Optometric referrals of patients requiring orthoptic input in the hospital eye service: suggest...

11 March 2019
Volume 20, Issue 1

The aim of this article is to help primary care optometrists improve their referral letter writing, which will allow secondary care to triage patients effectively.


Approximately 3% of referrals to the hospital eye service (HES) are for binocular vision problems.1,2 Lash2 advised that, because of the limited HES resources available, all referrals should be necessary and timely. It was noted that some referral letters had no practice address or legible optometrist’s name. Davey et al.1 sampled 433 new referrals to Bradford Royal Infirmary; 72% of these came from optometrists. They found optometrists used a variety of methods to refer: 77% were on a GOS 18 form, 9% were typed or hand-written letters, while the rest were made up of various shared care forms. There were issues with legibility of the letters: 55 had either no name or it was illegible. Only 73% of hand-written letters were fully legible – this can cause a delay or inaccuracy of the referral. Not all the optometrists recorded visual acuity (VA). Poor referral letter writing makes it difficult for the practitioner receiving the referral to triage it effectively. Referrals to the HES are sent to a consultant ophthalmologist. The orthoptic service works alongside their consultant and optometric colleagues to provide a multidisciplinary approach to patient care.

When optometrists make a referral to secondary care we are transferring responsibility for the patient’s care to another professional. Referral happens for a variety of reasons: advice on diagnosis or management, they require treatment or surgery or they wish to have a second opinion or reassurance.3 A Cochrane review investigated methods of improving referrals between primary and secondary care. They concluded:

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Related further reading

Should you re-examine a patient you have recently referred if their symptoms worsen?

How would you deal with a patient who does not want to be referred?

Kaye McIntosh on tackling the lack of standardisation when sharing ophthalmic images.