REFERRAL SYSTEM IN

OPHTHALMOLOGY

dr.Michael Indra Lesmana,Sp.M

Faculty of Medicine UKRIDA
 When to refer?
• Decreased of visual acuity with or without
eye redness and pain
• No improvement inspite of medical
treatment
• Medical competency (know the limitation)
 Eye Emergency-BPJS
• Corneal Foreign body
• Blenorrhoe
• Acute dacryosytitis
• Endophthalmitis/panophthalmitis
• Acute Angle closure Glaucoma
• Sudden B.O.V (Retinal detachment, CRAO,
Vitreous haemorrhage)
 Eye Emergency-BPJS
• Orbital cellulitis
• Any Corneal abnormality (erosion/ulcer)
• Ocular trauma
• Orbital tumour with bleeding
• Uveitis
 Referral System-Online
• Emergency Cases ----- Emergency Room
• Elective Cases--------- OPD
• Permenkes nomor 1 tahun 2012 tentang
Sistem Rujukan Pelayanan Kesehatan
Perorangan
• Tingkat I : Pelayanan kesehatan dasar yang
diberikan oleh dr/drg di puskesmas, tempat
praktek perorangan, klinik pratama, klinik
umum dan rumah sakit pratama.
• Tingkat II: Pelayanan kesehatan spesialistik
• Tingkat III : Pelayanan kesehatan sub
spesialistik
 Referral system
• Clinic-type C-B-A Hospital/ Public
Hospital
• Make a proper referral letter and give initial
treatment and have a good communication
• Refer to have ancillary test (USG,
perimetry, OCT, Biometry)
 BPJS-Eye diseases
1. Cataract
Indication of Phaco surgery is Visual acuity
is less than 6/18, at least one month interval
for the fellow eye.
2. Pterygium
Indication of Pterygiumplasty if Grade III-
IV (hospitalized)
 BPJS-Eye diseases
3. Diabetic Macula edema
Bevacizumab is off label drug, and has
been excluded as a drug covered by BPJS
4. Retinal detachment
should be referred to B/A type Hospital
5. Glaucoma
Pro Trabeculectomy, should be admitted,
control the IOP with Mannitol IV.
THANK YOU