When to refer glaucoma
Structured for Australian optometry practice.
Clinical decision support only
OptoGuide™ supports professional judgement and does not diagnose or replace clinician responsibility.
Quick answer
- Glaucoma referral decisions depend on the pattern of structural, functional, and pressure findings rather than IOP alone.
- Disc asymmetry, rim thinning, repeatable field loss, RNFL change, and angle concerns all affect referral urgency.
- Acute symptomatic pressure rise is different from chronic glaucoma suspicion and should be triaged separately.
- Refer when findings are repeatable, progressive, or clearly suspicious even if the pressure is not markedly elevated.
Common causes
- Primary open-angle glaucoma suspicion.
- Ocular hypertension with risk factors.
- Normal-tension glaucoma pattern.
- Angle-closure risk or intermittent angle issues.
- Secondary glaucoma from steroid response or inflammation.
Red flags (must not miss)
- Disc haemorrhage, marked asymmetry, or focal rim loss.
- Repeatable glaucomatous field defect.
- Very high IOP or symptomatic pressure rise.
- Narrow angles with symptoms or closure signs.
- Progressive OCT or visual field change.
Use OptoGuide™ to guide this decision during consult.
What to check
- Repeat IOP and assess corneal influences where available.
- Optic disc appearance, RNFL, and asymmetry.
- Reliable visual fields and trend over time.
- Anterior chamber angle assessment.
- Family history, steroid use, and other risk factors.
When to refer
- Urgent referral for acute angle closure or symptomatic markedly raised IOP.
- Routine glaucoma referral for consistent structural or functional suspicion.
- Earlier escalation if progression is documented on serial review.
Initial management
- Base referral on the overall glaucoma picture rather than a single measurement.
- Record disc, field, OCT, and pressure findings in a structured way.
- Use repeat testing where needed, but do not delay referral when suspicion is already clear.
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.