Direct referral of posterior capsular opacification by optometrists

Purpose: To study referrals of posterior capsular opacification (PCO) for laser capsulotomy by optometrists and compare direct referral with that via the general practitioner (GP). Methods: A prospective analysis of optometrist referrals with regard to diagnostic accuracy, appropriateness of referral, quality of letters and patient waiting times. Results: Of 222 referrals, 156 were direct and 66 via the GP. Forty-five (20.3%) letters were of good quality, 141 (63.5%) were average and 36 (16.2%) were poor. Waiting times for direct referrals ranged from 2 to 30 weeks (mean 8.3 weeks, S.D. 4.1); that for referrals via the GP ranged from 4 to 25 weeks (mean 10.3 weeks, S.D. 3.6). Directly referred patients thus waited 2 weeks shorter than patients referred via GPs (95% confidence interval 0.7-3.1, p = 0.002). Diagnostic concurrence was 99% (211/213 patients). The rate of laser capsulotomy was 98.2% (215/219); 103 (46.4%) letters utilised a referral form (GOS18); 146 (65.8%) discussed subjective visual problems and five (2.3%) incorporated patient consent for provision of feedback to the referring optometrist. Conclusion: Direct optometrist referral is effective, accurate and reduces patient waiting time and GP workload. Referral letters should be typed or printed to optimise legibility. Patient consent for feedback should be obtained by the referring optometrist.