Optometry’s future health-system role will be defined by whether relevant information reaches the right person, in the right format, for the right clinical action, writes Peter Larsen.
In my previous article, I argued that optometry’s next chapter depends on moving from individual clinical excellence to collective impact.¹ The profession is highly capable and central to community eye care. What it has historically lacked is not commitment, but health-system architecture: the shared infrastructure that allows consultations to become coordinated, measurable, and useful across populations.
This article takes one practical piece of that architecture and asks what it must do. The answer is deceptively simple: referrals and clinical communications must carry relevant information to the people who need to act on it.
For too long, referrals have been viewed as a point of handover. The optometrist identifies a problem, writes a letter, attaches what information they can, and sends the patient onward. Once that happens, the patient often moves into another part of the system, and optometry’s role becomes less visible.
It’s now recognised that the referral is not the end of an optometric episode. It is the interface between optometry, ophthalmology, general practice, hospitals, and patients. It is where optometry either becomes part of coordinated care or disappears into disconnected correspondence.
In the language of the previous article, referrals are part of the plumbing of eye care. They may not be glamorous, but without them, the system leaks. Health systems do not transform on technology alone. They transform when the plumbing works: when the right information reaches the right person, in the right format, at the right time, and in a way that supports action.
… referrals are part of the plumbing of eye care. They may not be glamorous, but without them, the system leaks.
The Contribution of Optometry to Hospital Care
A simple observation from work examining referrals into the Royal Victorian Eye and Ear Hospital (The Eye and Ear) illustrates the point.2 When structured referrals were sent through Oculo, some immediate value was not only in advanced imaging. It was in the basics. Patient names, addresses, phone numbers, and other identifying details were more consistently available. In non-platform referrals, these details were sometimes missing or harder to interpret.
That may sound mundane, but it is fundamental. Before a hospital can interpret a high-resolution optical coherence tomography (OCT) B-scan, it must know who the patient is, how to contact them, why they were referred, and how urgently they need to be seen. High-resolution data is valuable only when attached to a patient, pathway, and decision.
Adding Value to Communication
This is the central message. Digital referral is not simply about more data, or even better images. Data and images create value only when they communicate relevant information to the stakeholder who must act on it.
The research, therefore, examining digital referrals into the Eye and Ear is an important milestone.² In a medical retina clinic, ophthalmologists compared traditional faxed referrals with digital referrals containing high-resolution retinal imaging. Digital files made assessors more likely to downgrade appointment urgency or reject referrals compared with matched faxed referrals, suggesting that richer digital information can better align urgency with clinical need.2
The study compared the faxed version of a digital referral with the full digital referral, not the wider group of ad hoc, unstructured referrals sent outside such platforms. Even so, the value is clear: scarce ophthalmology capacity can be better directed to the patients who need it most.2
For a hospital ophthalmology service, the value of a referral is determined not by whether the sender has described everything they know, but by whether the receiving service can triage safely and efficiently. The data must be designed around the receiver’s decision.
For a medical retina clinic, that may mean visual acuity, symptoms, diabetic status, macular involvement, OCT findings, retinal images, and the reason specialist care is needed. For glaucoma, it may mean intraocular pressure, optic nerve findings, OCT metrics, visual field status, risk factors, progression, and the clinical question being asked. Without this information, a referral is a narrative. With it, it becomes a triage tool.
The Contribution of Optometry to Primary Care
The same principle applies to general practice. Recent Victorian work showed that general practices with proactive education could identify at-risk patients and refer more frequently to eye care providers. Across 46 practices, 3,599 referrals were made for eye assessment, with 78% directed to optometry.³
Yet the communication loop remained fragile. Correspondence back from eye care providers was received for only 35% of referrals, and many referrals and responses relied on mail, fax, email, hardcopy, phone calls, or information carried informally by the patient.³ This is not shared disease management; it is a system without connective tissue.
Intentional Connection to Primary Care
If optometry wants to be recognised as part of primary eye care, it must also be connected to primary care. A GP managing diabetes, hypertension, cardiovascular risk, kidney disease, or multiple chronic conditions does not need to know only that the patient has ‘seen the optometrist’. They need to know what was found, what it means, what happens next, and whether the finding changes broader risk.
The Contribution of Optometry to Diabetes
Diabetes provides the clearest example. Ask many optometrists the most important outcome of an examination for a person with diabetes, and the answer will often be: identifying the patient who needs urgent referral to ophthalmology because they are at significant risk of vision loss. That answer is correct, but incomplete.
Identifying sight-threatening diabetic retinopathy is critical but this affects only a minority of people with diabetes at any point in time. The larger system opportunity is the GP letter. For every person with diabetes, the optometric examination should generate a clear retinal grading: no diabetic retinopathy, or diabetic retinopathy with severity and macular involvement.
That information is not merely an eye care observation. It is a biomarker of systemic vascular damage. The retina is one of the few places where microvascular disease can be directly observed, and its severity is associated with broader risks including kidney disease and cardiovascular disease.⁴ The optometrist detecting diabetic retinopathy is uniquely placed to alert the patient’s GP that diabetic control is most likely sub-standard, and that the risk of other diabetic complications is rising sharply.
The GP does not need an optometric essay. They need the eye-health equivalent of a pathology report: a concise, trusted, standardised communication that can be understood quickly, acted on confidently, and incorporated into whole-person care.
Pathology reports are a useful model because they do not reproduce the whole clinical encounter. They communicate the result, reference point, abnormality, and implication in a format GPs already understand. Eye care should learn from that discipline: the goal is not to send every image or observation, but to answer the clinical question for the receiver.
For diabetes, that means a small number of clear signals: date of eye examination, retinal grading, macular status, whether ophthalmology referral is required, whether the patient has already been referred, the reason for referral, the urgency or timeframe, the review interval, and whether systemic risk escalation should be considered. These are simple categories, but they carry major clinical meaning.
The same principle applies beyond diabetes. Critical eye health information can often be communicated through simple words, agreed grading, defined metrics, and selected images: visual acuity, intraocular pressure, cup-disc ratio, OCT metrics, visual field mean deviation, suspected progression, suspected macular oedema, urgent referral required, routine review appropriate, or no referral required.
Structured Referrals
A practical next step is to define a small number of core clinical data fields that can be captured consistently within optometry software and referral workflows. Many of these observations are already part of routine clinical care: diabetic retinopathy grading, visual acuity, intraocular pressure, OCT metrics, visual field indices, and agreed grading systems such as the Beckman classification for age-related macular degeneration.⁵ When recorded in structured fields, this information becomes easier to communicate, audit, recall, benchmark, and use in shared care.
At present, clinically important information may be recorded in free text, stored separately in imaging devices, or captured in formats that are difficult to extract or transfer. This can make it harder for receiving clinicians to triage referrals efficiently, for practices to monitor outcomes, and for the profession to demonstrate its contribution to disease management.
The goal is not to add unnecessary administration. It is to make the information already collected in optometric care more usable for the next clinician, the patient, and the broader health system. Software vendors, digital referral platforms, professional bodies, and funders all have a role in making structured clinical data easier to capture and share.
The opportunity now is to move from variable communication to more consistent, useful clinical exchange. Digital referral is part of that shift, but the greater value comes when each communication clearly supports the next clinical decision.
Peter Larsen BOptom is the joint Managing Director of Chemist Warehouse Optometry and a Director of Vision 2020 Australia. He was integral to the development of Oculo, and a key instigator of KeepSight. With senior global leadership experience across optometry, technology, and research, he is passionate about inclusive, practical change that strengthens optometry’s role in preventing avoidable vision loss and improving connected care across the eye health system.
References
- Larsen P. From individual care to collective impact: From Individual Care to Collective Impact: Optometry’s next chapter. mivision. 2026;221:85-86 available at: mivision.com.au/2026/03/from-individual-care-to-collective-impact-optometrys-next-chapter [accessed May 2026].
- McGuinness MB, Waugh M, Larsen P, et al. Impact of digital versus faxed e-referrals on triage decisions in a medical retina clinic. Clin Exp Optom. 2026 Mar 3:1-8. doi: 10.1080/08164622.2026.2636145.
- Urbis. Evaluation of the embedding eye health preventative care into primary care pilot project: Final report. Prepared for the Victorian Department of Health. Melbourne: Urbis; April 19, 2024.
- Wong TY, Cheung CM, Simó R, et al. Diabetic retinopathy. Nat Rev Dis Primers. 2016 Mar 17;2:16012. doi: 10.1038/nrdp.2016.12.
- Guymer R. Age-related macular degeneration: Who progresses to vision-threatening disease? Learning to See More in the Image. Ophthalmol Retina. 2021 May;5(5):393-395. doi: 10.1016/j.oret.2021.02.010.
