Glaucoma is a condition which leads to damage of the optic nerve and progressive field loss. It is often linked to raised intraocular pressure, however it can still occur in patients with normal intraocular pressures (normal tension glaucoma). It is usually asymptomatic and picked up on routine optometry examination.
It increases in prevalence as age increases and is also more common in patients with a positive family history.
It is important to encourage yearly pressure checks in patient who have had an intraocular foreign body, hyphaema or trauma as this increases future risk of developing glaucoma.
GPs and opticians can help by promoting compliance with eye drop administration and supplying/advising a handi-aid if required. Good information about glaucoma is required to ensure patients don’t miss/run out of drops. It is asymptomatic until significant damage has occurred.
If there is not improvement despite good compliance alternatives will be tried. Some need multiple drop therapies. If on maximum treatment and progression is seen on OCT scan/visual field testing then glaucoma surgery may be carried out. The aim following this surgery is to be able to reduce/stop drops completely and hence stabilise vision preventing further deterioration.
All glaucoma referrals must include:
- Applanation IOP (Intraocular pressure)
- A repeatable visual field defect.
- Disc assessment.
Pachymetry readings, if available, are also useful.
Glaucoma waiting times depend on applanation IOPs see below:
| Acute angle closure | Emergency |
| IOP >34 | Urgent |
| IOP 29-34 | Soon |
| IOP <28 | Routine |
Ocular Hypertension
If you suspect ocular hypertension by raised intraocular pressure with no documented optic disc cupping and no visual field loss likely waiting times are listed below.
| >40 | Urgent |
| 35-40 | Soon |
| <35 | Routine |
Patients who present with a problem with their only seeing eye should be advised to see an optician/ophthalmologist for review.
How to refer:
We require a referral letter for EVERY patient.
The preferred referral process is via SCI Gateway. If sending/forwarding a referral via SCI gateway please include past medical history, allergies and medications.
PAEP/SJH > Ophthalmology – Glaucoma > LI Glaucoma
If you do not have access to fax or SCI Gateway e.g. if you have arranged an appointment out of hours please send a written referral letter with the patient to bring to their appointment.
Only if SCI Gateway is unavailable should a letter be typed or handwritten. Please write legibly and include your examination findings.
If you have arranged an appointment in the acute referral clinic and you are referring from within another hospital in Lothian please use TRAK to type the referral letter.
- Information from optometrists on the intraocular pressures, optic disc appearances and visual fields are very helpful. We receive a high volume of false positive referrals because of over-sensitive visual field tests used by optometrists, and falsely high intraocular pressure readings.
- Patients with minor asymptomatic visual field abnormalities but with normal optic discs and intraocular pressures should be rechecked by an optometrist rather than referred to us.
- Patients with intraocular pressures less than 25 mm Hg who have normal optic discs and no other complicating factors should be rechecked by an optometrist rather than referred to us.
- Optometrists will be asked to co-operate with these guidelines as well
