Referral information and guidelines

 

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Manchester Royal Eye Hospital has developed a new service to streamline and improve the access for patients requiring an urgent review of their macula. This has previously been done through the Macular Assessment Referral Refinement (MARRC) clinic and was primarily focussed on AMD patients. However, we recognise that with continuing development in macular treatments and other diseases being treated urgently such as central retinal vein occlusion and myopic CNV there was a need to alter the referral guidelines and improve access for patients. From week commencing 11th May it will be possible for you to refer all patients in whom you have concerns about the macula urgently to the new EMAC (Emergency Macula) Service.

The referral guidelines can be found at the bottom of this section.

All patients in whom you are concerned that the macula may need urgent assessment and treatment may be referred through this service.

Please use the contact details contained in the EMAC service referral guidelines at the bottom of this section; to make an urgent appointment for the patients while they are in your practice. If seen out of hours or on a weekend please take urgent contact details from the patient and call the next working day.

The patients will have a rapid access appointment in which the aim will be for them to be assessed urgently using OCT and appropriately triaged by our specialist optometrists either to an urgent macular treatment centre appointment for intravitreal therapy if necessary or routine outpatient clinics for less urgent pathology or for monitoring.  

 

 

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Download "EMAC " referral form from the bottom of this section

Glaucoma Referrals

Who is eligible for the GRRS service?

All patients registered with a Manchester GP who present at an optometrist or GP with any suspect signs of glaucoma or elevated intraocular pressure (IOP).

All patients registered with a Manchester GP who present at an optometrist or GP with any suspect signs of glaucoma or elevated intraocular pressure (IOP).

How do patients access the GRRS service?

Patients may be referred into the service from:

A non-accredited optometrist
A Manchester GP

What happens when I see the optometrist?

The optometrist will discuss the patients eye history, symptoms, risk factors and any related medical   history.

Patients should take their spectacles and a list of current medications to the appointment.

The optometrist will detect the presence or suspicion of glaucoma using specific tests relevant to the signs/symptoms.

The patient will be found:

- to not to have glaucoma, nor be at risk of developing glaucoma in the foreseeable future and be discharged back the care of their optometrist,

- or to have a diagnosis or suspicion of glaucoma and will be referred to the Eye Hospital (MREH) for further assessment

The GRRS optometrist will notify the patients GP and referring optometrist about the outcome of the 
consultation in order to ensure that medical records are updated.  


A sight test will not be performed as part of the assessment and a prescription for glasses will not be issued. However, where a referral originates with a GP it may be necessary to carry out a sight test first. The GRRS optometrist will be able to give advice. Any patient that you suspect has glaucoma or raised pressures ( taking into account the advice regarding age and pressures) should be referred to an accredited Optometrist for further assessment.

Cataract Referrals

Criteria: Cataract scheme applies if; Patients registered with a GP practice within NHS Manchester.


Patients with a visual acuity of 6/9 or better in either eye are considered a LOW PRIORITY for cataract surgery. 

Cataract surgery will be commissioned only for patients who, after correction have a visual acuity of less than 6/9 in their cataract affected eyes. 
Referral of patients with cataracts to ophthalmologists should therefore be based upon three following indications;

  1. Willingness to Undergo Surgery
    1. Before referring, the optometrist or OMP will have discussed the risks and benefits of surgery and ensured that the patient understands and is willing to undergo surgery
    2. Referral of patients for surgery should be based on the following indications:
      1. Reduced Visual Acuity
        1. Documented to be less than 6/9 in the affected eye (corrected), AND
      2. Impairment of Lifestyle such as:
        1. Patient at significant risk of falls
        2. Patients VA affecting their ability to drive
        3. Patients VA substantially affecting their ability to work
        4. Patients VA substantially affecting their ability to undertake leisure activities such as reading, watching TV or recognizing faces, OR
      3. Anisometropia and/or Glare
        1. Patients with cataract suffering significant functional disability from anisometropia and/or glare. These patients will not be required to fulfill criteria (2) and (3).
      4. Ability to remain still and lie supine (flat on their back) for approx 20 mins. 
        · On May 1st 2012, the DVLA have revised their guidelines for drivers to include Visual acuity
      5. Information regarding visual fields is available on the DVLA website.

      If you are accredited for cataract referrals - conduct the full examination and counselling. If the patient wants / is suitable for surgery, please send the completed cataract referral form printed from Webstar to CMCCG.Referrals@nhs.net using your NHS.NET email account.

      A copy is sent to the patients GP. ( Manchester GPs ONLY).

      The Referral Booking Management Service (RBMS) is now Manchester Integrated Care Gateway (MICG) Burnage Community Healthcare Centre 347 Burnage Lane Manchester M19 1EW.

      The new contact telephone number is 0161 443 0631, 

      The patient telephone number is 0800 092 4020

      If If their GP is not a Manchester registered GP - please use a GOS18.

      If you are not accredited for cataract referral, please ask the patient to contact an accredited Optometrist to carry out the referral - but also inform the GP of your actions

      Hospitals offering NHS cataract surgery.



      NHS: Withington / MREH Nell Lane

      Manchester M20 2LR



      Private hospitals providing NHS surgery

      Spa Medica Citygate Central

      Blantyre Street, Castlefield,

      Manchester, M15 4SQ

       



      Optegra:

      Optegra Manchester Eye Hospital

      One Didsbury Point

      2 The Avenue (off The Boulevard),

      Didsbury, Manchester, M20 2EU

 

EYELID LUMPS AND BUMPS 
NHS Manchester does not commission the surgical removal 
of eyelid lumps and bumps. However, as stated in the 
specification for the red eye scheme you should continue to 
refer lumps and bumps to the patients GP and they will then 
make the clinical decision to forward on the referral.

 

 The latest additions can be found here:


http://www.college-optometrists.org/en/professional-standards/clinical_management_guidelines/guidelines_by_condition.cfm