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Ophthalmology

Referral Acceptance

Ophthalmology referrals are prioritised by Senior Medical Officers based on the information contained within. Additional information should be attached where available. 

Tauranga Eye Specialists Clinic and Day Stay Theatre, hold contracts with the Bay of Plenty Health Board to provide Ophthalmic Public Outpatient Appointments and Public Elective Surgery.

All accepted referrals will be seen within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

Referral acceptance is a follows:

First Specialist Assessments

Waiting priority 1

Accepted

Waiting priority 2

Accepted

Waiting priority 3

Accepted

Waiting priority 4

Accepted

Waiting priority 4C

Declined


At First Specialist Assessment (FSA), patients are assessed by a specialist and if surgery is required, patients are then prioritised using the National Ophthalmology CPAC tool.  A 0-100 score is allocated to each patient.

Prior to acceptance for surgery, patients are assessed in Anaesthetic preassessment clinic to ensure they are fit for surgery.

All patients accepted for surgery will be treated within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

Surgery acceptance is as follows:

Treatment List - new CPAC form for Cataracts only

 

CPAC 60+

Accepted

Treatment List - other Surgery

 

Waiting Priority 1            91 - 100 points

Accepted

Waiting priority 2            71 -   90 points

Accepted

Waiting priority 3            51 -   70 points

Accepted

Waiting priority 4            12 -   50 points

Declined

Waiting priority               <   12 points

Declined

National Access Criteria for First Specialist Assessment (ACA)

Bay of Plenty Variation - November 2016

Category Criteria Examples (not an exhaustive list)

1. Immediate

 

The referring practitioner will need to phone the duty registrar or Ophthalmologist to discuss the case so that an appropriate appointment can be made

  • Trauma not able to be treated conservatively
  • Surgical trauma to the lids, orbit, ocular structures
  • Penetrating eye injuries
  • Retained intraocular foreign bodies
  • Hyphaema
  • Chemical burns
  • Painful red eye with significant loss of vision
  • Corneal ulcer
  • Acute glaucoma
 
  • Sudden severe vision loss
  • Ischaemic ocular conditions
  • Eg temporal arteritis
 
  • Painful diplopia
 
  • Third nerve palsy

2. Urgent

 

 

As above – the referring practitioner
will need to discuss the case by phone before an appropriate appointment can be made

  • Sudden visual loss
  • Retinal detachment / haemorrhage
  • Vitreous Haemorrhage
  • Neurological conditions threatening permanent damage if treatment delayed
  • Disc Oedema
  • Other cranial nerve palsies
  • Acute field defects
  • Painful red eye with loss of vision
  • Iritis
  • Herpes Zoster/simplex
  • Traumatic conditions
  • Corneal foreign bodies
  • Orbital blowout fracture
  • Corneal abrasions
  • Blunt trauma
  • Infective conditions
  • Acute dacryocystitis
  • Unresponsive conjunctivitis
  • Paediatric conditions
  • Watering eye with cloudy cornea
  • White pupil

3. Semi Urgent

 

Diabetic conditions with loss of vision

Retinopathy

Neoplasms

Intraocular malignancy

Chronic impairment of visual function

Bilateral “hand movement” cataracts

Infective disease

Chronic dacrocystitis

4. Routine

 

4

  • Chronic impairment of visual function
  • Glaucoma suspects – high risk
  • Amblyogenic conditions
  • Strabismus
  • Refractive conditions in children
  • Lid Tumours
  • BCC’s and SCC’s
  • Moderately progressive diabetic conditions
  • Vision threatening retinopathy
  • Retinopathy in pregnancy
  • Misc conditions threatening permanent damage if treatment delayed
  • Entropion
  • Infective disease
  • Chronic dacrocystitis
  • Orbital disease
  • Proptosis – displacement of globe
  • Tyroid eye disease
  • Chronic impairment of vision
  • Cataracts and media opacities
  • ARM
  • Glaucoma suspects – low risk
  • Dry AMD
  • Significant pterygia and ptosis
  • Childhood cosmetic squint
  • Congenital epiphora
  • Refractive error with co-morbidity
  • Keratoconus
  • High Myopia

4C
(Not accepted)

  • Chronic non sight threatening conditions
  • Adult epiphora
  • Ectropian
  • Cosmetic abnormalities without other pathology
  • Adult refractive conditions without other pathology

 

Referral Guidelines

Public Hospital Referrals

Please clearly identify Public Ophthalmology Referrals):

Post: Regional Referral Centre, Bay of Plenty District Health Board, Private Bag 12024, Tauranga 3143
Fax: Regional Referral Centre 07 578 9571
Email: ReferralCentre@bopdhb.govt.nz (scanned referral attachments only)

Please note: We accept referrals from Medical Doctors, Optometrists, ED Nurse practitioners/CNS and School Vision and Hearing testers only

Urgent Referrals

Please phone Tauranga Eye Specialists 07 578 7508 to speak with the duty Ophthalmologist/Registrar.
If advised/agreed urgent by the Ophthalmologist/Registrar, the referral should then be clearly marked "URGENT" and emailed or faxed directly to Tauranga Eye Specialists. Email: referrals@teye.co.nz OR Fax: 07 578 7508

  • Please do not phone cellphones – these are switched OFF during practice hours
  • Please do not mark ‘urgent’ if the eye pathology is not urgent

Refer

1. Cataracts – (please consider optometry referral in the first instance as this is faster for the patient) only refer if:

a) Binocular best corrected visual acuity is 6/12 or worse, or
b) Best corrected visual acuity in worse eye is less than 6/36

2. Children up to 4 years of age if vision is 6/18 or worse in WORSE eye (corrected or uncorrected)

Never refer without including best corrected visual acuity - binocular and for each eye separately (preverbal children excluded).

As the Ministry of Health requires ethnicity to be recorded, referrals that do not state ethnicity will be returned.

Don't Refer

1. Pterygia unless atypical or significant corneal encroachment – ie. more than 3mm from edge of cornea

2. Childhood epiphora without infection in first twelve months

3. Adult epiphora

4. Children older than 4 years with 6/18 vision or better - refer to optometrist first

5. Meibomian (tarsal) cysts UNLESS atypical

6. Adult refractions

7. Glaucoma screening

8. Uncomplicated Ectropion / Ptosis / Eye lid Malposition

9. Hydroxychloroquine monitoring unless on treatment for 5 years or more

10. Cosmetic abnormalities without other pathology

With increasing referral numbers being received beyond capability of the service we are contracted to provide, we would appreciate it if you would consider whether optometry services would be able to solve the clinical problem you have in each case.

With thanks,

Mike O'Rourke, Mark Saunders, Sam Kain, Andrew Thompson, Cheefoong Chong and Mark Fajgenbaum