Background In 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.

Methods Discharge 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.

Results Of 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.

Conclusion Referral by optician prior to ophthalmology A and E assessment is more likely to result in rapid referral for urgent hospital assessment and inpatient admission.