What criteria should I use to determine when to refer a patient with visual impairment to an ophthalmologist?

Refer a patient with visual impairment to an ophthalmologist if any of the following criteria are met:

• There is optic nerve head damage detected on stereoscopic slit lamp biomicroscopy.
• A visual field defect consistent with glaucoma is present.
• Intraocular pressure (IOP) is 24 mmHg or more measured by Goldmann-type applanation tonometry.
• There is a decline in visual acuity or the patient reports a decline in visual function despite stable OCT appearances, suggesting possible neovascularisation or macular abnormalities.
• Visual impairment is severe and cannot be corrected with standard glasses or contact lenses, affecting the patient’s ability to function in a visual environment.

Before referral, consider repeating visual field assessment and IOP measurement on another occasion to confirm findings unless urgent referral is indicated.

Provide all examination and test results with the referral to facilitate diagnosis and management.