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Glaucoma (chronic open angle glaucoma) Referral Access Criteria

Glaucoma (chronic open angle glaucoma) Referral Access Criteria

Referrers should use this page when referring patients to public adult ophthalmology outpatient services for glaucoma (chronic open angle).
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.
  • Nil
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate ophthalmology assessment (seen within 7 days):
  • Acute angle closure glaucoma (unilateral red eye associated with pain, nausea, loss of vision, photophobia, steamy cornea, hard tender globe, ‘rainbows’ around lights, or sluggish pupil reactions)
  • Congenital glaucoma e.g. big eye/s, cloudy cornea, photosensitive, tearing
  • Patients with intraocular pressure (IOP) >35mmHg
  • Patients with elevated IOP of 25-35 mmHg with accompanying signs (e.g. uveitic glaucoma)
  • Uveitic glaucoma, neovascular, lens related glaucoma, unstable secondary glaucoma

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).
  • Suspected or known glaucoma
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 treatment and outcome
  • Relevant history, onset and duration of symptoms
  • Family history             
Examination
  • Nil
Investigations
  • Most recent optometrist or private ophthalmologist report including:
    • Visual acuity
    • Refraction
    • Intraocular pressure (IOP)
    • Gonioscopy
    • Pachymetry
    • Visual fields
    • Disc assessment            
Highly desirable
History
  • Nil             
Examination
  • Nil
Investigations
  • Other relevant optometrist or ophthalmologist reports/results such as:
    • Optical coherence tomography (OCT)
    • Retinal nerve fibre layer results
    • Optic disc photos
Indicative clinical urgency category

Category 1

Appointment within 30 days

  • Likely diagnosis of glaucoma and any of the following:
    • IOP 30-35 mmHg
    • severe disc damage
    • severe field loss             

Category 2

Appointment within 90 days

  • Likely diagnosis of glaucoma and any of the following:
    • signs of early disc damage or field loss consistent with glaucoma
    • IOP >28mmHg <30mmHg without disc damage or field loss
    • suspicion of narrow iridocorneal angles with risk of angle closure glaucoma           

Category 3

Appointment within 365 days

  • IOP ≥22mmHg < 28mmHg with any of the following:
    • central corneal thickness <555
    • high risk medicine (e.g. steroids)
    • history of trauma
    • pseudo exfoliation
    • pigment dispersion
    • very high myopia
    • family history             
Exclusions
  • Nil
Useful information

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