Care of the patient with retinal detachment and related peripheral vitreoretinal disease.

Diagnosis of Retinal Detachment and Related Peripheral Vitreoretinal Disease

Evaluation of patients with retinal detachment or related peripheral vitreoretinal disease includes the elements of a comprehensive eye and vision examination. It may include, but is not limited to, the following areas:

Patient History
The clinician should review the patient's present and past history of ocular and systemic disease and elicit information regarding:
- Loss of vision
- Sudden, recent onset of floaters
- Flashing lights
- Loss of peripheral visual field
- Family members with loss of vision or history of retinal disease
- History of trauma.
Ocular Examination
The examination for retinal detachment and related peripheral vitreoretinal disease may include, but is not limited to:
- Best corrected visual acuity
- Pupillary responses
- Biomicroscopy
- Binocular indirect ophthalmoscopy, with scleral indentation if indicated
- Tonometry
- Visual field screening (confrontation)
- Retinal drawing or photodocumentation, if indicated.
Supplemental Testing
- Fundus biomicroscopy with Hruby lens, fundus contact lens, or other precorneal condensing lens
- Ultrasonography
- Fluorescein angiography
- Formal visual field testing

Management of Retinal Breaks and Detachment

Management Strategy for Retinal Breaks
The optometric management of the patient with peripheral vitreoretinal disease varies with the type and severity of the retinal break and is discussed in the guideline document.
Management Strategy for Retinal Detachment
Initial optometric management of the patient with retinal detachment includes restriction of physical activity and reduction in eye movement. Without surgery nearly every eye with a symptomatic retinal detachment will become blind. Following the diagnosis of significant retinal detachment, the optometrist should make an immediate referral to a retina specialist for surgery. Refer to the guideline document for further discussion.
Patient Education
The optometrist should educate the patient about the symptoms of a retinal detachment, retinal tear, or related peripheral vitreoretinal disease and advise him or her to return immediately if the symptoms occur.
Prognosis and Follow-Up
The prognosis for the patient with a retinal break and the need for follow-up by the optometrist depend on the type and severity of break. The frequency and composition of evaluation and management visits and the prognosis for patients with specific conditions are summarized in the table, below:

Frequency and Composition of Evaluation and Management Visits for Retinal Detachment and Related Peripheral Vitreoretinal Disease


Type of Patient	Frequency of Examination	Patient History	Visual Acuity	Binocular Indirect Ophthal	Formal Visual Field Testing	Photo Documentation	Management Plan

Posterior vitreous detachment	Every 2 to 3 weeks until photopsia resolves	Yes	Yes	Yes	No	No	Educate patient; observe for possible progression to break or detachment
Peripheral retinal lesion without break	Every 6 to 12 months	Yes	Yes	Yes	No	If possible	Document for future reference; educate patient; observe for possible progression to break or detachment
Atrophic hole
Asymptomatic	Annual	Yes	Yes	Yes	No	If possible	Document for future reference; educate patient; observe
Asymptomatic with local detachment or at-risk patient	Every 6 to 12 months	Yes	Yes	Yes	No	If possible	Document for future reference; educate patient; observe or consult with retina specialist/ophthalmologist
Operculated tear
Asymptomatic	Annual	Yes	Yes	Yes	No	If possible	Document for future reference; educate patient; observe
Asymptomatic with local detachment or at-risk patient	Every 6 to 12 months	Yes	Yes	Yes	No	If possible	Document for future reference; educate patient; observe or consult with retina specialist/ophthalmologist
Symptomatic							Referral to retina specialist/ophthalmologist
Flap or linear tear
Asymptomatic	Every 6 months	Yes	Yes	Yes	No	If possible	Document for future reference; educate patient; observe for possible progression or consult with retina specialist/ophthalmologist
Asymptomatic with local detachment or at-risk patient							Consult with retina specialist/ophthalmologist
Symptomatic							Referral to retina specialist/ophthalmologist
Retinal dialysis
Asymptomatic and scarred over	Annual	Yes	Yes	Yes	No	If possible	Document for future reference; educate patient; observe
Asymptomatic or symptomatic with open break							Referral to retina specialist/ophthalmologist
Retinal Detachment
Recent symptomatic	Annual	Yes	Yes	Yes	Yes	If possible	Urgent referral to retina specialist/ophthalmologist
Recent, advancing close to posterior pole							Immediate (stat) referral to retina specialist/ophthalmologist
Long standing detachment (>1 yr)							Document for future reference; educate patient; observe

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