Category: Ophthalmology Referrals

Ophthalmology referral guidelines

Ophthalmology WET AMD Referral Guidelines

Scott McLaughlin
Disclaimer

Please note that this protocol is only for referrals from Community Optometry to Health Boards.

Wet AMD Fundus Images

When attaching a fundus image to this referral please bear in mind the following points:

  1. The total size of the attachment file must be less than 2MB.
  2. The image should ideally be sent in PDF format (or JPEG format if unable to save as a PDF)
  3. Please ensure each image shows the patient’s name before sending i.e. rename the file if necessary.

Please consult the manufacturer’s guidelines for the particular brand of camera for instructions regarding how to save images in the appropriate format prior to attachment.

Wet AMD OCT Scans

Please note that full OCT files are too large to be sent through SCI Gateway.

CT information must be sent as a screenshot or a report covering the area of retina in question in PDF format (or JPEG format if you are unable to save as a PDF).

The points above also apply to OCT information.

Please consult the manufacturer’s guidelines for your particular brand of OCT scanner for instructions regarding how to save reports/images in the appropriate format prior to attachment.

Reference:
Lead Clinician:
Review Date:

Ophthalmology Cataract Referral Guideline

Scott McLaughlin
Disclaimer

Please note that this protocol is only for referrals from Community Optometry to Health Boards.

One Stop Cataract Clinic E-Referral Criteria

One Stop Cataract Clinic E-Referral Criteria

Only patients with a Lanarkshire postcode can be referred to the Lanarkshire Cataract Service.

This is a One Stop Service therefore it is ESSENTIAL that the patient understands the outcome of this referral is surgery.

Before completing this e-referral please ensure the following:

  1. Patient is symptomatic due to significant cataract. Patient should actually complain that their sight is not good enough for day to day activity, working, driving etc. Optometrists must ensure that the cataract is causing visual problems. In absence of Posterior Subcapsular Cataract, Visual Acuity should normally be 6/10 or worse to warrant referral. However all cases of cataract induced visual loss should be considered, and the case for unusual referrals e.g. glare, poor contrast etc., should be made in the “Patient History and Details” section.
  2. Patient is keen to have cataract surgery. Patients must have been informed that the cataract can only be dealt with by surgery. Do they feel their sight is affected enough to have an operation?
  3. Patient agrees to take 5% risk of complications and 1:1000 risk of blindness related to cataract surgery
  4. If the cataract is affecting the “only” or “better seeing” eye, does the patient accept the risk of complications/blindness to that eye?
  5. Patient does not have significant ocular co-morbidity. The following conditions are unsuitable for One Stop Referral:
    • Suspicion of Glaucoma
    • Macular Hole
    • Diabetic Retinopathy or Maculopathy
    • Macular lesions that may require OCT e.g. Wet AMD
    • Vitreous Haemorrhage
    • Lid problems, Entropion, Ectropion, Ptosis, Chazion etc.
    • Corneal Scarring / Opacification / Oedema
    • Endothelial Dysfunction (not endothelial pigment)
    • Anterior Uveitis (or signs of past inflammation)
    • Amblyopia / Squint / Recent Onset Dipolopia
  6. Patient does not have significant Medical Pathology such as Diabetes, Angina / IHD, Hypertension, COPD, Tremor
  7. Patient is not taking Steroids, Anti-Coagulants or Prostate Medication e.g. Tamsulosin
    Please refer any of the above (sections 5, 6 and 7) to other Ophthalmology clinics as indicated, noting that patient is NOT SUITABLE for Direct Referral to One Stop Cataract Clinic.
  8. Patient with significant dry macular changes has sufficient cataract that surgery will be beneficial. These patients should be counselled with regard to limited improvements in VA after surgery and the reality of their expected visual outcome. Use the “Ocular Examination” section to inform the receiving ophthalmologist.
  9. Patient does not have Wet AMD: Refer patients to AMD clinic using the appropriate e-referral or paper form.
  10. Patient is not already attending the local eye unit with ocular co-morbidity. In these cases a letter should be sent to the consultant in charge of the patient informing them of findings or changes.
  11. All IOP readings have been made with contact tonometers such as the Perkins or Goldman. In addition, fundus examination should have been carried out by binocular slit lamp technique using an appropriate condensing (Volk type) lens
  12. ALL information requested on the referral template should be provided, including visual acuity and applanation tonometry.
For patients who fit the above criteria:
  1. Give eyelid hygiene instruction and Blepharitis leaflet
  2. Give Cataract Consent Form information leaflet
  3. Contact lens wearers should be advised to remove contact lenses 2 weeks (soft lenses) or 4 weeks (GP lenses) prior to their appointment, to enable accurate pre-assessment
  4. Ensure that the following items are recorded in the “Patient History and Details” section
    • Reason for referral e.g Blurred vision / Glare / Essential Driver / Poor contrast sensitivity / Carer
    • Relevant social history e.g. Working/Driver / Lives alone / Hearing impaired / Mobility impaired
  5. Ensure that the following items are recorded in the “Ocular Examination” section:
    • Do pupils dilate well?
    • Presence of Blepharitis and if treatment started
    • Type of cataract e.g. Nuclear / Cortical / Posterior Subcapsular
    • Presence of an IOL in the other eye
  6. If this is the second eye referred for cataract surgery, please ensure that the “Administrative Information” section is completed with the date of surgery of the first operation.
  7. Send e-referral.
  8. Print a copy of the completed e-referral and send to GP marked “For Information”

Reference:
Lead Clinician:
Review Date: