Childhood Glaucoma - Paediatric CPC

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

Southern Adelaide Local Health Network

• Flinders Medical Centre (08) 8204 5511

Women's and Children's Health Network

• Women’s and Children’s Hospital (08) 8161 7000

Exclusions

• second opinions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

• children with suspected glaucoma and corneal haze or asymmetrical eye growth

Category 2 (appointment clinically indicated within 90 days)

• suspected glaucoma
• screening in children with a family history of glaucoma
• medical conditions that may lead to the development of glaucoma
• child at high risk of developing glaucoma as a result of prescribed medication/

Category 3 (appointment clinically indicated within 365 days)

• transfer of care (previously diagnosed glaucoma) requiring ongoing management

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.

• antenatal, birth, developmental, medical, family history. Note any developmental or behavioural issues such as autism spectrum disorder (ASD), and attention deficit disorder (ADD), or attention deficit hyperactivity disorder (ADHD)
• ocular history, including:
  • other eye conditions
  • eye trauma
  • surgery and medical management, including glasses and/ or amblyopia therapy
• eye and vision examination in both eyes:
  • intraocular pressures, if possible
  • pupillary light reactions and red reflexes
  • corneal haze
  • asymmetry of eye size or growth
  • slit lamp examination of cornea and iris, if possible
  • literate children using a visual acuity chart
  • preschool children using a picture or letter matching chart
  • pre-literate children using visual behaviour e.g. ability to fix and follow an object of interest
• visual field assessment, if possible
• optical coherence tomography (OCT)
• optometrist report within the last 3 months
• photograph with patient’s consent, where secure image transfer, identification and storage is possible, where appropriate

Clinical management advice

Glaucoma is not commonly found in children, but it can pose a significant risk to their vision. It is crucial to refer children with glaucoma early on to improve their long-term prognosis. Glaucoma can cause rapid deterioration of eyesight and have lasting effects on the vision of infants and young children.Glaucoma that occurs during infancy or at birth can lead to accelerated eye growth in children under 2 years old and may present with the following symptoms:

• eyes appearing different from one another
• excessive tearing of the eye
• cloudiness of the cornea
• sensitivity to light

Clinical resources

• American Academy of Ophthalmology - Primary Congenital Glaucoma
• Royal Children’s Hospital Melbourne - Glaucoma

Consumer resources

• Royal Children’s Hospital Melbourne - Glaucoma
• Women’s and Children’s Hospital Ophthalmology Fact sheets

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.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.