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.

  • for newly diagnosed proliferative diabetic retinopathy – please call the on call registrar to discuss prior to referral to emergency

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

Exclusions

  • patients without confirmed diabetic retinopathy
  • patients with minimal or mild non-proliferative diabetic retinopathy (NPDR)

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • confirmed diabetes along with any of the subsequent conditions:
    • proliferative diabetic retinopathy (PDR) – please call registrar to discuss
    • vitreous haemorrhage – please call registrar to discuss
    • assessment of diabetic retinopathy during pregnancy

Category 2 (appointment clinically indicated within 90 days)

  • confirmed diabetes along with any of the subsequent conditions:
    • moderate NPDR characterized by multiple microaneurysms, dot-and-blot haemorrhage, venous beading, and/or cotton wool spots
    • non-centre macular oedema
    • centre-involved macular oedema
    • severe non-proliferative diabetic retinopathy (NPDR) characterised by cotton wool spots, venous beading, and severe intraretinal microvascular abnormalities

Category 3 (appointment clinically indicated within 365 days)

  • diabetic retinopathy not otherwise specified

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.

  • pregnancy status
  • relevant past medical/surgical history
  • current medications, allergies
  • ocular history, including:
    • symptoms and duration of clinical presentation
    • surgery and medical management, including glasses/retinal laser
    • diabetes history
    • medication management
    • other eye conditions, for example, unilateral vision
  • eye and vision examination both eyes:
    • best corrected visual acuity
    • retinal examination through dilated pupils were possible including optic nerve, macula and peripheral retinal examination
    • anterior eye assessment with slit lamp examination where possible
  • relevant social information including:
    • employment/education associated implications
    • carer for partner/family member
    • lives alone, unable to manage daily activities due to vision loss
  • optical coherence tomography (OCT) where possible
  • optometrist report less than 3 months old at time of referral
  • photograph – with patient’s consent, where secure image transfer, identification and storage is possible where appropriate

Additional information to assist triage categorisation

  • blood pressure trend/s
  • pathology:
    • complete blood examination (CBE)
    • urea electrolytes and creatinine (UEC)
    • estimated glomerular filtration rate (eGFR)
    • glycated haemoglobin (HbA1C) trends for past 12 months where possible
    • fasting blood glucose results
    • fasting lipids results

Clinical management advice

For individuals diagnosed with type 2 diabetes mellitus, screening for diabetic retinopathy should be performed at the time of diagnosis, with further screenings occurring every two years if retinopathy is not present

Ensure that all people with diabetes have a dilated fundus examination and visual acuity assessment at the diagnosis of diabetes and at least every 2 years

Those with type 1 diabetes should be screened every two years from the onset of puberty.

Patients falling under specific categories, including those with a duration of diabetes exceeding 15 years, suboptimal glycaemic control, systemic disease, foot ulcers, and those of Aboriginal and Torres Strait Islander/culturally and linguistically diverse (CALD) background, should undergo yearly screenings carried out by a community optometrist.

Non-centre involving macular oedema refers to the swelling of the macula that occurs outside the foveal centre, which is the part of the retina responsible for sharp central vision. In the case of diabetic macular oedema, it specifically refers to the thickening that occurs at a distance of two-disc diameters from the foveal centre but not closer than 500 microns. This condition can cause vision problems and is often accompanied by other symptoms such as microaneurysms, haemorrhages, and hard exudates.

Clinical resources

Consumer 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.