When should I consider referring a patient with primary open-angle glaucoma to an ophthalmologist?

Consider referring a patient with primary open-angle glaucoma (POAG) to an ophthalmologist if any of the following are present:

• There is suspected optic nerve head damage detected on stereoscopic slit lamp biomicroscopy.
• There is a repeatable visual field defect consistent with glaucoma.
• Intraocular pressure (IOP) is 24 mmHg or more measured by Goldmann-type applanation tonometry, confirmed by repeat measurement unless urgent referral is indicated.

Referral should be for further investigation, definitive diagnosis, and formulation of a management plan by a consultant ophthalmologist or a suitably trained healthcare professional with specialist qualifications and relevant experience.

Additionally, do not base referral decisions solely on non-contact tonometry IOP measurements, and consider repeating visual field and IOP assessments before referral unless clinical urgency exists.

Provide all examination and test results with the referral to facilitate specialist assessment.