Sir,

We read with interest the article by Park et al1 ‘evaluating a new cataract referral pathway’ and would like to advocate the importance of GP involvement in the direct referral pathway. At 12 months after introducing the direct referral forms to optometrists in the catchment area served by Frimley Park Hospital, we compared the quality of referrals with that obtained through the traditional GP route.

Comparison of 54 age- and date-of-referral-matched referrals showed that direct optometrist referrals documented the symptoms and Snellen visual acuity adequately compared with the traditional GP route (100 vs 97.4%). In agreement with Park et al, past medical history was more often documented on the traditional referral forms compared with the direct referral forms (66.6 vs 22.5%). Traditionally, patients diagnosed by their optometrist with cataracts would be referred to their GP and then unto the hospital eye service (HES). A comparison of the time to HES from diagnosis, showed a significant reduction in time-to-first appointment with direct optometrist referrals (74.9 vs 94.9 days),2 indicating that streamlining the referral pathway does reduce waiting times. Nevertheless, the involvement of the GP in the referral ensures access to the medical and social history of the patient. Although, this information did not seem to affect the outcome of surgery in the Park et al study, this is probably because the information is subsequently obtained from the patient by the ophthalmologist before surgery and appropriate action undertaken. General medical and social history is certainly useful for triaging patients and referral to the appropriate ophthalmic sub-specialist. GP involvement is invaluable in ensuring the quality of the referral and should be an integral part of education on cataract referrals from community services. We conclude that direct referral through the optometrist is effective but requires participation and co-ordination between services to ensure and maintain quality.

Conflict of interest

The authors declare no conflict of interest.