Retinal tears and detachments are sight-threatening emergencies requiring urgent intervention to prevent irreversible vision loss, with outcomes directly linked to timely diagnosis. In the UK, optometrists serve as primary gatekeepers for ocular emergencies, yet studies report variable referral accuracy. For instance, Muen and Hewick (2006) found only 37% accuracy for neovascular age-related macular degeneration referrals [1] , while Sanders et al. (2023) identified a 29% false-positive rate for retinal pathology in community optometry [2] . In Wales, the Welsh Eye Care Service (WECS) pathway delegates triage responsibility to community optometrists, but recent audits reveal suboptimal sensitivity for vitreoretinal emergencies compared to self-referrals [3] .

Accurate referrals are critical: delayed diagnosis of retinal detachment reduces surgical success rates from >90% to <50% when macular involvement occurs [4] . Despite advances in ultra-widefield imaging and validated triage tools like the BElfast Retinal Tear and Detachment Score (BERT Score), systemic gaps persist [5] . This study evaluates referral accuracy across primary care sources in South Wales, contextualizing findings against contemporary Welsh data and proposing evidence-based solutions to improve triage efficiency.

Given these considerations, evaluating the accuracy of referrals for suspected retinal tears and detachments is essential for identifying gaps in current practice and informing targeted interventions. This study aims to assess the referral patterns and diagnostic accuracy of primary care providers, including optometrists, GPs, and other sources against confirmed diagnoses in a tertiary eye care setting. By contextualizing our findings within contemporary literature, we seek to highlight opportunities for improving referral pathways and, ultimately, patient outcomes.

A total of 1089 referrals for suspected retinal pathology were triaged between 2022 and 2024. Of these, 119 cases (10.9%) were confirmed to have retinal tears, retinal detachments, or posterior vitreous detachment (PVD) following clinic assessment.

To address these challenges, integrating advanced technologies into primary care is imperative. Deep learning systems trained on ultra-widefield fundus images have demonstrated 94.2% sensitivity for retinal detachment detection, offering a scalable solution to reduce diagnostic variability [12] . Additionally, point-of-care ultrasound (POCUS), validated in emergency settings with 91% sensitivity for retinal detachment, could be adapted for community optometry, particularly in rural areas where specialist access is limited [13] . Standardized training modules, such as those focusing on peripheral retinal lesions and OCT interpretation, should be mandated for WECS accreditation [5] [14] . Pilot programs could evaluate telemedicine protocols incorporating the Belfast Retinal Tear and Detachment Score (BERT Score), which improves risk stratification through symptom-based algorithms [14] .

This study has several limitations. Its retrospective design introduced selection bias, particularly due to the exclusion of 14.6% of cases with undocumented referral sources, potentially underestimating primary care contributions [10] [11] . Small sample sizes for non-WECS referral groups (e.g., GP: n = 4) reduced statistical power, limiting subgroup analyses. Furthermore, the reliance on clinic-confirmed diagnoses as the gold standard may overlook early-stage pathology detectable only through advanced imaging [9] [12] . Regional focus on Wales limits generalizability to other UK pathways, such as Scotland’s Community Eyecare Services, which employ distinct referral refinement protocols [15] .

While WECS optometrists remain pivotal to retinal emergency management, their moderate sensitivity highlights the need for protocol modernization. Future initiatives should prioritize AI-aided decision tools, POCUS integration, and standardized training to bridge current triage gaps. Addressing documentation inconsistencies and expanding imaging access in community settings will be critical to optimizing patient outcomes.

This study was exempt from ethics due to the nature of the study by the NHS Health Research Authority.