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what change occurred to the “Rules relating to Injury or Disease of the Eye, 1999” on 01/01/2000 regarding optometrists

the change in law allowed optoms to manage patients’ conditions and only refer when clinically necessary.

prior to that, all optoms had to refer abnormal or pathological findings to a registered medical practitioners at all times


what is the speed of a routine referral and who does it get sent to

- Generally 5-6 weeks
- Generally via the General Medical Practitioner
- But may be a routine direct referral to the hospital e.g. for cataract surgery or AMD


what is the speed of a urgent referral and who does it get sent to

- To be seen within one week
- To an ophthalmology outpatient clinic (either via the GP or directly referred to the clinic)


what is the speed of a emergency referral and who does it get sent to

- Within 24 hours
- To eye casualty, ophthalmic outpatient clinic, or Accident and Emergency


what is the AOP's advice if a patient refuses to be referred

- Write to patient explaining what you found and your advice
- Enclose referral letter which they can take to their GP or A and E
- Letter should be “signed for” to give evidence of postage and receipt
- Keep the receipt and keep a copy of everything!


list 6 things that a good referral should contain

- Date
- Full name referring optom and practice address
- Full details of patient:
Name, address, phone no., date of birth
Reason for referral
Supporting signs and symptoms
Reports of relevant tests, including copies of data
- Provisional diagnosis
- Indication of urgency
- Letters should be marked “Private and confidential”


list 4 key aims that a referral should meet

- Outlines the reason for the referral
- Identifies the unusual or abnormal findings
- Recognises the skills and knowledge of the recipient
i.e. GPs versus Ophthalmologists
- Indicates the speed (relative urgency) of the referral as GP does not have much time to decide on this


list the 5 steps of how to refer

- Use headed paper
- GOS 18 form
- Use an alternative form e.g. Camden and Islington form
- But whatever method you use:
Keep a copy
- Mechanism of getting referral to destination
Routine (Standard) – post letter or give to patient to deliver
Urgent – fax or give to patient to deliver (?Post)
Emergency – give to patient to deliver


how informed should a patient be about their reason for referral (state what the AOP recommends and what the CoO guidelines recommend) and what is a useful way to phrase your referral

AOP (2007) advice on referrals:
The optometrist “must give the patient a written statement that he has done so, with details of the referral”. This is in the Opticians Act (1989)

CoO guidelines:
- the patient should have a written copy of their referral letter or details of their referral
- but not if it may cause harm to them e.g. by making them worried or stressed
- phrasing it as "to exclude" a medical condition is useful as your have to strike balance between not alarming patient and ensuring they will attend RMP!


what is the referral refinement scheme and who is involved in it

- schemes often for patients who have glaucoma etc
- optoms are given further training (so before referring to ophthalmologist, can refer to them)
- these accredited optoms examine all the referrals for glaucoma by the other Optoms and GPs in the area and decide if to refer to hospital or can manage themselves

- Also have schemes (such as in parts of Essex) where GPs refer patients initially to accredited Optoms
Not just glaucoma but all non emergency conditions
In an audit, more than 75% of patients did not need to attend secondary care


what is the repeat measurement scheme and what is its benefits

- Optoms rebook patients to repeat fields and tonometry
- Increases quality of referrals and reduces number of unnecessary referrals
- Saves up to 60% of hospital outpatient costs


what is the direct referral scheme and how does it work

- Particularly useful for Cataract and also for wet AMD in many areas
- Suitable patients are referred directly to the outpatient clinic in the hospital (ophthalmologist)
- Ensures referral letter does reach the ophthalmologist!
- But keep GP informed


what does the NICE guidelines state about at diagnosis the tests that all people who have COAG, who are suspected of having COAG or who have OHT should be offered

(name 5 tests)

- IOP measurement using Goldmann applanation tonometry (slit lamp mounted)
- central corneal thickness (CCT) measurement
- peripheral anterior chamber configuration and depth assessments using gonioscopy
- visual field measurement using standard automated perimetry (central thresholding test)
- optic nerve assessment, with dilatation, using stereoscopic slit lamp biomicroscopy with fundus examination