Vitro Retina Referral System

1 Diagnosis

2 Clinical Assessment

3 Examination

4 Details

5 Advice & Download

Select Diagnosis

Please select the primary diagnosis or condition you are referring for:

🔴

Retinal Detachment

Emergency referral for retinal detachment

🩸

Vitreous Haemorrhage

Bleeding into the vitreous cavity

👁️

Macular Degeneration

Age-related macular degeneration

💉

Diabetic Retinopathy

Retinal changes due to diabetes

🔄

Retinal Vein Occlusion

Blockage of retinal veins

📋

Other Condition

Other retinal condition

Clinical Assessment

Examination Findings

Affected Eye *

Visual Acuity RE

Visual Acuity LE

Urgency Level *

Examination Findings *

Investigations Performed

Additional Details

Referring Doctor *

Practice/Hospital *

Referral Date *

Patient Name *

Date of Birth

NHS Number

Presenting Complaint *

Relevant History