Patient selection: onset of floaters and/or flashes with or without visual loss
Parameters:
(1) duration of symptoms
(2) past history of posterior vitreous detachment
(3) additional findings
|
Duration of Symptoms
|
Past History
|
Additional Findings
|
Recommendations
|
|
weeks to months
|
none
|
no high risk features and not bothersome for patient
|
1, 2
|
|
new onset
|
none
|
monocular visual field loss (red flag finding)
|
3
|
|
new onset
|
none
|
high risk (see below)
|
4
|
|
new onset
|
none
|
none
|
2, 5
|
|
new onset
|
uncomplicated posterior vitreous detachment
|
NA
|
6
|
|
NA
|
uncomplicated posterior vitreous detachment
|
new subjective visual reduction
|
6
|
where:
• A patient with symptoms for weeks or months and who is bothered by them probably should be referred to an ophthalmologist for a dilated eye exam.
High-risk findings:
(1) subjective or objective visual reduction
(2) vitreous hemorrhage or vitreous pigment on slit-lamp examination
Recommendations:
(1) Elective referral to ophthalmologist
(2) Inform patient about findings (monocular visual field loss, high risk findings) that should prompt immediate evaluation by an ophthalmologist.
(3) Immediate referral to a retinal surgeon.
(4) Same day referral to an ophthalmologist or retinal surgeon for dilated eye exam.
(5) Referral in 1-2 weeks to an ophthalmologist for dilated eye exam.
(6) Contact ophthalmologist to determine urgency (immediate vs same day). Need to exclude new retinal tear or detachment.
