Do we always need to refer?

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It is impossible to remove every unnecessary referral and a percentage of 'false positive' referrals will always need to be factored into a screening programme. A specificity of over 90 per cent is often thought to be a good result for a diabetic retinopathy or open-angle glaucoma shared care programme, but of course this will result in 10 per cent false positives.

Shared care programmes deal with patients who are at a specific risk of eye disease, so these false positives are a fact of life. There are, however, a whole host of other eye conditions that result in referrals from the bigger 'not at risk' bank of patients we see on a day to day basis. Sometimes this can be due to the patient asking for a second opinion, although more often it can be due to practitioners not being able to offer the perceived correct degree of follow-up. This is especially the case for mobile optometrists that aren't always sure when they might re-visit the practice concerned, so it often feels better to deal with any unusual eye condition by referring the patient on the day of the sight test.