Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • cataract with symptoms suggestive of secondary glaucoma

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Category 1 (appointment clinically indicated within 30 days)

  • unlikely to be category 1 unless significant risk to eye health or the individual / impact on activities of daily living

Category 2 (appointment clinically indicated within 90 days)

  • documented symptomatic cataract with any of the below:
    • best corrected visual acuity (BCVA) of 6/36 or worse in each eye, attributed to or predominantly to cataract formation with normal or reasonable visual potential
    • ocular comorbidities requiring urgent cataract surgery, for example, phacolytic glaucoma, phacomorphic glaucoma, need for posterior segment examination or treatment not possible due to cataract formation.
      • significant impact on activities of daily living
      • the need to maintain a licence
    • cataract-based loss of capacity to safely navigate at home and work
    • severe anisometropia (≥5D)

Category 3 (appointment clinically indicated within 365 days)

  • visually symptomatic cataract
    • a BCVA of >=-6/9 in the better eye, >6/36 in the other
    • no visual symptoms or comorbidities which would otherwise be considered category 1 or 2 priority.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • relevant past medical and surgical history
  • current medications, allergies
  • ocular history:
    • symptoms and duration of clinical presentation
    • surgery and medical management, including glasses and/ or amblyopia therapy
    • medication management
    • other eye conditions for example, unilateral vision
  • eye and vision examination both eyes:
    • best corrected visual acuity (BCVA) both eyes
    • retinal examination information where possible and preferably with dilated pupils
    • slit lamp examination(where possible
  • relevant social information including:
    • driving status / reliance on driving for occupational purposes
    • employment/education associated implications
    • falls risk
    • carer for partner/family member
    • lives alone, unable to manage daily activities due to vision loss
  • photograph with patient’s consent, where secure image transfer, identification and storage is possible where appropriate

Additional information to assist triage categorisation

  • optometrist report less than12 months old at time of referral - highly desirable to ensure issue is cataract
  • visual field test results if applicable
  • recent optical coherence tomography (OCT) if available

Clinical management advice

Untreated cataracts can lead to complications such as secondary glaucoma, inflammation, and vision loss. Cataract surgery is a safe and effective procedure that can remove the cloudy lens and replace it with an artificial one, restoring clear vision and improving quality of life for patients.

Although generally cataracts progress slowly and are not urgent, the impact of the vision loss may increase the urgency of treatment considering potential impact on activities of daily living (ADLs), falls risk, and the ability to work and live independently. This may result in the treatment becoming more urgent.

Clinical resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.