Selected high-volume medical retina services such as treatment for age-related macular degeneration and diabetic screening may be located within the community in a hub-and-spoke model. This places care closer to the patient and reduces pressure on hospitals.

Services requiring a medical ophthalmologist include specialised commissioned services such as Behcet’s disease service.

As medical ophthalmology is a new specialty and there are relatively few specialists, some services provided may also be performed by surgically trained ophthalmologists with a specialist interest in medical retinal services and other subspecialties. The requirements for the service in terms of infrastructure remain the same.

Service planning therefore needs to take into account the specific needs of the department. 

Referral pathways

  • Community optometrists refer patients with suspected eye disease to the eye hospital via their GP
  • GP referral
  • Ophthalmic Emergency Department for unscheduled care
  • Interdisciplinary referrals from secondary or tertiary care specialties, eg rheumatologists may refer patients who have ocular manifestations of a rheumatological condition
  • Intradepartmental ophthalmology referrals from other ophthalmology specialties requiring the input of a medical ophthalmologist
  • National diabetic screening service to diabetic retinopathy services within hospitals.

Unscheduled care

People with acute visual symptoms such as distortion of vision, sudden sight loss or orbital pain may present for unscheduled care. They are then admitted if indicated or treated and followed up via a scheduled outpatient service. People with certain conditions such as ‘wet’ or exudative age-related macular degeneration are seen within 2 weeks.

Scheduled care

This is typically in the form of outpatient clinic visits or for regular treatments such as anti-VEGF injections into the vitreous cavity of the eye and corticosteroid implants into the eye for retinovascular lesions, diabetic macular oedema or uveitis.


Medical ophthalmology services, including complex uveitis and neuro-ophthalmology services, are commissioned by NHS England and are expected to work in a multidisciplinary manner with other tertiary care departments.