Flashes and floaters as predictors of vitreoretinal pathology: Is follow-up necessary for posterior vitreous detachment?

Abstract

Newcastle upon Tyne SUMMARY Purpose. The aim of the study was to determine whether patients presenting with an isolated posterior vitreous detachment require follow-up to identify retinal breaks not apparent at presentation and whether some histories are more predictive of asso ciated serious posterior segment pathology.Methods. The notes of 295 patients presenting to eye casualty with flashes andlor floaters were reviewed.Results. One hundred and eighty-nine patients (64%) had isolated posterior vitreous detachments, 49 (16.6%) had retinal detachments and 31 (10.5%) had flat retinal tears. Three new breaks (3.3% of all tears found, 1.9% of review appointments) were identified only at follow-up. Although a subjective reduction in vision and a history of less than 6 weeks' duration were strongly predictive of retinal breaks, the large group of patients presenting with floaters alone (124/295, 42 %) still harboured a significant proportion (26.7%) of the retinal breaks. Conclusions. A follow-up visit for patients with anisolated posterior vitreous detachment can be justified to detect the small percentage of asymptomatic retinal breaks. Although a subjective reduction of vision is the symptom most predictive of serious posterior segment pathology, it would be unsafe to identify particular subgroups of patients alone for careful examination.Patients complaining of flashes and floaters make up a significant proportion of the cases presenting to eye casualty departments. Of these, between 10% and 30% 1-3 will have retinal breaks requiring immediate treatment and approximately half will have an isolated posterior vitreous detachment. ! , 4 The latter group are usually followed up in outpatients approxi mately 6 weeks after the onset of symptoms, to allow the identification of retinal breaks which may have developed after the first visit.Our aims were to determine whether significant pathology associated with posterior vitreous detach ment was being detected at the follow-up visit and to identify characteristics of the history which were more strongly indicative of the presence of retinal breaks or detachments. PATIENTS AND METHODSWe retrospectively studied 295 consecutive patients who presented to eye casualty in 1993 and 1994 with symptoms of floaters and/or flashes due to posterior vitreous detachment. Patients who were referred directly to outpatients, or who had a history of trauma or concurrent posterior segment disease such as diabetic retinopathy and vascular occlusions, were excluded. All had been examined at the first visit by the senior house officer in casualty and a diagnosis of separation of the posterior vitreous face from the retina was made using slit lamp biomicroscopy with the 90 dioptre lens or Goldmann 3-mirror contact lens. Indirect ophthalmoscopy with scleral indenta tion was also performed to identify any peripheral retinal pathology and patients were then treated immediately as necessary or given a retinal detach ment warning and followed up in clinic. Patients' symptoms, pathology, timing of f...

Prophylactic treatment of retinal breaks – a systematic review

“…(Dayan et al. ) The second study examined 105 eyes with PVD with 6‐week follow‐up. At presentation, 11 eyes were identified with retinal tears, two were found at follow‐up (84.6% and 15.4%, respectively), and so 2/105 (1.9%) of the total eyes with PVD developed delayed retinal breaks.…”

Ageing of the vitreous: From acute onset floaters and flashes to retinal detachment

“…In the study of Dayan et al, the incidence of retinal detachment was 16.6% in patients presenting with an isolated PVD. Furthermore, retinal tear was detected in 26.7% of patients with PVD presenting with floaters alone (Dayan et al, 1996). Sharma et al found floaters to be a presenting symptom of patients with PVD-related retinal tears in 89% of cases, flashes in 62% and both in 51% of cases with duration of less than 1 month from 92.7% of the examined patients (Sharma et al, 2004).…”

Symptoms related to posterior vitreous detachment and the risk of developing retinal tears: a systematic review

“…Posterior vitreous detachment is associated with increased risk of developing retinal tears, retinal detachment and vitreous haemorrhage (Dayan et al. ; Sarrafizadeh et al. ).…”