Study of Ophthalmology Referrals Finds “Considerable Room for Improvement” in Documentation, but Best Overall Scores for ODs

A new retrospective study from Canada looked at the case details included (or excluded) when a patient is referred to an ophthalmologist to see if specific patterns emerge by provider type, to test whether referral quality affected triage urgency and to consider how closely the provisional diagnosis at referral matched the final diagnosis. The researchers found, unsurprisingly, that incomplete referrals can make specialist triage more difficult, but not all referral details matter equally. Communication-related elements—especially identifying the referrer and clearly stating the clinical question—were most strongly associated with better diagnostic concordance. They also found high variability of referral completeness among different healthcare professions. On a scale of one to 20, the mean score of referral completeness across professions was 11.6, which researchers argue suggests “considerable room for improvement in communication between referring providers and ophthalmologists.” Optometry scored the highest at 13.1.  In this graph from the study, the solid bars show the percentage of referrals in which each checklist item was documented. Dashed bars show the corresponding domain-level completion (aggregate across items within each domain). Domains are color-coded as follows: patient information (purple), history of presenting illness (blue), ocular vitals (green), ocular examination (orange) and referrer identification/communication (red). Photo: Sams M, et al. AJO Int. July 8, 2026. Click image to enlarge. The study, published recently in AJO International, reviewed 634 consecutive faxed referrals to the Urgent Eye Care Centre at Kingston Health Sciences Centre over a five-month period in 2024. Referrals came from a wide range of providers, including family physicians, emergency physicians, optometrists, nurse practitioners, ophthalmologists and other medical and surgical specialists. Most referrals came from primary care (69.2%, n=439), followed by optometrists (21.3%, n=135). The investigators developed a 21-item checklist spanning these five domains: patient identifiers/demographics, history of present illness, ocular vitals, ocular examination and referrer identification/communication. Each item received one point if documented, resulting in a total score from 0 to 21. Two reviewers also assessed whether the triage diagnosis matched the final in-person diagnosis.Overall referral completeness was moderate, with scores ranging from 2 to 20 out of 21 and a mean score of 11.6, which the researchers say highlights “considerable room for improvement in communication between referring providers and ophthalmologists.” The most complete domain was history of present illness, documented in 65.0% of cases, followed by referrer identification/communication at 62.6%. The weakest areas were ocular vitals, completed in only 27.3% of referrals, and ocular examination details (20.6%). Referral completeness varied by provider type, with those from optometry being the most complete overall. The researchers noted in their paper that this likely reflects optometrists’ “access to specialized ophthalmic equipment and familiarity with ocular terminology and examination standards.” The average scores by profession (0-21 scale) were as follows: • optometry: 13.1• nurse practitioners: 12.3• family medicine: 11.9• ophthalmology: 11.4• emergency medicine: 10.4 • internal medicine: 8.3 • other surgical specialties: 6.6“Nurse practitioners and family physicians also demonstrated relatively high completeness scores,” the researchers noted in their paper, “which may reflect their longitudinal relationships with patients and access to pre-documented clinical information including past medical history and medications.” Also notable was the finding that referrals from other ophthalmologists “displayed the greatest variability in completeness,” with a bimodal distribution representing both highly complete and highly incomplete referrals. “This may reflect heterogeneity in subspecialty focus and referral urgency; some ophthalmologists may provide detailed documentation when referring complex patients for tertiary care, while others may provide concise notes for second opinions,” the authors suggested.Triage urgency differed across completeness groups in unadjusted analysis. Higher completeness scores were associated with a greater likelihood of urgent triage  (same day or within 48 hours); however, that association disappeared after the study authors adjusted for referring profession (odds ratio: 0.95), which they believe “may suggest confounding by referral source and systematic differences in case mix and diagnostic certainty.”More than referral completeness, specific domains mattered; ocular examination completeness and referrer identification/communication were significantly associated with triage category. Notably, referrer identification/communication was linked to better diagnostic concordance between the referral impression and final diagnosis.“Together,” the authors concluded in their paper, “these findings highlight that enhancing referral completeness through targeted education and standardized, yet flexible, templates including prompting a specific referral question or provisional diagnosis may contribute to improved clarity of clinical communication and support triaging decisions, interprofessional collaboration and ophthalmic patient care.”Click here for the journal source. Sams M, Hutchinson KA, Pucchio A, et al. Ophthalmology referral completeness and its impact on triage urgency and diagnostic concordance. AJO Int. July 8, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.