When to refer diabetic retinopathy
Structured for Australian optometry practice.
Clinical decision support only
OptoGuide™ supports professional judgement and does not diagnose or replace clinician responsibility.
Quick answer
- Referral timing in diabetic retinopathy depends on severity, macular involvement, proliferative features, and unexplained vision change.
- Macular oedema, neovascularisation, pre-retinal haemorrhage, and rapid change require earlier escalation.
- The decision is not based on microaneurysms alone; the pattern and extent of disease matter.
- Refer promptly when retinopathy is more than mild background change or when macular function is threatened.
Common causes
- Mild to moderate non-proliferative diabetic retinopathy.
- Severe non-proliferative diabetic retinopathy.
- Diabetic macular oedema.
- Proliferative diabetic retinopathy.
Red flags (must not miss)
- Neovascularisation of the disc or elsewhere.
- Pre-retinal or vitreous haemorrhage.
- Hard exudates or thickening threatening the fovea.
- Rapid acuity reduction in a patient with diabetes.
- Extensive haemorrhages, venous beading, or IRMA pattern.
Use OptoGuide™ to guide this decision during consult.
What to check
- Visual acuity and symptom change.
- Retinopathy severity across both posterior poles and mid-periphery.
- Macular involvement or oedema suspicion, ideally with OCT.
- Laterality, diabetic control history if relevant, and review interval.
- Whether the changes fit stable screening or treatment-level disease.
When to refer
- Prompt retinal referral for macular oedema or proliferative features.
- Routine ophthalmology referral for more than mild background disease where ongoing shared care is needed.
- Urgent escalation for vitreous haemorrhage or proliferative change with vision impact.
Initial management
- Grade severity rather than recording diabetic retinopathy as a single label.
- Document macular involvement separately from retinopathy stage.
- Shorten review and escalate when progression or treatment-level features appear.
Clinical basis
This guidance reflects standard optometric clinical reasoning based on:
- Australian optometry clinical practice patterns
- Australian medicines regulation and PBS prescribing context
- Common ophthalmology referral standards
- Evidence-based clinical training and practice
Use OptoGuide™ during consult for structured clinical guidance.