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.

  • new onset of reduced central vision and/or distortion due to exudative (wet) age-related macular degeneration (AMD)
  • new fluid on a macular optical coherence tomography (OCT) scan consistent with wet AMD

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

  • non-exudative (dry) age-related macular degeneration (AMD)
  • asymptomatic epiretinal membranes

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • full thickness macular hole
  • reduced central vision and/or distortion due to exudative (wet) AMD

Category 2 (appointment clinically indicated within 90 days)

  • vitreomacular traction without lamellar macular hole if visual symptoms and vision diminished to <6/9

Category 3 (appointment clinically indicated within 365 days)

  • vitreomacular traction without lamellar macular hole without visual symptoms
  • lamellar macular hole
  • symptomatic epiretinal membrane

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/surgical history
  • current medications, allergies
  • smoking / vaping history
  • ocular history including:
    • best corrected visual acuity (BCVA) both eyes
    • refraction
    • retinal examination
  • optical coherence tomography (OCT) if possible

Clinical management advice

  • If a patient presents with any of the following symptoms or complains of a sudden change in their central vision, it is important to refer them for clinical assessment. Symptoms of a macular hole may include:
    • blurred or distorted vision, particularly in the central field of vision
    • a dark spot or blind spot in the centre of the visual field
    • difficulty seeing fine details or reading small print
    • visual disturbances such as flashing lights or floaters
  • Regular eye examinations to assess and monitor the condition are imperative to slow disease progression and manage symptoms.
  • Patients referred for macular disorders must continue community monitoring by an optometrist for progression of disease until hospital care is received and re-referred if they require more urgent care.

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.