Acute visual distortion Referral Access Criteria

Referrers should use this page when referring patients to public adult ophthalmology outpatient services for acute visual distortion.

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
Acute injury e.g. trauma, burns, chemical exposure, foreign body

Immediate referral
Immediately contact on-call registrar or service to arrange immediate ophthalmology assessment (seen within 7 days):
Post ophthalmic surgery suspected endophthalmitis or other complications – recent Hx surgery or intraocular injection, sudden vision loss, or sudden onset of pain and/or inflammation Retinal artery occlusion – patient with central or branch retinal artery occlusion Sudden severe visual loss e.g. vitreous haemorrhage, retinal detachment or retinal vascular occlusion Corneal graft rejection – if seen on examination Contact lens keratitis, corneal ulcers – H/o contact lens wear with reduced vision or epithelial defect, trauma, pain Uveitis/scleritis – pain, photophobia, circum-corneal congestion +/- vision loss Intraocular pressure >35 mmHg Signs/symptoms of retinal detachment – flashing lights, floaters, curtain/waterfall across vision or shadow of missing vision To contact the relevant service, see Clinician Assist WA: Acute Ophthalmology Assessment (external site)

Immediate referral

Immediately contact on-call registrar or service to arrange immediate ophthalmology assessment (seen within 7 days):

Post ophthalmic surgery suspected endophthalmitis or other complications – recent Hx surgery or intraocular injection, sudden vision loss, or sudden onset of pain and/or inflammation
Retinal artery occlusion – patient with central or branch retinal artery occlusion
Sudden severe visual loss e.g. vitreous haemorrhage, retinal detachment or retinal vascular occlusion
Corneal graft rejection – if seen on examination
Contact lens keratitis, corneal ulcers – H/o contact lens wear with reduced vision or epithelial defect, trauma, pain
Uveitis/scleritis – pain, photophobia, circum-corneal congestion +/- vision loss
Intraocular pressure >35 mmHg
Signs/symptoms of retinal detachment – flashing lights, floaters, curtain/waterfall across vision or shadow of missing vision

To contact the relevant service, see Clinician Assist WA: Acute Ophthalmology Assessment (external site)

Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
Long standing distortion / kinking of lines (ensure not new onset of distortion)

Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason). This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History	Details of previous treatments and outcome
Examination	Best corrected visual acuity (BCVA) – vision with most recent distance spectacles
Investigations	Nil

Highly desirable
History	Nil
Examination	Nil
Investigations	Most recent optometrist or private ophthalmologist report including: Refraction Impact of symptoms Optical coherence tomography (OCT)

Indicative clinical urgency category
Category 1 Appointment within 30 days	Full thickness macular hole
Category 2 Appointment within 90 days	Epiretinal membrane with BCVA worse than 6/12
Category 3 Appointment within 365 days	Symptomatic epiretinal membrane with BCVA 6/12 or better NB: asymptomatic epiretinal membranes with good BCVA (6/9+) should not be referred

Indicative clinical urgency category

Category 1

Appointment within 30 days

Category 2

Appointment within 90 days

Category 3

Appointment within 365 days

Symptomatic epiretinal membrane with BCVA 6/12 or better
- NB: asymptomatic epiretinal membranes with good BCVA (6/9+) should not be referred

Exclusions
Nil

Useful information
For optometry requests see Clinician Assist WA: Optometry Requests (external site)

If you would like to submit feedback on the contents of the Referral Access Criteria, please complete this form.

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