Glaucoma - Adult CPC

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

• Royal Adelaide Hospital (08) 7074 0000
  
• The Queen Elizabeth Hospital (08) 8222 6000

Northern Adelaide Local Health Network 

• Lyell McEwin Hospital (08) 8182 9000
  

Southern Adelaide Local Health Network

• Flinders Medical Centre (08) 8204 5511
  

Category 1 (appointment clinically indicated within 30 days)

• suspected glaucoma and any of the following:
  • intra ocular pressure (IOP) between greater than 30 30-35 mmHg, in one or both eyes
  • iris neovascularisation/rubeosis
  • significant damage or injury to the optic nerve head
  • severe visual field loss including:
    • loss of peripheral vision
    • tunnel vision

Category 2 (appointment clinically indicated within 90 days)

• suspected glaucoma and any of the following:
  • IOP greater than 28mmHg and less than 30mmHg, in one or both eyes without optic disc damage or visual field loss
  • early disc damage or field loss consistent with glaucoma
  • suspicion of narrow iridocorneal angles with risk of angle closure glaucoma as assessed by an optometrist
• pre-existing glaucoma diagnosis requesting transfer of care

Category 3 (appointment clinically indicated within 365 days)

• IOP equal to or greater than 22mmHg but less than 28mmHg with any of the following:
  • corneal thickness of less than 555
  • high risk medication use such as steroids
  • history of trauma
  • pseudo exfoliation
  • pigment dispersion
  • very high myopia
  • family history

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 including family history
• current medications, allergies
• ocular history, including:
  • 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
  • retinal and optic nerve examination
  • slit lamp examination where possible
  • visual field assessment
  • refraction
• 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 6 months old at time of referral
• photograph – with patient’s consent, where secure image transfer, identification and storage is possible

Additional information to assist triage categorisation

• eye and vision examination
  • gonioscopy, pachymetry

Clinical management advice

Evidence strongly supports a screening approach that targets individuals at higher risk of developing glaucoma, rather than the general population. High risk groups may include:

• people aged greater than 50 years of age
• familial history of glaucoma
• diabetes
• presence of myopia

Those referred for glaucoma must continue community monitoring for progression of disease until hospital care is received and re-referred if they require more urgent care.

Clinical resources

• NSW Health– Eye emergency app
• Royal Australian and New Zealand College of Ophthalmologists – Guidelines for collaborative care of glaucoma patients

Consumer resources

• Good Vision for Life: Vision Problems

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.