Referral guideline – Decreased visual acuity

Introduction

The most common cause of reduced vision is a refractive error.

In the younger child and infant, refractive errors are most likely to present as a squint. In the older child, refractive errors may cause school problems with an inability to read the blackboard or visual fatigue on prolonged close work.

GP management

Please check the indicators listed below.

  • Visual acuity if child is of an appropriate age (usually older than 3yrs). If the child is too young to check visual acuity, ascertain whether the child can fix and follow – for toddlers try a toy, for infants try a toy or a light.
  • If blurred vision clears when looking through a pinhole, a significant refractive error is almost certainly present.
  • Ocular motility – ask child to look in the direction of gaze of the extraocular muscles. Use a toy or a light for very young children.
  • Fundus examination and note presence/absence of red and white reflex.
  • Bruckner reflex (simultaneous red reflex test).
  • Pupillary reactions and sizes.
  • Note any behavioural issues (was the child hard to assess, do they have a history of ADHD or autism etc).

When to refer

  • If refractive error is suspected with no other pathology, in a school aged child, refer to an optometrist. Note: behavioural optometry is NOT indicated as there is no evidence base for this. View the list of LCCH aligned optometrists.
  • Refer if either eye is 6/12 or worse, or if there is a two-line difference in results for both eyes.

Essential referral info

  • Presenting complaint and reason for referral
  • Detailed history of symptoms and any associated symptoms
  • Visual acuity in each eye
  • Patient details (name, age and gender)
  • Medicare number
  • Parent/Carer’s name and contact details
  • Referring clinician details (name, contact details, provider number, date and length of referral)

From 1 May 2019 referral criteria will apply at CHQ. This condition has minimum demographic and essential clinical referral information that is required to be included prior to submission of the referral. Visit the CPC website for the required condition. If you are unable to provide the required “essential information” please state the reason when you submit the referral.

Helpful referral info

  • Ocular history, including other eye problems, injuries, diseases, surgery, treatments including glasses and/ or amblyopia therapy
  • Other past medical and surgical history
  • Antenatal and perinatal history that may be relevant – prematurity, birth weight, birth trauma, alcohol/drug use in pregnancy
  • Family history – of eye conditions or genetic conditions
  • Current medications and allergies
  • Examination findings – including any dysmorphic features, full ocular examination
  • Is the patient of Aboriginal or Torres Strait Islander descent?

Parent service

Ophthalmology

Contact details

Hospital Switchboard
(Ask for Ophthalmology On-call Registrar)
t: 07 3068 1111

Resources

Description of Red Reflex (Bruckner) test
Red Reflex video
List of CHQ aligned optometrists
Emergency Eye Manual
Paediatric Optometry Alignment Program