In a survey of nearly 75000 eye examinations, 6% of patients were referred to a medical doctor and the doctor was notified in a further 2% of cases. The level of referral was 2% higher than in 1986; 70% of referrals were the result of reminders or periodic attendances, and 80% of those referred were over 40 years of age. The general pattern of referral was broadly in agreement with a survey conducted in 1986 but indicates that some categories of eye conditions are being referred at a higher rate.