Referral guidelines Flashcards
state duration for non-urgent, early, urgent and immediate referral
non-urgent: >2 weeks, preferably within a month
early: within 2 weeks
urgent: same day
immediate: attend AnE or eye clinic immediately
what is the referral guideline for cataract? typical, white cataract in adult, subluxated cataract and lens induced glaucoma
typical: VA worse than 6/12, PSCC and daily tasks affected:
Non urgent referral if patient is keen for surgery, advice sheet given for all
white cataract in adult: early if cornea clear, urgent if cornea hazy
subluxated cataract: early
lens induced glaucoma: urgent
what is the referral guideline for glaucoma? Van herick <0.25, disc changes, IOP, VF
general: If glaucoma confirmed, early referral
Van herick <0.25: if symptoms present, within 3 days. No symptoms non-urgent. advice sheet
disc changes: non-urgent regardless of iop. advice sheet
IOP: 22-25: non-urgent 25-35:early >35: witin 3 days AACG: immediate give advice sheet
VF: refer based on clinical assessment of possible underlying etiology
what is the referral guideline for AMD? No AMD, early AMD, intermediate AMD, late AMD
No AMD: Small drusen <63μm within 2 disc diameters of the fovea
• No referral required. Follow up annually
Early AMD: Small and medium sized (63-<125μm) drusen
Minimal or no RPE abnormalities (hyper-/hypopigmentary changes within 2 disc diameters of the fovea)
No referral required. Follow up 6 months
Monitor with Amsler Grid
Educate patient on symptoms of wet AMD, dietary/lifestyle modifications
intermediate AMD: Extensive medium sized drusen, or 1 or more large druse (≥125μm) in 1 or both eyes)
Non urgent referral
Educate patient on symptoms of wet AMD, dietary/lifestyle modifications
late AMD: Urgent referral for wet AMD affecting fovea i. Subretinal fluid/haemorrhage ii. Retinal edema iii. Grey-green CNV iv. Pigment epithelial detachment v. Central scotoma / metamorphopsia
Non-urgent referral for geographic atrophy affecting fovea
what is the referral guideline for NPDR? mild, moderate, severe
mild: Microaneurysms onl
- Non-urgent referral
- Advise strict glycaemic control and regular follow up with healthcare providers eg GP, ophthalmologist
moderate: Dot/blot haemorrhages and/or microaneurysms, hard exudates, venous beading, IRMA, CWS (extent
not meeting 4-2-1 criteria of severe NPDR)
Non-urgent referral
-Advise strict glycaemic control and regular follow up with healthcare providers eg GP, ophthalmologist
severe: Haemorrhages in 4 quadrants or venous beading in ≥2 quadrants or IRMAs in ≥1 quadrant
- Early referral (< 2 weeks)
- Advise strict glycaemic control and regular follow up with healthcare providers eg GP, ophthalmologist
what is the referral guideline for PDR?
Severe NPDR and 1 or more of the following
Neovascularization (NVD, NVE, NVI) and/or
Vitreous/preretinal haemorrhages
- Urgent referral (same day)
- Advise strict glycaemic control and regular follow up with healthcare providers eg GP, ophthalmologis
what is the referral guideline for CSME and Diabetic macular edema not meeting the criteria of CSME?
Diabetic macular edema not meeting the criteria of CSME
- Non-urgent referral
CSME
retinal thickening < 500μm of the foveola or
hard exudates <500μm of foveola with retinal thickening which may be outside 500μm or
retinal oedema ≥1 DD, any part of which is <1 DD from the centre of the foveola
- Early referral (< 2 weeks)
- Advise strict glycaemic control and regular follow up with healthcare providers eg GP, ophthalmologist
what is the referral guideline for gradual flashes and floaters onset?
no sign of RD: no referral
px education, warn ssx of RD, avoid rigorous exercise and lifting heavy objects, regular eye check for DFE
what is the referral guideline for acute (<6 weeks) flashes and floaters onset? OR confirmed/ suspected RD?
No sign of RD – Early referral
RD or retinal hole seen - Immediate referral
*timely referral of RD is crucial, quicker tx=higher success rate for surgery.
