The quality of optometristsÕ referral letters for glaucoma Natalie D. Scully 1 , Ling Chu 1 , Dilani Siriwardena 2 , Richard Wormald 2 and Aachal Kotecha 1,3 1 Department of Optometry and Visual Science, The Henry Wellcome Laboratory for Visual Sciences, City University, Northampton Square, London EC1V OHB, UK, 2 Glaucoma Service, Moorfields Eye Hospital, London, and 3 NIHR Biomedical Research Centre, Moorfields Eye Hospital and the Institute of Ophthalmology, London, UK Abstract Purpose: The purpose of the study was to evaluate the quality of content of optometrist-initiated glaucoma referral letters arriving at the appointment booking centre at Moorfields Eye Hospital (MEH). Methods: The minimum standard of information required for an ophthalmologist to determine the appropriateness and urgency of glaucoma suspect referral was determined, and criteria for three standards of referral letter formulated: ÔIdealÕ, ÔAcceptableÕ and ÔFailÕ. These standards were applied to a prospective review of all optometrist-derived referrals for glaucoma or suspected glaucoma cases arriving in the MEH booking centre over a 4-month period. The contents of each letter were scrutinised and classified based on the criteria within each standard. Results: Forty-nine per cent of referral letters were found to be of ÔacceptableÕ quality, 7% ÔidealÕ quality and the remainder classed as ‘‘fail’’. The main reason for failure was an omission of non- clinical information, including patient and/or referring practice details, although 26% of letters failed to include an optic disc evaluation and 6% failed to provide intra-ocular pressure measurements. Two- thirds of ÔacceptableÕ letters did not reach the ÔidealÕ standard due to a lack of discussion of risk factors, visual field analysis or recommendations for referral speed. Discussion: The information gleaned from this prospective study indicates a need to improve the quality of optometristsÕ glaucoma referral letters, particularly with respect to completion of all the items set out on the General Ophthalmic Services (GOS) 18 referral form. Keywords: glaucoma, optometrist, referral Background In England and Wales, it has been reported that there are approximately 60 000 suspected cases of glaucoma referred to ophthalmologists each year (Tuck, 1991), forming the second most common referral to the Hospital Eye Service (HES). Optometrists are respon- sible for initiating referrals in almost 100% of cases (Harrison et al., 1988; Sheldrick et al., 1994; Newman et al., 1998; Theodossiades and Murdoch, 1999; Bowl- ing et al., 2005). Glaucoma is the leading cause of irreversible blindness in the world (Resnikoff et al., 2004), affecting 1% of over 40 year olds and 5% of 65 year olds and increasing in prevalence with advanc- ing age (Tuck and Crick, 1998). It was responsible for 11% of registered blindness in the UK between 1999 and 2000 (Bunce and Wormald, 2006). Optometrists refer glaucoma suspects to their general practitioner (GP) who decides whether further referral to the HES is necessary. GPs may forward the original optometrist letter or formulate their own referral using the information provided by the optometrist. Many optometrists use the General Ophthalmic Services (GOS) 18 form as a primary method of referral Received: 26 March 2008 Revised form: 18 June 2008; 25 July 2008 Accepted: 26 July 2008 Correspondence and reprint requests to: Dr Aachal Kotecha. Tel.: +44 20 7040 3898; Fax: +44 20 7566 2826. E-mail address: aachal.kotecha.1@city.ac.uk Ophthal. Physiol. Opt. 2009 29: 26–31 doi: 10.1111/j.1475-1313.2008.00600.x ª 2009 The Authors. Journal compilation ª 2009 The College of Optometrists