The College of Optometrists

Would everyone refer a pvd?, or is it sufficient to inform patients of symptoms of RD and to attend casualty if they occur?

Is a letter of notification to GP sufficient?

ach px would need your professional care - and this would make each px have a different care plan.

For example a pvd in a young person maybe be notify gp only

but in an elderly high myope with a touch of cataract - refer.

On the whole - the px is the weak link and non-compliant and can't be trusted to do the corect thing.

As long as you have dilated the patient, looked for 'tobacco dust' in the anterior vitreous and scanned the retina with some form of indirect ophthalmoscopy then doing as you say is emminently sensible. Due the large number of PVD's that occur everyday in the population then I am sure ophthalmologists do not want ever PVD referred. However, if the patient has already had a RD in the other eye or has predisposing factors, eg high myopia etc then a referral soon would be indicated.

I would also review in 3/12 since around 2%-5%(from memory can go on to develop a RD.

I would also review in 3/12 since around 2%-5%(from memory can go on to develop a RD.

upps seeing double again

There is no accepted management strategy. I think the College should produce (a practical) one, which as well as helping guide optometrists would to help settle cases that end up in court.

The gold standard of management of a PVD is a thorough retinal examination with headset BIO with scleral indentation to exclude a RD. As such, for the majority of optometrists, this requires referral.

However, this is completely impractical. Due to the high number of PVDs and the low number that cause a RD. The overworked NHS would could (can) not cope with this workload.

Personally, in symptomatic patients I offer them referral - which to be any benefit must be very soon (days). If not keen I dilate. Then check the anterior vitreous for pigment and the posterior fundus with slitlamp BIO (supervitreofundus). If OK, I reassure Px, but make them aware that a RD could develop over the next 3 weeks, the time taken for the vitreous to become detached. Following this, I ask them to go directly to casulty if they develop a shadow (like a curtain) that they cannot see through, and to look for this monocularly every day until theor next appointment with myself. I then rebook them in 3 weeks and give them a leaflet of PVDs and RDs.

How this would stand up in court I do not know.