Optometry referral urgency

Introduction

Deciding on referral urgency can be difficult, and the following is designed to give a rough indication of how urgent particular conditions are. The main list on this page is organised by priority of referral, but immediately below is an alphabetical list, with links to the main list. There are additional clinical notes on many of the conditions, as indicated in the main list. The practicalities of referring to my clinics are given here.

This information is offered as a guide only, as clinical situations vary. The following generalisations are based on my own experience, rather than a locally or nationally agreed consensus.

Alphabetical list of retinal disease (click on link for referral urgency).

Age related macular degeneration
    exudative (wet)
    atrophic (dry)
Best disease
Branch retinal artery occlusion
    macular involvement
    macular sparing
Branch retinal vein occlusion
Central retinal artery occlusion
    <24 hours duration
    >24 hours duration
Central retinal vein occlusion
Central serous retinopathy
Choroidal naevus
Choroideremia
Diabetic retinopathy
    background diabetic retinopathy
    mild / moderate non-proliferative retinopathy
    severe non-proliferative retinopathy
    proliferative retinopathy
    maculopathy
Epiretinal membrane
Gyrate atrophy
Hypertensive retinopathy
Lattice degeneration (hospital referral not always required - see clinical notes)
Macular hole
Macular oedema after cataract surgery (pseudophakic macular oedema / Irvine Gass syndrome)
Macular telangiectasia
Posterior vitreous detachment
    asymptomatic (hospital referral not usually required - see clinical notes)
    symptomatic
Retinal detachment
Retinal hole (see clinical notes)
Retinal tear
Retinal macroaneurysm
Retinitis pigmentosa
Shafer's sign positive ('tobacco dust' in anterior vitreous)
Stargardt disease
Toxic maculopathy
Vitreous haemorrage


Retinal referral urgency

Immediate

Central retinal artery occlusion (or branch retinal artery occlusion with macular involvement) of < 24 hours duration.

with macular involvement.

Retinal detachment (keep nil by mouth ) (see clinical notes)

Within 24 hours

New or exudative age-related macular degeneration with suspected neovascularisation (see clinical notes)

Branch retinal artery occlusion not involving the macula

Retinal tears (see clinical notes)

Central retinal artery occlusion >24 hours duration

Posterior vitreous detachment with flashes and floaters (see clinical notes)

Positive Shafer's sign ('tobacco dust' / pigment cells in the vitreous)

Vitreous haemorrhage

Urgent (within one week)

Proliferative diabetic retinopathy (see clinical notes)

Toxic maculopathy

Branch retinal vein occlusion (see clinical notes)

Central retinal vein occlusion (see clinical notes)

Soon (within one month)

Severe non-proliferative diabetic retinopathy (see clinical notes)

Diabetic maculopathy (see clinical notes)

Pseudophakic macular oedema

Central serous retinopathy

Retinal macroaneurysm

Routine

Mild to moderate non-proliferative diabetic retinopathy or background diabetic retinopathy (see clinical notes)

Hypertensive retinopathy (refer urgently to GP to treat hypertension)

Retinitis pigmentosa or other pigmentary retinopathy

Best disease

Stargardt disease

Choroideremia

Gyrate atrophy

Choroidal naevus

Macular telangiectasia

Atrophic (dry) age-related macular degeneration where choroidal neovascular membrane has been excluded (see clinical notes)

Lattice degeneration with atrophic round holes but no tears (see clinical notes)

Macular hole (see clinical notes)

Epiretinal membrane (see clinical notes)