The College of Optometrists

I am abit confused on the speed of referral I would send a pateint with hypertensive retinopathy if the pateint was unaware that they had high blood pressure. I would assume if you saw a patient with a macular star and/or swollen optic nerve head you would send straight to A&E but what about if you just see cotten wool spots etc..

Hi

sorry for the delay - I have been away.

I think the first thing to consider - is that if you see a retinopathy - you can't really tell easily what is the cause. I mean, diabetes, anaemia and hypertension all cause haemorrhages, neovascularisation and retinal thickening.

So you really have to grade the referal speed on what you see and the final vision.

If you saw a macula star, poor vision or gross retinopathy - then yes to eye casualty as their vision is at stake. Further more, the eyes may well mirror problems elsewhere.

If you saw something like flame haemorrhages here and there - and the patient was unaware of any problems and was not under the gp for hypertension, diabetes etc. - then I would phone eye dept and get their advice (because there are other factors - such as age, obesity, pre-existing conditions etc - that would affect urgency.

Otherwise, I would urgent referal via the gp with reccommendation of HES in a week. Acive retinopathy due to hypertension increases the risk of strokes and heart attacks and this is thus an urgent referal, especially if px gets headaches (usually when wakes up), or gets other signs - such as dizziness, pains in the chest etc. The GP can usefully be put in the loop - as he can initiate treatment after a few tests.

If the vessels are suggestive of hypertension - but the retina looks fine - then a routine referal to GP for tests is in order.

In conclusion,

Active retinopathy signals urgent referal - as can mean kidney problems or untreated diabetes, etc.

Vascular changes - soon referal to GP. I recall a guy in his 40's who came for a routine eye test. He smoked and held an unhealthy life. He had 6/6 vision, no headaches - but remarkably constricted arteries. I refered him to the GP for hypertension checks. He 'could not be bothered' - and had a stroke 3 weeks later.

Interesting topic!

hope it helps - steve

Thanks that helped alot!