of highest spherical power he simply transposes it. The method used is called flat transposition, and it consists of just a few simple sums. Because a person new to these ideas might become confused by an alternative format, the method to check and transpose prescriptions is included in a separate section.

Another task that your optician would take for granted is the modifying of the distance prescription for near or intermediate use. For voucher checking this just involves adding some numbers so it has been included also.

Refer again to the prescription in Table 1. The main data of interest here describe the powers of the correction lenses. In fact powers are expressed in dioptres. Because dioptre values can be added directly, opticians prefer these to the difficulty of adding focal lengths. The focal lengths, in meters, are the reciprocals of dioptres.

The figures seen in the Sphere, Cylinder, and Add boxes of the prescription are all power values; they are used by the optician to work out the details of lens grinding. Large power values also tell him that more material and more work will be needed to grind the lenses.

Some of the main prescription ideas are these:

There are shorthand methods to express lens prescriptions. One such method for lenses is shown below. Notice that it is written in the sequence sphere, cylinder, then axis. The example describes the two distance lenses of Table 1. The word prescription itself is often just written as Rx.

+6.5   -1.5 X 95   RIGHT
+5.5   -1   X 85   LEFT

**Table 2**. Unsuitable for the voucher table.
The same eye prescription for Mr. A. Person in the more unusual notation.
	Distance.	Sphere	Cylinder	Axis
	Right eye, (O.D)	+5	+1.5	5
	Left eye, (O.S.)	+4.5	+1	175

	Intermediate.	Add
	Right eye, (O.D)	+1
	Left eye, (O.S.)	+1.25

	Near	Add
	Right eye, (O.D)	+1.5
	Left eye, (O.S.)	+1.75

The Sphere column describes the uniform curvature of each lens. It is quite common for the left and right eyes to need different corrections. These curvature components can best be imagined as if they were sliced from the surface of a sphere.
The Cylinder column is not always used. Only those with astigmatism will have these entries. When this is the case, these figures describe the extent to which the eyes' functions deviate from the true spheres. These too are often different for each eye.
The signs for the various lens powers can differ. When we refer to lens powers for benefits vouchers we really mean to say the magnitude of the power, that is to say without regard to the signs of the numbers. Although the signs have importance for the lens-maker and for some calculations, the voucher tables do not need them.
It may still be of interest to know however, that for the lens-maker, negative and positive powers relate to divergent and convergent lens behaviour respectively. If after any transposition, your prescribed lens powers are positive, you might be referred to as far-sighted or long-sighted, since your unaided eyes focus behind the retina. If prescribed negative powers, you might be referred to as near-sighted or short-sighted since your eye's point of focus falls short of the retina.
The Add values are power increments. These are added to their respective sphere figures for reading glasses (near), or for screen viewing glasses (intermediate). These increments are invariably positive and as such their signs are often missing.
The Axis entry states the angle for the cylinder function. It tells the optician the angle from the horizontal at which to add the cylindrical compensation, and although it is of importance for lens-making it does not affect the benefit amount. These often differ for each eye.

In making a lens with a given sphere or cylinder power, it would be possible to have the back of the lens flat and all of the spherical or cylindrical functions on the front. However, this would make a thick-looking lens. In fact the lens maker splits his efforts between the back and front of the lens, so that the two surfaces combine to make the prescribed values. His ability to do this makes for thinner lenses.

Method Summary

The section provides an overview of the method to use in choosing the correct voucher value for a new pair of single-vision glasses. The sequence is as follows:

Inspect the prescription to make sure that both lenses in the distance eye prescription are written in the format of highest spherical power. If they are not, then transpose them so that they both are.
Add the respective sphere increments if the glasses are for near or intermediate use, to make a new prescription.
Conduct a trial-lookup of the voucher tables, noting the category for each lens.
Select the higher of the two category values to be the voucher category for the glasses as a whole.

The sections below explain how to adjust a distance prescription for near or intermediate glasses, how to know whether or not a prescription is in the right format to interpret the voucher table, and if it is not, explains how to transpose it to the format that is. A recent benefits table is included.

Near and Intermediate

If the glasses are for near or intermediate work the respective increments in the add boxes of the prescription must be added to the sphere powers of the distance listing. For example, if glasses for near or intermediate use were needed for the subject in Table 1, their prescriptions could be formed as follows:

Increments to the Distance Prescription of Table 1.

            NEAR GLASSES

    LEFT EYE             RIGHT EYE 

 To the 'distance' prescription:

  +5.5 -1 X 85        +6.5 - 1.5 X 95 

 Add these 'near' values to the sphere:

     +1.75                 +1.5

 To give the 'near' prescription:

  +7.25 -1 X 85       +8 -1.5 X 95

          INTERMEDIATE GLASSES

    LEFT EYE             RIGHT EYE 

 To the 'distance' prescription:

  +5.5 -1 X 85        +6.5 - 1.5 X 95 

 Add these 'intermediate' values to the sphere:

     +1.25                 +1

 To give the 'intermediate' prescription:

  +6.75 -1 X 85       +7.5 -1.5 X 95

Sometimes glasses for near or intermediate work will fall into a higher voucher category than distance glasses, owing to these increments. Higher voucher categories attract higher benefits.

It may also be of interest to know that because increments are invariably positive, they can be added either before or after transposition, without affecting their use in voucher tables.

Transposing the Format

As was mentioned above, there are two optical prescription formats in use. It should not be a surprise to learn that both of these formats make an identical lens. One type of lens prescription will have a greater sphere figure than the other, and within such a highest spherical power prescription, the respective sphere and cylinder for each lens can be found. As an example, the prescriptions in Tables 1 and Table 2 are identical, but Table 1 is written in highest spherical power format and Table 2 in the complementary format. The conversion method is described below.

With practice, these sums can be done in your head, but for those who are unfamiliar with prescriptions, it is best to do a trial calculation in any case, then check to see which of the two has the greater sphere powers. The method is as follows:

For each eye in the distance data:

Add the sphere and cylinder powers, observing their signs; this sum is the new sphere power for the trial format; make sure that you take the signs into account in doing the sum; later, for looking up the voucher table we will use only the magnitude of the found number.
The new cylinder power is found by using the same cylinder power but with a reversed sign; if it was negative then make the new value positive; if positive, then make it negative.
The new axis value is found by adding 90 degrees to the existing value. If the result is greater than 180, then subtract 180 from the number found so that the eventual number does not exceed 180 degrees.
Make a note of the new format in the sequence sphere, cylinder, then axis, and make a note as to which eye it is for.

For example; +10 -3 X 50: right eye.

Transposition Examples

The following two glasses examples show test-transposition and the rewritten results. It is unusual for lenses to be specified in different formats within the same pair of glasses, but it was deemed appropriate here to better demonstrate the method, and to generate worthy examples.

Finding the highest spherical power for both lenses.

              Original            Transposed         Version with     Rewritten
            Prescription         Prescription       Highest Sphere   Prescription  

 LEFT:     +10  -3.5 X 70  =   +6.5 +3.5  X 160      Original       +10  -3.5 X 70
 RIGHT:    +9   +2   X 80  =   +11  -2    X 170      Transposed     +11  -2   X 170         

 LEFT:     -3   -1   X 70  =   -4   +1    X 160      Transposed     -4   +1   X 160 
 RIGHT:    +5.5 -1.5 X 30  =   +4   +1.5  X 120      Original       +5.5 -1.5 X 30

The UK Benefit Rates

The vouchers for single vision spectacles are given in four categories; A, B, C, and D. The table below lists the amounts for 2015-16 and 2016-17; the amounts are usually updated on the first of April of each year. Up-to-date amounts can be found in the official publication HC12: a quick guide to help with health costs: including charges and optical voucher values. For those years that follow a year in which the Retail Prices Index (RPI) was negative, the rates usually stay the same as before.

Table 2: *NHS Maximum Voucher Amounts for Single Vision Spectacles*
Prescription Details	2019-20	2020-21
A. Single vision glasses with a sphere power not more than 6 dioptres, but with cylinder power not more than 2 dioptres.	£39.10	£39.10
B. Single vision lenses: 1. Glasses with a sphere power more than 6 dioptres, but less than 10 dioptres, with cylinder power not more than 6 dioptres; 2. Glasses with a sphere power less than 10 dioptres, and a cylinder power more than 2 dioptres but not more than 6 dioptres.	£59.30	£59.30
C. Glasses with a sphere power 10 or more dioptres, but not more than 14 dioptres, with cylinder power not more than 6 dioptres.	£86.90	£86.90
D. Single vision lenses: 1. Glasses with a sphere power of more than 14 dioptres, with any cylinder power; 2. Glasses with a cylinder power of more than 6 dioptres, with any sphere power.	£196.00	£196.00

Notes on the table:

The voucher amounts tend to not change by much from year to year. For example, no change at all between 2016-2017 and 2017-2018.
The term 'single-vision' means simple glasses for one purpose, as opposed to bifocal.
Table assumes prescription is in the highest spherical power format.

Where vouchers do not cover the cost of the selected product, they reduce the cost at their face value. Although these voucher values are the maximum amounts that opticians can recover from the NHS, they might well make additional marketing offers of their own.

Worked Example

The general method for awarding benefit is repeated here for the convenience of the reader, and fully worked examples for near and distance glasses are given, starting from the prescription of Table 2, i.e., starting from a prescription in other than the correct format.

The method is:

Inspect the prescription to make sure that both lenses in the distance eye prescription are written in the format of highest spherical power. If they are not, then transpose them so that they both are.
Add the respective sphere increments if the glasses are for near or intermediate use, to make a new prescription.
Conduct a trial-lookup of the voucher tables, noting the category for each lens.
Select the higher of the two category values to be the voucher category for the glasses.

Choosing vouchers for glasses using the prescription of Table 2

                                
                                LEFT EYE       RIGHT EYE 

A. 'Distance' prescription:  +4.5  +1 X 175   +5   +1.5   X 5  

   A quick look at the numbers shows that neither of the lens
   prescriptions is in the format of ''highest spherical power''.
   Applying the method shown in the section Transposing the Format
   we obtain the correct format as:   

   'Distance' transposed:    +5.5  -1 X 85    +6.5 - 1.5 X 95     (1) 


B. Now add the ''near'' increments to the ''distance'' sphere values
   to make the reading prescription: 


   Add ''near'' increments:      +1.75            +1.5


   Gives 'near' prescription:  +7.25 -1 X 85    +8  -1.5  X 95    (2)   


C. Then making a trial-lookup for both of these 'near' lenses in the
   voucher table gives:                      

   Trial-lookup 'near' categories:     B               B

               
D. Select the highest 'near' category; 'near' category is:     B  
   

E. Now conduct a trial-lookup for the 'distance' glasses in the
   voucher table:  (using expression (1) )  

   Trial-lookup 'distance' categories: A               B


F. Select the highest 'distance' category; 'distance' category is: B


G. For this claimant, both the 'near' and the 'distance' glasses are
   given a category B optical voucher.  A similar method could be used
   to find the voucher for the intermediate case.

These examples do not go into the details of complex lens benefits, bifocals, varifocals, or other GOS services like repairs. You should know that your optician is the best source of advice on all such optical matters, and that participating opticians, that is to say, all of the largest companies in the UK, can advise on the amount of benefits due for a particular claimant; there is no need to understand all of these details before claiming.

Nonetheless, this description will hopefully allow interested readers to estimate the basic optical benefits for themselves, and perhaps check that the benefits that they have received are correct. In the event that you disagree with an award of benefit, first ask the dispensing optician to review the matter. Beyond that, whether or not there is a right of appeal for optical benefits is unclear.

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