6.1.5 Recognises common ocular abnormalities and refers when appropriate.

Before referral for further investigation and suspected diagnosis of Glaucoma, all of the following tests should be performed:

• Central VF assessment using standard automated perimetry (full threshold or supra-threshold)

• ON assessment and fundus examination using stereoscopic slit lamp biomicroscopy or ONH image if available.

• IOP measurement using GAT

• Peripheral AC configuration + depth assessment with VH or OCT

Glaucoma

Before deciding to refer, consider:

repeated VFA and IOP measurements on another occasion to confirm a VF defect or IOP of 24mmHg or more

(unless clinical circumstances indicate urgent or emergency referral if needed)

Glaucoma

Refer for secondary care investigation and diagnosis of glaucoma if:

• ONH damage on stereoscopic slit lamp biomicroscopy

• VF defect consistent with glaucoma

• IOP is 24mmHg or more using GAT

What are the visual acuity criteria for cataract referral?

• Binocular VA of 6/9 or worse for drivers

OR

• Binocular VA of 6/12 or worse for non-drivers

OR

• Monocular VA of 6/18 or worse irrespective of the VA of the other eye

What other factors may justify cataract referral?

• Pt is experiencing disabling glare from lights even though visual acuity is relatively unaffected

• Pt lives alone or is the main carer for a partner or other relative

• Significant hearing impairment

• Significant impact on the pt’s day to day activities

When may AMD patients require an urgent HES assessment?

Subretinal haemorrhage and subretinal fluid suggest choroidal neovascularisation. Urgent referral and assessment

Intraretinal haemorrhage centrally and exudates deposition superiorly. There may be subtle subretinal fluid or thickening. The presence of exudates is an important sign of leakage from choroidal neovascularisation. Urgent referral and assessment

Small areas of intra / subretinal haemorrhage amongst the drusen suggest choroidal neovascularisation. Urgent referral and assessment

AMD

If best corrected visual acuity is worse than 6/96..

These patients may require a HES assessment on a non-urgent basis.

They may benefit from LVA assessment, visual impairment counselling and/or registration

Only patients with wet AMD or CRVO will be offered the 2-week pathway