The task
Assume that today's date is 22 October 2026. You examined Mr Lockyer this morning.
You are an optometrist in private practice. Using the information in the case notes, write a letter of referral to Dr Nomsa Aitken, Consultant Ophthalmologist, requesting assessment of Mr Lockyer for cataract surgery. Address the letter to Dr Nomsa Aitken, Consultant Ophthalmologist, Eye Surgery Clinic, 22 Market Street. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Referral letter.
Case notes
Patient details
- Name: Mr Dean Lockyer
- DOB: 14/03/1963 (63 yrs)
- Address: 8 Banksia Lane
- Last eye exam 2 yrs ago: BCVA R 6/6, L 6/9
Social background
- Self-employed carpenter; fine measuring work, uses power tools daily
- Drives work van daily; now avoids night driving due to glare from headlights
- Lives with wife; she can drive him to appointments
- Enjoys fishing on weekends
- Wife says he 'should have retired years ago and is too stubborn to stop'
Medical history
- BPH: tamsulosin 400 microg daily (3 yrs)
- Type 2 diabetes: metformin 500 mg BD; well controlled per GP
- Hypertension: amlodipine 5 mg daily
- Allergies: nil known
- # R wrist 2019, fully healed
- Metal foreign body R cornea removed 2015; no sequelae, cornea clear
Presenting complaint
- Gradual ↓ vision L eye over 12/12
- Glare in bright sunlight and from oncoming headlights; difficulty reading tape measure at work
- Has turned down 2 jobs in past 3/12 because of vision
Examination (22/10/26)
- BCVA R 6/6, L 6/24; no improvement with pinhole L
- Refraction: L myopic shift (approx. −1.50 D since last exam); R stable
- Slit lamp: L dense nuclear cataract; R mild nuclear sclerosis
- IOP R 15, L 16 mmHg; anterior chambers deep
- Pupils equal and reactive, no RAPD; both pupils dilated poorly with tropicamide
- Fundus: R normal, no diabetic retinopathy; L view hazy, no retinopathy seen, macula not clearly visualised
- Binocular VA meets private driving standard; advised to avoid driving at night
- Pt complained previous optometrist 'never noticed anything was wrong'
Plan
- Pt keen for surgery; aware risks and benefits will be discussed by ophthalmologist
- Refer to ophthalmologist: routine assessment for L cataract surgery
- New spectacles not prescribed — limited benefit for L eye
- Has private health insurance
- Copy of letter to GP
- Review R eye in 12/12 or sooner if vision changes
Who is reading, and what do they need?
Dr Aitken is a consultant ophthalmologist who will decide on surgery and has not seen the patient. She needs objective findings, the functional impact, and factors that could affect assessment or surgery. She does not need basic optometric explanation or the family's views, so the detail should be focused and clinical.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Gradual ↓ vision L eye over 12/12; glare; difficulty reading tape measure | This gives the history and symptoms that support the referral request. |
| BCVA R 6/6, L 6/24, no pinhole improvement; last exam L 6/9 | The objective acuity and the change from two years ago show the decline and that refractive error does not explain it. |
| L myopic shift approx −1.50 D; L dense nuclear cataract; R mild nuclear sclerosis | These are the key slit lamp and refraction findings supporting cataract as the cause in the left eye, with the right eye status noted. |
| Both pupils dilated poorly with tropicamide; tamsulosin daily for 3 years | Poor dilation and the medicine are relevant for the surgeon's planning. State both factually without drawing a conclusion the notes do not give. |
| L fundus view hazy; no retinopathy seen; macula not clearly visualised | The macula could not be assessed in the left eye, and the patient has diabetes, so this limit must be stated honestly. |
| T2DM on metformin, well controlled per GP; hypertension on amlodipine; nil allergies | Systemic conditions and allergies matter for surgical assessment. Attribute the control of diabetes to the GP, as the notes do. |
| Carpenter with fine measuring work; turned down 2 jobs; avoids night driving; advised not to drive at night | This shows the functional impact justifying surgery and the driving advice given. The notes say binocular VA meets the private driving standard only. |
| Keen for surgery; has private health insurance | It tells the ophthalmologist the patient's wishes and funding pathway; risks and benefits are left for her to discuss. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Wife says he 'should have retired years ago and is too stubborn to stop' | This is a third party's opinion about the patient. It looks relevant to work and driving but has no place in a referral. |
| Pt complained previous optometrist 'never noticed anything was wrong' | A complaint about another practitioner does not help the referral and risks sounding critical. |
| # R wrist 2019, fully healed; enjoys fishing | Unrelated history and hobbies do not affect cataract assessment. |
| Wife can drive him to appointments | Convenience detail the ophthalmologist does not need; it is not part of the clinical case. |
| New spectacles not prescribed; review R eye in 12/12; IOP 15 and 16 | Compress to at most a brief clause. These are practice-level actions and normal readings that do not change the referral decision. |
A paragraph plan for this case
Start with the request for assessment for left cataract surgery and the reason, then set out symptoms and functional impact. Give examination findings next, including poor dilation and the limited left macula view, then relevant history, medicines and driving advice, ending with the patient's wishes, insurance and the copy to the GP.
Where candidates slip on this task
- Do not imply the left macula or fundus is normal. The notes say the view was hazy, no retinopathy was seen, and the macula was not clearly visualised, so state that limit clearly.
- Place tamsulosin and the poor tropicamide dilation together so the surgeon sees both, but do not name a condition or complication. The notes only record the two facts.
- Report the driving position accurately: binocular VA meets the private driving standard and night driving was advised against. Do not say he is safe to drive generally or mention a commercial standard.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Optometry letter tasks
- Bilateral optic disc swelling: urgent referral referral letter
- Diabetic eye check: early retinopathy found update letter
- Early dry age-related macular degeneration in a smoker update letter
Your profession's guide: OET Optometry. Layout and structure: OET letter format.
Questions about this task
Should this letter sound urgent?
No. The plan states a routine assessment. Describe the decline, the functional effects and the findings clearly, but request routine assessment rather than using urgent language.
Is the previous eye exam worth including?
Yes, briefly. Acuity of L 6/9 two years ago against 6/24 now shows the change over time, and the refraction shift supports the picture. Other old details can stay out.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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