The College of Optometrists

Hello

If a px attended for a sight test c/o Flashes and floaters of sudden onset => if you find that VA's are NOT reduced, normal equal IOP's, No RAPD, no history of Migrane attacks.

On dilation, you find no evidence of a PVD, NO pigmant cells in the anterior Vitreous, and NO breaks or tears. only floaters seen. HOW SHOULD THAT PX BE MANAGED?

i would br grateful to hear your opinion on this matter as i have already heard different views and opinions from diff opticians.

some say that the px should be referred rouinely (poss for scleral indentation, however does this clogg up the referral pathway?)

others say that the px should be councilled and given a leaflet on flashes and floaters and told to return or go to A&E if sx's increase.( the thinking being that being, you should be confident in the results of the tests carried out and that nothing more can be done at the HES)

linking on to this, if the above px now happened to be a -10.00ds myope or someone who plays contact sports, or someone who recently had a fall => assuming we still got the same findings as above, would your management differ.

and finally, a px with a PVD (floaters + weiss ring seen, NO Tabacco Dust/breaks or tears), how soon should that px be referred? and for what purpose should that px be referred?

many thanks

p.s. sorry its very long winded!

you shouldphone eye emergency at HES and ask their advice as they will have a protocol for this.

However, if hothing terrible is seen - then in my view give them the leaflet about how to go to eye clinic if they see spots shaddows etc. And rebook them for routine dilation again for 3 weeks at the same time refer for routine fundoscopy at HES. If I can't refer then they should be reexamined again 3 months later on as well(as detatchments can happen months after the acute PVD.)

If they had extra risk factors (high myopia etc) - then I would definitely need a second opinion to fundoscopy (so refer) and suggest to px at least annual dilated retinal exams. If they have the PVD : then I will need a second opinion to my fundoscopy. No I would not treat this group much different - as I would want to stay in touch and redilate anyone with a PVD.

If I see the evidence of the PVD (Weiss ring etc) and it co-incides with their symptoms exactly, but without evidence of any retinal break = then I would carry out a repeat dilation 3 weeks later and decide if referal is worth it then. I would always warn them what to do if a break occurs in the mean time.

The idea of my care plan is to inform the px what to do if any sudden break happens, to try and anticipate any slow retinal break, to ensure the fundoscopy has a second opinion, to try and cover the risk of break later on.

-thats my ideas anyway