Download Best Practice for Ophthalmic Referrals

Best Practice for Ophthalmic Referrals
Contents
Best Practice for Ophthalmic Referrals ................................................................................................... 1
General Referral Best Practice ............................................................................................................ 1
Cataract Referrals ............................................................................................................................... 2
Glaucoma Referrals ............................................................................................................................. 3
Wet AMD Referrals ............................................................................................................................. 3
General Referral Best Practice
The organisation for booking NHS appointments across Devon is Devon Referral Support Services
(DRSS). This covers TRAC (Tamar Referral and Appointments Centre) and DART (Devon Access and
Referral Team).
The advantages of using the referral forms are that it:



Ensures the referral form is legible:
Ensures the patient is placed in the correct clinic
Ensures a timely referral.
Delays in referrals through the DRSS have been reported due to missing information and the form
being illegible. Please fill out the form completely.
Please choose 1 clinic on the referral form. For patients with multiple co-morbidities— pick the clinic
that is most important and in the free text comments explain other relevant history and symptoms.
Patient and GP Details
Ensure all patient details including the current GP name and address are correct and up to date
before referral. It is important to ask the patient if their details are correct at the point of referral.
This will ensure that there is no delay in referral for the patient.
Non-Ocular referrals
Any referrals for non-ocular conditions such as skin lesions on the cheek must be first referred to the
patients GP.
Referral conditions
When referring patients for Ophthalmic Conditions please choose one condition for referral and put
other relevant information in the free text. Consider which is the most important condition and
which clinic is the best clinic to treat that condition. For example, if a patient presents with cataract
and blepharitis, choose cataract as the reason for referral and place blepharitis in the free text.
Lesions around the eye When referring lesions around the eye please state: How long the lesion has
been present and the size of the lesion.
Blepharoplasty
Blepharoplasty (eyelid surgery) and brow lift is regarded as a low priority procedure and is therefore
not routinely funded by the NHS.
Blepharoplasty with and without brow lift will be funded when the following criteria are met:
•
•
Impairment of visual fields in the relaxed, non-compensated state: Evidence will be required
that eyelids impinge on visual fields, reducing field to 120 degrees laterally and 40 degrees
vertically (20 above and 20 below).
Correction of ectropion (eyelid turns outwards) or entropion (eyelid turns inwards towards
the eye) with ocular irritation and causing functional implications.
All referrals for low priority procedures are to be made via the GP .
Cataract Referrals
Please note that this information is not essential but classified as best practice for cataract referrals
in Devon.
Criteria for surgical referrals:






There should be sufficient cataract to account for the visual symptoms
Is the Cataract affecting the patients quality of life?
Have the risks of the surgery been explained to the patient?
Is the patient available for the next 18 weeks
Is there any other pathology especially any macula changes?
report from a recent sight test
The patient should be informed of the risks and benefits of surgery:
80-90% of patients report a benefit from surgery including improved clarity of vision and improved
colour vision. Surgery in the second eye may allow significant additional gains in visual function in
everyday activities and QoL above and beyond what is achieved after surgery in the first eye [1]:


functional improvement in visual symptoms
ability to meet the DVLA driving standard
The risks include:
Common: bruising of the eye or eyelids , cystoid macular oedema, refractive surprise, dropped
nucleus or fragments, capsule tear, dislocation of the implant lens.
Rare: further loss of visual function (about 0.1% of surgical patients lose vision in operated eye),
infective endophthalmitis (1 in 1000 operations), corneal decompensation, post-operative raised
intraocular pressure, glaucoma, retinal detachment, postoperative infection, in one-eyed patients,
possibility of total blindness, and suprachoroidal haemorrhage.
The patient should wish to undergo surgery - do not refer patients who:


do not want surgery; or
do not feel they need it
Glaucoma Referrals
Please note that this information is not essential but classified as best practice for glaucoma referrals
in Devon.
Best practice for glaucoma and OHT referrals that have been refined by the IOP refinement scheme:
 Visual Fields: You must attach and send with the referral

IOP: Document type of equipment used and the time of the day the reading was taken

Disc assessment: Cup to disc, Pallor, Depth, Lamina cribrosa appearance, vessel structure
and placement

Document any family ocular history
Other information if available:
 Van Herricks: Scale 0-4

Pachimetry

Any other eye pathology
Wet AMD Referrals
For Wet AMD referrals to be as effective as possible then they need to be seen by the Local AMD
centre within 2 weeks. There needs to be a rapid access to a retinal specialist and treatment
irrespective of geographical location. This means that all Devon referrals should be marked as
urgent and where appropriate the
WET AMD forms should be filled out:




Plymouth (REI): Referral form and additional wAMD form
Exeter (RD&E): Referral Form only (send to DRSS)
North Devon (NDDH): Referral form and additional wAMD form
South Devon (SDHCFT): Referral form only (send to DRSS)
For patients attending the REI then please fax the referral and WET AMD form to 01752 398783. For
patients attending NDDH send the additional form to DRSS along with the DRSS referral form. We
advise that your referral should include: all relevant patient data and GP details (as with all referrals
to the Hospital Eye Service), the latest prescription with distance and Near VA's and IOP results. In
the comments section please include:
Affected eye, any large changes in prescription, any co morbidities, any changes to the retina:
including haemorrhages, exudate, Amsler results, and any other information that you feel is
appropriate.