When Do I Need an Ophthalmologist Referral?

An ophthalmologist is a medical specialist equipped to prescribe medication and perform surgeries with expertise that is different than most optometrists can provide. Their extensive training includes medical school, an ophthalmology residency, and often additional specialized training.

Optometrists can effectively diagnose and treat many common eye diseases by prescribing eye drops and provide prescriptions for glasses and contact lenses. But for complex or severe eye conditions, you may need a referral to visit an ophthalmologist. Your optometrist can organise a referral to see an ophthalmologist.

I’m Dr. Nandita Chowdhury, owner and principal optometrist of Picton Eyecare in the Wollondilly Shire. My background spans 15 years of corporate and independent optometry. Our practice is dedicated to providing comprehensive eye care tailored to our community’s needs.

In this blog post, my goal is to explain the specific services ophthalmologists offer and guide you on when a referral to such a specialist might be necessary.

When to Consider an Ophthalmologist Referral

Let’s examine some of the services which a specialist eye doctor can provide.

Cataract Removal

Cataracts develop when proteins in the eye’s lens break down and clump together, causing cloudiness which obstructs clear vision. This can result in symptoms like blurring, glare, and difficulty seeing in low light conditions.

The most common method of cataract removal is phacoemulsification. Here, the surgeon makes a small incision in the eye, uses ultrasound waves to break up the cloudy lens, and then suctions it out.

After the removal of the natural lens, it is replaced with an intraocular lens (IOL) – a clear, artificial lens. This lens is designed to restore vision and, in many cases, can be tailored to the patient’s visual needs, sometimes even reducing the need for glasses.

The procedure is typically done on an outpatient basis, meaning you can go home the same day. Recovery is usually swift, with most patients noticing a significant improvement in vision within a few days.

Post-operative care is essential for optimal recovery. This includes using prescribed eye drops to prevent infection and inflammation, and attending follow-up appointments to monitor healing. Generally 4-6 weeks after your cataract surgery you need to see your optometrist to update your glasses.

Cataract surgery has a high success rate and is considered a safe and effective way to restore vision.

Crossed Eyes and Lazy Eye

Strabismus and amblyopia, commonly known as “crossed eyes” and “lazy eye” respectively, are two conditions that can have a notable impact on vision, particularly if left untreated.

Strabismus occurs when the eyes don’t align properly and point in different directions. One eye may look straight ahead while the other eye turns inwards, outwards, upwards, or downwards. This misalignment can happen all the time or intermittently.

Strabismus can disrupt binocular vision, affecting depth perception and leading to double vision. If it develops in childhood, it can also lead to amblyopia.

Amblyopia, or lazy eye, develops when one eye is weaker than the other. The brain favors the stronger eye, and over time, the vision in the weaker eye deteriorates due to underuse.

If not addressed early, amblyopia can result in permanent vision loss in the affected eye. Treatment often involves correcting refractive errors with glasses and using eye patches or eye drops to strengthen the weaker eye.

Optometrists typically manage these conditions with various non-surgical methods. This includes prescribing glasses, vision therapy, and exercises to improve eye alignment and strengthen the weaker eye in cases of amblyopia.

In more severe cases of strabismus, particularly where non-surgical methods haven’t been effective, surgical intervention might be necessary. Ophthalmologists perform surgery to adjust the muscles around the eye to align the eyes properly.

Early diagnosis and treatment are crucial, especially in children. Effective management of these conditions can prevent long-term vision problems and ensure proper visual development.

In summary, while optometrists play a significant role in the early detection and management of strabismus and amblyopia, certain cases may require the expertise of an ophthalmologist for surgical intervention. Regardless of the severity, early and proactive treatment is key to ensuring the best possible outcomes for vision health.

Glaucoma Treatment

Glaucoma is a serious eye condition that primarily affects the optic nerve, the vital connection between the eye and the brain. It’s often associated with an increase in the pressure inside the eye, known as intraocular pressure, which can damage the optic nerve over time. If left untreated, glaucoma can lead to irreversible loss of vision and is one of the leading causes of blindness worldwide.

“Open-angle glaucoma”, the most prevalent form, generally develops gradually without noticeable early symptoms, often making it hard to detect without regular eye exams. On the other hand, “angle-closure glaucoma”, though less common, can manifest abruptly with severe symptoms such as intense eye pain, blurred vision, and headaches, necessitating immediate medical attention.

Risk factors for glaucoma include age, family history, certain medical conditions like diabetes, and extreme nearsightedness. For those diagnosed with glaucoma, ongoing monitoring is essential to assess the effectiveness of treatment and to track the progression of the condition.

In many cases, glaucoma can be managed with prescription eye drops that help to lower intraocular pressure. It’s important for patients to use these medications exactly as prescribed to effectively control their condition.

In cases where medication is not sufficient to control intraocular pressure, surgery may be necessary. Surgical options vary from laser treatments that help fluid drain from the eye to more invasive surgeries to create a new drainage channel.

Glaucoma management is a long-term commitment, and the goal of treatment is to prevent further loss of vision. While the damage caused by glaucoma can’t be reversed, early detection and consistent treatment can significantly slow its progression, helping patients maintain their vision and quality of life.

Regular eye exams are key in diagnosing glaucoma early, and ongoing support from an eye care professional is essential for managing the condition effectively.

Age Related Macular Degeneration (ARMD)

AMD is a progressive eye condition that primarily affects individuals as they age. It involves the deterioration of the macula, a small area in the centre of the retina responsible for central vision. AMD cab be classified into two main types: dry AMD and wet AMD.

Dry AMD:

• Prevalence: Dry AMD is the more common type, accounting for about 80-90% of AMD cases.
• Progression: It progresses slowly over time.
• Symptoms: In the early stages, it may cause slightly blurred vision and require more light for reading and other tasks. As it advances, you might notice a blurred spot in the center of your vision.
• Cause: It’s characterized by the thinning of the macula and the accumulation of drusen, small yellow deposits under the retina.
• Treatment: There’s no cure for dry AMD, but certain nutritional supplements along with good diet, and protecting eyes from UV might slow its progression.

Wet AMD:

• Prevalence: It’s less common but more serious and accounts for about 10-15% of AMD cases.
• Progression: Wet AMD can cause rapid and severe vision loss.
• Symptoms: It can lead to distorted vision (straight lines appearing wavy) and blind spots in your vision. It may also cause rapid and noticeable changes in your central vision.
• Cause: Wet AMD is caused by abnormal blood vessels growing under the retina, which leak fluid or blood, damaging the macula.
• Treatment: It’s more likely to respond to treatments, which may include medications injected into the eye to slow the growth of new blood vessels, laser therapy, or photodynamic therapy.

Optometrist can play a crucial role in monitoring AMD, especially in its early stages. Monitoring can be done with amsler chart, retinal imaging and OCT scan. Protecting your eyes from UV by wearing sunglasses, eating healthy and taking vitamins like Macutec, Macuvision Plus and quitting smoking can slow down the progression of AMD.

If AMD has progressed to an advanced stage, particularly wet AMD, referral to an ophthalmologist is necessary to start anti-VEGF injections.

Retinal Detachment

Retinal detachment is a serious and urgent eye condition where the retina, the light-sensitive layer of tissue at the back of the eye, pulls away from its normal position. This detachment can occur suddenly and is often accompanied by noticeable symptoms, making immediate medical attention essential to prevent lasting damage to vision.

The onset of retinal detachment may be marked by an increase in floaters (small dark shapes that float across your vision), sudden flashes of light, or a shadow or curtain-like effect over part of the visual field. These signs should never be ignored, as they indicate the need for prompt evaluation.

Factors that can increase the risk of retinal detachment include age, severe myopia (nearsightedness), previous eye surgeries, or trauma to the eye.

If you experience symptoms of retinal detachment, seek help from an eye care professional immediately. The sooner the retina is reattached, the better the chances are for recovering vision.

Treatment typically involves surgery, and the method used depends on the severity and type of detachment. Options can include laser, pneumatic retinopexy (injecting a gas bubble into the eye), or scleral buckling (attaching a small band around the eye to push the wall of the eye against the detached retina).

Regular eye exams play a crucial role in early detection of issues that could lead to retinal detachment.

Eye Cancer and Melanoma

Eye cancer, including melanoma of the eye, necessitates specialized medical attention from an ophthalmologist. These cancers can affect various parts of the eye and surrounding structures, including the eyelids. If left untreated can spread to the other parts of the body.

Treatment for eye cancer varies based on the type, size, and location of the tumor, as well as the patient’s overall health. It may include surgery to remove the tumor, radiation therapy, or laser treatment.

In some cases, particularly with small melanomas, the tumor may be surgically removed while preserving the eye. In more advanced cases, removal of the entire eye (enucleation) may be necessary.

Eyelid cancer, while not as common as some other types of skin cancers, still represents a notable portion of skin cancer cases in Australia, which has one of the highest rates of skin cancer in the world. The most common type of eyelid cancer is basal cell carcinoma, followed by squamous cell carcinoma and melanoma.

The key to successful treatment lies in early detection and prompt, specialized care. Regular eye examinations are vital, as they can detect signs of cancer that patients might not notice. If you experience any changes in your vision or eye appearance, or if eye cancer runs in your family, consult an eye doctor as soon as possible.

LASIK Surgery

LASIK, which stands for Laser-Assisted In Situ Keratomileusis, is a procedure where a laser is used to precisely reshape the cornea – the clear, round dome at the front of the eye. By adjusting the cornea’s shape, LASIK changes the way light rays enter the eye to focus more directly on the retina, resulting in clearer vision.

The surgery involves creating a thin flap in the cornea, lifting it to allow the laser to reshape the underlying corneal tissue, and then replacing the flap. This is a quick procedure, often taking only about 20-30 minutes for both eyes. Some patients may experience halos, glare and dry eyes after laser refractive surgery.

Endophthalmitis

Endophthalmitis is a severe, potentially vision-threatening condition characterized by inflammation of the interior of the eye. This inflammation usually results from an infection caused by bacteria or fungi, which can occur after eye surgery, an eye injury, or spread from other parts of the body.

The signs of endophthalmitis can develop quickly and may include severe eye pain, redness, swelling, blurred or decreased vision, and sometimes discharge from the eye. Sensitivity to light and the appearance of floaters are also common symptoms.

Individuals who have recently undergone eye surgery or have sustained an eye injury are at higher risk, as well as those with weakened immune systems.

Endophthalmitis, while rare, is a serious condition that requires immediate medical attention to preserve vision. Its treatment is complex and often involves a multidisciplinary approach, including ophthalmologists specializing in retina and vitreous diseases.

Emergency Referrals

Certain eye conditions necessitate immediate, emergency referrals to an ophthalmologist. These scenarios typically include sudden, unexplained loss of vision or severe eye injuries, such as those caused by blunt object trauma.

Sudden vision loss can manifest as a complete blackout, a significant decrease in visual clarity, or a loss of vision in one part of the visual field. This can be due to various reasons, including retinal detachment, severe glaucoma, or blockage of the blood vessels supplying the eye.

Injuries from blunt objects can range from surface-level damage, like corneal abrasions, to more severe conditions like globe rupture, where the integrity of the eyeball is compromised.

Prompt referral to an ophthalmologist can often mean the difference between full recovery and long-term visual impairment. It’s essential for patients to understand the signs of these emergencies and to seek immediate professional help. At Picton Eyecare we always prioritize emergency eye care scenarios.

Co-Management: Your Ophthalmologist and Optometrist as a Team

Co-management represents a collaborative and integrative approach in eye care, where your optometrist and ophthalmologist work hand-in-hand. This partnership is crucial, especially in managing complex eye conditions, ensuring you receive the best support possible. As a patient, you benefit from this holistic approach because:

• Co-management ensures that all aspects of your eye health are addressed. Your eye doctors collaborate to create a comprehensive care plan, combining the strengths of optometry and ophthalmology.
• Continuity of Care: This approach also provides continuity of care, which is particularly important in chronic conditions. Both your optometrist and ophthalmologist stay informed about your eye health journey, leading to more effective management of your condition.
• Personalized Treatment: With two professionals overseeing your treatment, you receive more personalized care. This might include a combination of medical treatment, lifestyle recommendations, and regular monitoring.

As your primary eye doctor, an optometrist plays a critical role in this partnership, ensuring early detection and regular care, while the ophthalmologist brings specialized medical and surgical skills to the table. Together, they form a formidable team, safeguarding your vision and overall eye health. At Picton Eyecare, we are committed to this collaborative model, ensuring our patients in Wollondilly Shire receive the most comprehensive and personalized eye care available.

Medicare Cover

It’s important to note that while Medicare may cover part of the consultation fees, there might be additional costs for specific treatments or procedures, particularly surgical interventions that are not fully covered. Patients are advised to discuss the details of their coverage and any potential out-of-pocket expenses with their ophthalmologist, as well as to check with Medicare directly for the most accurate and up-to-date information regarding their coverage.

Conclusion

Understanding when to seek an ophthalmologist referral is key to ensuring your eyes receive the best care possible. At Picton Eyecare, we’re committed to guiding you through this process, ensuring you get the right care at the right time.

You can call us on (02) 4603 2309 or arrange an appointment using the “Book Now” button in the navigation menu. We are conveniently located in the heart of Picton, NSW. There is plenty of parking available at the back of our store.