Clinical Safety Reminder: Urgent Referral Required for Transient Monocular Visual Loss/Suspected Amaurosis Fugax

The LOC have been made aware of the increasing number of routine letters going to GPs for onward referral regarding patients with transient visual loss / suspected amaurosis fugax, where no urgent referral has been made.

Transient monocular visual loss / suspected amaurosis fugax may represent a transient ischaemic attack and carries a risk of stroke. In such cases, urgent assessment in line with national and local stroke/TIA pathways is essential, with aspirin given as soon as possible and the patient to be referred and seen in a TIA clinic within 24 hours.

Therefore, on advice from our local GPs and the LMC, the LOC would like to remind optometrists that for any patients who has presented with amaurosis fugax symptoms (that have stopped) should be referred immediately to their GP or other appropriate medical service. The LMC would suggest that the optometrist telephones the GP practice. Bypass numbers for practices can be found on NHS Service Finder or there is often an option for professionals.

If this is not possible (due to the timings e.g. Weekends or practices near closing time/ closed/ transport delay) then the patient should be directed to another service that is able to assess them urgently – this may be 111, an urgent treatment centre or ED. There is a map of these here: Urgent and Emergency Care Facilities – Google My Maps created by the Local Medical Committee or you can search on the NHS website.

The patient should also be provided with a copy of the referral letter detailing their symptoms and possible diagnosis clearly stated.

In the case of ongoing symptoms which could therefore be a stroke then the patient should call 999 immediately in line with NHS advice.

With GP practices receiving several hundred letters per day then routine correspondence asking the GP to “consider referral” for suspected amaurosis fugax, without clear risk stratification or urgency, is not safe or clinically appropriate. It also risks patients not being seen within recommended timeframes with adverse clinical outcomes.