BackgroundOptical coherence tomography (OCT) is a rapid and painless way to provide a record of the optic disc structure. Though not specific, it can identify swollen optic discs. We determined the impact of OCT prior to referral on the pathway for managing suspected papilloedema.MethodsAudit of adults referred from the Western Eye Hospital to St Mary’s Hospital with suspected papilloedema was performed between 1/1/17 and 16/5/17. A follow-up re-audit was performed from 1/6/17 to 31/8/17 following implementation of OCT prior to referral.ResultsThe initial audit identified 50 patients over 136 days and the re-audit 26 patients over 92 days. In the initial audit 6/50 had OCT and 17/50 (34%) were admitted. 6/50 patients were subsequently found not to have papilloedema on fundoscopy, none of whom had OCT. 4/6 underwent unnecessary neuroimaging and lumbar puncture. 3 were admitted, equating to 18% of all admissions, for an average of 2.3 days. In the re-audit all had OCT, 6/26 (23%) were admitted and none were subsequently found not to have papilloedema.ConclusionUse of OCT prior to referral for suspected papilloedema helps to reduce unnecessary investigations.

BackgroundIn a landmark case in August 2016 an optometrist was found guilty of missing papilloedema. We examined the current referral pathway for managing papilloedema to determine whether initial assessment by an optician impacted resource use.MethodsDischarge summaries from St Marys Hospital (SMH) between 1/1/17 and 16/5/17 the referral centre for the Western Eye Hospital (WEH) accident and emergency (A and E) were searched to identify subjects with suspected papilloedema. Analysis of the patients journey was performed.ResultsOf 76 patients identified, 26 were excluded either due to being<18 years old or were treated elsewhere. Of the 50 included, 25/50 were seen by an optician prior to a WEH A and E ophthalmologist, 75% of these were referred for urgent hospital assessment with an admission rate of 45.8%. Of 19/50 assessed by WEH A and E only there was a significantly lower urgent assessment referral rate (75% vs 52.6%, p=0.02) and admission rate (45.8% vs 21%, p=0.02). Of the 6/50 patients finally found to have normal discs, 5 were initially referred by opticians.ConclusionReferral by optician prior to ophthalmology A and E assessment is more likely to result in rapid referral for urgent hospital assessment and inpatient admission.