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Nikhil Batra, Ravi Patel, Shaun Ittiara, Seenu Hariprasad; The Utility Of Scleral Depression For Detecting Peripheral Vitreoretinal Pathology. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2859.
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To examine the utility of scleral depression for detecting peripheral vitreoretinal pathology using indirect ophthalmoscopy.
One hundred eyes of 50 new patients (25 with symptoms, 25 without) were enrolled in this prospective study. A single examiner first examined the peripheral retina of each patient using a 28 diopter condensing lens and findings were recorded. Then the examination was repeated using 360-degree scleral depression, and any differences between the two exams were recorded. Patients rated the level of pain associated with each exam technique. An online survey seeking current opinion and clinical practice regarding scleral depression was emailed to 128 practicing vitreoretinal specialists.
Prospective trial: No significant difference in peripheral vitreoretinal pathology was detected by the use of scleral depression. Patients reported a higher level of pain associated with the exam with scleral depression. Survey: Scleral depression amongst survey responders is symptom driven with an average of 88% of new patients with symptoms receiving an exam with depression compared to 24% without symptoms. There was no difference in rates of scleral depression when comparing responses of specialists based on type of practice, or experience.
In our study, an exam using a 28 D lens with scleral depression did not provide any additional benefit to an exam without depression during indirect ophthalmoscopy. Scleral depression significantly increased patient discomfort. Amongst a representative sample of practicing vitreoretinal specialists most new patients with symptoms receive an exam with depression.
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