Guideline:
Care of the patient with retinal detachment and related peripheral vitreoretinal disease
Bibliographic Source(s)
- American Optometric Association. Care of the patient with retinal detachment and related peripheral vitreoretinal disease. St. Louis (MO): American Optometric Association; 1995. 79 p. (Optometric clinical practice guideline; no. 13). [201 references]
Guideline Status
This is the current release of the guideline.
According to the guideline developer this guideline has been reviewed on a biannual basis and is considered to be current as of 2004. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.
Guideline Category
Diagnosis
Evaluation
Management
Prevention
Intended Users
Health Plans
Optometrists
Guideline Objective(s)
- To diagnose significant or frequently encountered peripheral vitreoretinal diseases and related congenital ocular abnormalities
- To improve the quality of care rendered to patients with retinal diseases and related congenital ocular abnormalities
- To identify patients at risk of developing retinal breaks or detachment
- To minimize the ocular morbidity and severe vision loss related to retinal disease through diligent monitoring and timely consultation or referral
- To monitor the gains obtained through treatment
- To inform and educate patients and other health care practitioners about the complications and prevention of retinal disease and the availability of treatment.
Target Population
Patients with suspected or diagnosed retinal detachment or related peripheral vitreoretinal disease.
Interventions and Practices Considered
Diagnosis
- Patient History
- Ocular Examination
- Supplemental Testing
Management
- Management Strategy for Retinal Breaks
- Monitor for progression to detachment
- Referral to a retina specialist or general ophthalmologist
- Surgery (retinopexy)
- Periodic follow-up examinations
- Management Strategy for Retinal Detachment
- Urgent or immediate consultation with a retina specialist
- Retinal detachment surgery
- Periodic follow-up examinations
- Patient Education
Major Outcomes Considered
Not stated
Methods Used to Collect/Select Evidence
Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
The guideline developer performed literature searches using the National Library of Medicine's Medline database and the VisionNet database.
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus (Committee)
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not applicable
Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Internal Peer Review
Description of Method of Guideline Validation
The Reference Guide for Clinicians was reviewed by the American Optometric Association (AOA) Clinical Guidelines Coordinating Committee and approved by the AOA Board of Trustees.
Major Recommendations
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 Detachmentand 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 | |||||||
| Annual | Yes | Yes | Yes | No | If possible
| Document for future reference; educate patient; observe |
| 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 | |||||||
| Annual | Yes | Yes | Yes | No | If possible | Document for future reference; educate patient; observe |
| Every 6 to 12 months | Yes | Yes | Yes | No | If possible | Document for future reference; educate patient; observe or consult with retina specialist/ophthalmologist |
| Referral to retina specialist/ophthalmologist | ||||||
| Flap or linear tear | |||||||
| 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 |
| Consult with retina specialist/ophthalmologist | ||||||
| Referral to retina specialist/ophthalmologist | ||||||
| Retinal dialysis | |||||||
| Annual | Yes | Yes | Yes | No | If possible | Document for future reference; educate patient; observe |
| Referral to retina specialist/ophthalmologist | ||||||
| Retinal Detachment | |||||||
| Annual | Yes | Yes | Yes | Yes | If possible | Urgent referral to retina specialist/ophthalmologist |
| Immediate (stat) referral to retina specialist/ophthalmologist | ||||||
| Document for future reference; educate patient; observe | ||||||
Clinical Algorithm(s)
- An algorithm is provided for Optometric Management of the Patient with Peripheral Vitreoretinal Disease.
- An algorithm is provided for Optometric Management of the Patient with Retinal Detachment.
Type of Evidence supporting the Recommendations
The type of supporting evidence is not specifically stated for each recommendation.
Potential Benefits
The optometrist is in a position to diagnose peripheral retinal conditions that are of great significance to the ocular health of his or her patients. Through early detection and timely treatment preventive measures can protect and maintain the patient's ocular health and vision. A comprehensive eye examination including a stereoscopic retinal examination through a dilated pupil enables the optometrist to diagnose potentially sight-threatening conditions. Management of the patient with peripheral retinal disease involves appropriate documentation patient follow-up and when appropriate referral for consultation with or treatment by a retina specialist or a general ophthalmologist experienced in retinal disease.
Subgroups Most Likely to Benefit:
The most common risk factors for retinal detachments are myopia (40%-55%) aphakia (30%-40%) and ocular trauma (10%-20%).
Potential Harms
Not stated
Qualifying Statements
Clinicians should not rely on this Clinical Guideline alone for patient care and management. Please refer to the references and other sources listed in the original guideline for a more detailed analysis and discussion of research and patient care information.
The components of patient care described are not intended to be all inclusive. Professional judgment and individual patient symptoms and findings may have significant impact on the nature extent and course of the services provided.
Description of Implementation Strategy
An implementation strategy was not provided.
IOM Care Need
Getting Better
Living with Illness
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness
Timeliness
Bibliographic Source(s)
- American Optometric Association. Care of the patient with retinal detachment and related peripheral vitreoretinal disease. St. Louis (MO): American Optometric Association; 1995. 79 p. (Optometric clinical practice guideline; no. 13). [201 references]
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
Funding was provided by the Vision Service Plan (Rancho Cordova California) and its subsidiary Altair Eyewear (Rancho Cordova California)
Guideline Committee
American Optometric Association Consensus Panel on Care of the Patient with Retinal Detachment and Related Peripheral Vitreoretinal Disease
Composition of Group that Authored the Guideline
Members: William L. Jones O.D. (Principal Author); Anthony A. Cavallerano O.D.; Kirk M. Morgan M.D.; Leo P. Semes O.D.; Jerome F. Sherman O.D.; Robert S. Vandervort O.D.; Robert P. Wooldridge O.D.
AOA Clinical Guidelines Coordinating Committee Members: John F. Amos O.D. M.S. (Chair); Barry Barresi O.D. Ph.D.; Kerry L. Beebe O.D.; Jerry Cavallerano O.D. Ph.D.; John Lahr O.D.; David Mills O.D.
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
This is the current release of the guideline.
According to the guideline developer this guideline has been reviewed on a biannual basis and is considered to be current as of 2004. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) from the American Optometric Association Web site.
Print copies: Available from the American Optometric Association 243 N. Lindbergh Blvd. St. Louis MO 63141-7881
Availability of Companion Documents
None available
Patient Resources
The following is available:
- Answers to your questions about spots and floaters. St. Louis MO: American Optometric Association. (Patient information pamphet).
Print copies: Available from the American Optometric Association 243 N. Lindbergh Blvd. St. Louis MO 63141-7881; Web site www.aoanet.org.
Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.
NGC STATUS
This summary was completed by ECRI on December 1 1999. The information was verified by the guideline developer on January 31 2000.
COPYRIGHT STATEMENT
This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions as follows:
Copyright to the original guideline is owned by the American Optometric Association (AOA). NGC users are free to download a single copy for personal use. Reproduction without permission of the AOA is prohibited. Permissions requests should be directed to Jeffrey L. Weaver O.D. Director Clinical Care Group American Optometric Association 243 N. Lindbergh Blvd. St. Louis MO 63141; (314) 991-4100 ext. 244; fax (314) 991-4101; e-mail ClinicalGuidelines@theAOA.org.
NGC Disclaimer
The National Guideline Clearinghouse™ (NGC) does not develop produce approve or endorse the guidelines represented on this site.
All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies relevant professional associations public or private organizations other government agencies health care organizations or plans and similar entities.
Guidelines represented on the NGC Web site are submitted by guideline developers and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .
NGC AHRQ and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC AHRQ or its contractor ECRI Institute and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.
Readers with questions regarding guideline content are directed to contact the guideline developer.
Tools
No Quick Reference tools have been developed.
Details
FDA Warning
- Category:
- Optometry
- Conditions:
- Retinal Detachment and Related Peripheral Vitreoretinal Disease Retinal Detachment Rhegmatogenous Retinal Detachment Nonrhegmatogenous Retinal Detachment Retinal Breaks Atrophic Retinal Holes Operculated Retinal Tears Horseshoe and Linear Retinal Tears Retinal Dialysis Related Peripheral Vitreoretinal Disease Retinal Tufts Lattice Retinal Degeneration Snail-Track Degeneration Retinoschisis White-Without-Pressure Meridional Folds and Complexes Peripheral Pigmentary Degeneration and Pigment Clumping Peripheral Retinal Hemorrhage Pars Planitis Chorioretinal Scar Posterior Vitreous Detachment
- Published:
- 1995 (revised 1999; reviewed 2004)
- Endorsed by:
- American Optometric Association