Medical & Surgical Retina

Scope:

Medical Retina
  • Age related macular degeneration
  • Retinal vascular disorders (vein and artery occlusions and macroaneurysms)
  • Diabetic retinopathy
  • Retinal dystrophies
  • Retinal and Choroidal mass lesions (suspicious naevi and choroidal melanomas)
Surgical Retina
  • Retinal tear / detachment
  • Vitreous haemorrhage
  • Vitreo-macular traction
  • Epi-retinal membrane
  • Macular hole

Assessment

Signs and Symptoms

Medical Retina
  • Sudden blurred central vision
  • Sudden distorted central vision
  • Distorted amsler grid
  • Difficulty in reading or performing daily living tasks due reduced visual acuity
Surgical Retina
  • Sudden blurring of vision
  • Sudden central blurring
  • Curtain effect, flashing lights and significant new floaters

History and Examination

  • Previous medical history including medications, allergy list & family history
  • Previous ocular history
  • General Ophthalmic Services (GOS)
  • Recent refraction – when available
  • Body Mass Index (BMI)
  • Mobility
  • Interpreter required

Red Flags

  • Sudden onset – blurred vision or distorted central vision in one or both eyes
  • Sudden loss of vision refer to on call Ophthalmologist
Urgent Care Services:

Royal Devon & Exeter Hospital: Attend ED

Investigations

  • Optical Coherence Tomography (OCT) Scan (when available)
  • Recent Refraction
  • GOS
  • Previous records/information from other providers including letters, OCT scans, retinal photos

Management

Community optometrist management may be appropriate for monitoring:

  • Dry age related macular degeneration
  • Benign flat choroidal naevi
  • Stable retinal dystrophies
  • Stable asymptomatic vitreo-macular traction
  • Stable asymptomatic epi-retinal membrane
  • Stable macular hole (full thickness)
Medical Retina

Age related macular degeneration

When to refer:

  • Decreased visual acuity
  • Sub retinal fluid or intra retinal fluid/ intra retinal cysts on OCT scan, Pigment Epithelial Detachment (PED)
  • Macular Haemorrhage

Retinal vascular disorders (vein and artery occlusions and macroaneurysms)

When to refer:

  • Decreased visual acuity
  • Distorted central vision
  • Retinal haemorrhage
  • Optic disc swelling
  • OCT increased central retinal thickness indicating CSMO
  • Refer to GP for assessment of cardio vascular risk factors

Diabetic retinopathy

When to refer:

  • OCT when available - increased Central Retinal Thickness (CRT), Intraretinal fluid (IRF), Intraretinal Cysts (IRC), due to macular oedema
  • Macular exudate / macular haemorrhage
  • Suspicion of NVD/NVE/NVI – indicating proliferative diabetic retinopathy
  • Evidence of beading, looping, cotton wool spots, dot & blot haemorrhages – indicating pre proliferative changes that require HES monitoring
  • Background diabetic changes may be referred to DESP for yearly surveillance

Retinal dystrophies

When to refer:

  • Patient is visually symptomatic with distorted central vision
  • Retinal and Choroidal mass lesions (suspicious naevi and choroidal melanomas)

When to refer:

  • Refer to secondary care – 2 weeks pathway if suspected malignant melanoma
Surgical Retina

Retinal tear / Detachment /Vitreous haemorrhage

When to refer:

  • All patients with either sudden onset of flashing lights and/or floaters need urgent referral to the flashes and floaters clinic

Vitreo-macular traction / Epi-retinal membrane / Macular hole

When to refer:

  • When visually symptomatic if the patient wishes to be considered for surgery

Referral

Referral Criteria

Before a referral is made the referrer must confirm that:

  • The patient understands that the purpose of the referral is for assessment to determine appropriate management

Referrals must include the following history and examination:

  • GOS
  • Previous medical history including medications, allergy list & family history
  • Most recent refraction – when available
  • OCT scan if available
  • BMI
  • Mobility
  • Interpreter required

Referral Instructions

e-Referral Service Selection

  • Specialty: Ophthalmology
  • Clinic Type: Other Medical Retina
  • Service: DRSS-Eastern-Ophthalmology-Devon CCG- 15N

Referral Forms

DRSS (GP) Referral Form

Opticians Referral Form

Supporting Information

Patient Information

Patient Information from the Royal College of Ophthalmologists

Pathway Group

This Guidance has been signed off by NEW Devon CCG

Publication date: January 2017

 

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