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Medical Forum / General / Vision / June 2006PVD -> Retinal Detachment?
Given PVD symptoms like peripheral flashes, how likely is it that you won't get retinal detachment, and what are the signs that things are settling down without detaching retina (only Posterior Vitreous Detachment)? This case involved someone with risk characteristics, suddenly getting couple hours of strong light flashes (even with closed eyes) but not much increase in floaters. Puhleeeeze, pretty please fill in some info instead of deferring entirely to obvious urgent reccomendations to see eye doc asap. Gravity of the danger is understood: http://www.vrmny.com/PVD.htm , but need to be a prepared consumer of medical services, which can be an excruciatingly slow and uncooperative player in this case. Additionally, the standard dilation exam has proved infeasible in past due to particular patient issues; what about this ultrasonography approach? Thanks! > Given PVD symptoms like peripheral flashes, how likely is it that you > won't get retinal detachment, and what are the signs that things are [quoted text clipped - 11 lines] > due to particular patient issues; what about this ultrasonography > approach? Thanks! Usually the odds are in your favor that a pvd will not develop into a retinal tear and detachment. I see pvd's almost daily and, I think, out of the last 20 pvd's I've seen , one had a horseshoe tear. But it's kind of weird, you can go weeks without seeing a pvd with a tear and suddenly have two back to back. Many times, unless one has a tear that develops into a detachment involving the macula, the symptoms can be minimal. frank > Given PVD symptoms like peripheral flashes, how likely is it that you > won't get retinal detachment, and what are the signs that things are [quoted text clipped - 11 lines] > due to particular patient issues; what about this ultrasonography > approach? Thanks! Odds are in the 95% range that it won't be a RD, but if you are the in the 5% and the RD is not found then permanent vision loss is probable. >From the patient's side, symptoms of RD and PVD are identical and 50% of tears with potential of RD have no patient symptoms. So the answer truly is an urgent visit to the eye doc. In most offices, new flashes and/or floaters are the magic words to get a same day or next day appointment. If not, you can always go Emerg at the nearest hospital. A dilated exam will be necessary, if the patient can't co operate it can be done with sedation. Ultrasound may not find all tears. Dr Judy >Given PVD symptoms like peripheral flashes, how likely is it that you >won't get retinal detachment 95-98% in the general population. If you have "high risk" risk factors such as high myopia, history of lattice degeneration, cataract surgery, trauma, history of retinal detachment in the other eye, then the percentage is much lower, say only 90%. >and what are the signs that things are settling down without detaching >retina (only Posterior Vitreous Detachment)? The test of time. The further time goes on without developing a retinal detachment (RD), the more likely things have settled down. IMHO, if an acute PVD has not progresssed to a RD within the first 6 weeks, it is quite unlikely it ever will. >This case involved someone with risk characteristics, suddenly getting >couple hours of strong light flashes (even with closed eyes) but not [quoted text clipped - 3 lines] >entirely to obvious urgent reccomendations to see eye doc asap. >Gravity of the danger is understood: http://www.vrmny.com/PVD.htm, No sane doctor is going to give info and tell you it is OK to not get your eyes checked. There are NO reliable symptoms that differentiate an acute posterior vitreous detachment (PVD) without a retinal break (RB) from an acute PVD with an associated RB. And there are no symptoms that can reliably distinguish between an acute symptomatic horeshoe retinal tear (which requires prompt treatment) from an operculated tear (which may or may not require treatment). Therefore, when a person has an acute PVD, a dilated fundus examination with careful and meticulous examination of the retinal periphery is required. IOW, every person with an acute PVD (especially with risk characteristics) needs an appropriate (peripheral) retinal examination. >but need to be a prepared consumer of medical services, which can be >an excruciatingly slow and uncooperative player in this case. What do you mean by this? Patients with acute PVD without symptoms of RD are seen in my office the same day if possible. If not, they are seen the following day or the next day my office is open. They are worked in. If a patient has an acute PVD with symptoms of RD, they are seen the same day or, on my days off, I go into the office on an urgent basis. However, the urgency is in hours, not minutes. >Additionally, the standard dilation exam has proved infeasible in past >due to particular patient issues What does this mean? Please elaborate. >what about this ultrasonography approach? B-scan ultrasonography has a lot of false negatives, but very low false positives. It misses a lot of RDs and probably every RB. It is useful for people with media obstructions such as dense cataract, vitreous hemorrhage, etc. but it is a horrible substitute for a peripheral retinal examination with binocular indirect ophthalmoscopy with scleral depression or a contact fundus lens. |
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