Information for Optometrists and GPs Referring Patients

This page is intended as a practical referral resource for optometrists and GPs managing patients with cataract, corneal disease, refractive error, keratoconus, or macular degeneration. I consult at Northern Eye Consultants in Bundoora and at Bass Coast Eye Centre in Wonthaggi. Referrals are welcome for routine and complex cases across all subspecialty areas. A GP or optometrist referral is required for Medicare rebates to apply.

Subspecialty areas and referral indications

I accept referrals for the following conditions and procedures:

Cataract surgery: routine and complex cases including dense or mature cataracts, pseudoexfoliation syndrome, posterior polar cataracts, previous corneal refractive surgery (LASIK, PRK, RK), subluxated lenses, combined cataract and corneal transplant procedures, and patients with coexisting macular or retinal disease. For referral guidance on timing, see the section on when to refer below. Full clinical detail on the procedure is available in the phacoemulsification cataract surgery guide. For information on lens implant choices relevant to your patient, see intraocular lens options and the premium IOL guide.

Corneal disease and transplantation: Fuchs endothelial dystrophy (DMEK, ultrathin DSAEK), keratoconus (crosslinking, contact lens management, DALK, PKP), recurrent corneal erosion, corneal scarring, and anterior segment reconstruction. See the corneal surgery and transplantation overview and the keratoconus page for clinical detail.

Refractive surgery and refractive lens exchange: LASIK, PRK, and refractive lens exchange for patients seeking spectacle independence. Pre-operative assessment including corneal topography, pachymetry, and aberrometry is performed at the time of consultation.

Macular degeneration and intravitreal therapy: age-related macular degeneration (wet and dry), diabetic macular oedema, and retinal vein occlusion requiring intravitreal anti-VEGF injection therapy. Clinical detail is available in the macular degeneration guide.

Laser procedures: YAG capsulotomy for posterior capsule opacification, laser peripheral iridotomy, and selective laser trabeculoplasty where indicated.

When to refer for cataract surgery

Refer routinely when: best-corrected visual acuity is 6/12 or worse in the affected eye, the patient reports functional impairment from their cataract (difficulty driving, reading, or with daily activities), or the patient is seeking assessment for premium lens options regardless of current acuity.

Refer urgently (within days) when: there is a rapidly progressive or mature cataract causing significant visual impairment, a cataract is causing secondary glaucoma (phacolytic or phacomorphic), or the patient has had a sudden change in vision that may be related to cataract progression combined with another pathology.

It is not necessary to wait until acuity reaches a specific threshold before referring. Functional impairment is the primary indication for surgical referral, and early assessment allows adequate time for pre-operative planning particularly in complex cases.

What to include in a cataract referral

The most useful referral letters include current best-corrected visual acuity in each eye, a description of the cataract type and density if available, any relevant ocular history including previous surgery, trauma, or corneal disease, current ocular medications, and systemic medications particularly alpha-blockers such as tamsulosin which require surgical modification.

For complex cases, please specify the complexity in the referral so that appropriate surgical planning time can be allocated. Complex referrals include eyes with previous LASIK, PRK, or RK, eyes with pseudoexfoliation, combined cataract and corneal disease, and patients with coexisting macular pathology affecting lens selection.

Post-operative co-management and refractive targets

I am happy to co-manage post-operative cataract patients with referring optometrists. The standard post-operative review schedule is day one, week one, and six weeks. I perform the day one and week one reviews. The six-week review can be performed by the referring optometrist if preferred, with a clear refraction to assess the refractive outcome and identify any residual astigmatism or refractive error requiring spectacle correction.

Typical refractive targets for standard monofocal lenses are plano for distance in the dominant eye, with slight myopic offset in the non-dominant eye for patients who want some functional near vision. For premium lens patients, refractive targets are discussed in detail at the pre-operative consultation and communicated to the referring optometrist in the post-operative letter.

Glasses should not be updated until at least six weeks post-operatively, when the refraction has stabilised. Patients who notice their vision becoming hazy months to years after surgery should be assessed for posterior capsule opacification and referred back for YAG capsulotomy if indicated. See the full guide to YAG capsulotomy and posterior capsule opacification for more detail.

When to refer for corneal disease

Refer for keratoconus when: there is documented topographic progression on serial maps, the patient is struggling with contact lens tolerance, best-corrected visual acuity is declining, or the patient is seeking crosslinking assessment. Earlier referral for crosslinking consideration is preferable to waiting until the disease is advanced, as crosslinking is most effective when performed before significant stromal thinning has occurred.

Refer for Fuchs endothelial dystrophy when: the patient has symptomatic corneal oedema causing visual impairment, best-corrected acuity is 6/12 or worse, or the patient is being assessed for cataract surgery and has a low endothelial cell count that will affect surgical planning. Combined cataract and corneal transplant surgery (triple procedure) can be performed in appropriate cases.

Refer urgently for: acute corneal hydrops, significant corneal infection or ulceration not responding to initial treatment, and any corneal condition causing rapid visual deterioration.

When to refer for macular degeneration

Refer urgently (within days) when: the patient reports new onset metamorphopsia, new distortion on Amsler grid, sudden central vision loss, or a known history of dry AMD with new or worsening symptoms. Wet AMD is a medical urgency and early treatment with anti-VEGF injections is associated with significantly better visual outcomes.

Refer routinely for: patients over 60 with drusen detected on fundus examination, reduced best-corrected visual acuity without adequate explanation from anterior segment pathology, and patients with a strong family history of AMD who have not had a recent comprehensive examination.

Patients already receiving intravitreal injection therapy who are moving to the area or seeking a change of provider are welcome to transfer their care. Please include a summary of treatment history, current anti-VEGF agent, injection interval, and most recent OCT report in the referral.

How to refer

Referrals can be addressed to Dr Ross MacIntyre, Northern Eye Consultants, Northpark Private Hospital, Bundoora VIC 3083. Referrals can be sent by fax, post, or via your practice management software using the Northern Eye Consultants provider details.

For patients in the Gippsland region or South Gippsland, referrals can also be addressed to Dr Ross MacIntyre, Bass Coast Eye Centre, Wonthaggi.

Urgent referrals should be flagged as urgent in the referral letter. Please call Northern Eye Consultants directly on (03) 9466 8822 for same-day or next-day urgent appointments.

For patients who want more clinical background on any of the conditions listed above before referring, the educational resources on this site cover cataract surgery, corneal transplantation, refractive surgery, intraocular lens options, macular degeneration, and YAG capsulotomy in detail.