When to refer diabetic retinopathy
Structured for Australian optometry practice. Source-cited clinical reference; not individually clinician-reviewed.
Clinical decision support only
OptoGuide™ supports professional judgement and does not diagnose or replace clinician responsibility.
Quick answer
- RANZCO sets referral by retinopathy grade as a TIMEFRAME, not a review interval: proliferative disease within 1 week, severe non-proliferative within 4 weeks, moderate non-proliferative within 12 weeks alongside a comprehensive eye and fundus examination.
- Macular oedema is graded separately from retinopathy stage, and the two timeframes are deliberately different: centre-involving oedema within 4 weeks, non-centre-involving within 12 weeks.
- Proliferative disease is a one-week referral whether or not vision is affected. Acuity can be normal in proliferative retinopathy, so preserved vision is not a reason to wait.
- Mild non-proliferative disease is re-screened at 1 year; no retinopathy is 2 years, shortened to 1 year by any RANZCO clinical modifier.
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 — graded separately from retinopathy stage.
- Laterality, and diabetic control history where relevant.
- Whether the changes fit stable screening or treatment-level disease.
When to refer
- Proliferative diabetic retinopathy: refer to ophthalmology within 1 week — regardless of visual acuity.
- Severe non-proliferative diabetic retinopathy: refer within 4 weeks.
- Moderate non-proliferative diabetic retinopathy: comprehensive eye and fundus examination, and refer within 12 weeks.
- Centre-involving diabetic macular oedema: refer within 4 weeks. Non-centre-involving: within 12 weeks. Grade the macula separately from the retinopathy stage — these two timeframes are not interchangeable.
- Vitreous haemorrhage, or any unexplained rapid loss of vision in a patient with diabetes, warrants same-day discussion rather than a scheduled referral.
Initial management
- Grade severity rather than recording diabetic retinopathy as a single label.
- Document macular involvement separately from retinopathy stage.
- From moderate non-proliferative disease upward, RANZCO gives a referral TIMEFRAME rather than a review interval. Recording "review in 3 months" in place of "refer within 12 weeks" is not the same instruction and does not discharge it.
- These timeframes are the RANZCO Screening and Referral Pathway for Diabetic Retinopathy in Australia. Confirm against the current pathway before relying on them.
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.