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Meleha Ahmad, Julia Sein, Adrienne Scott, Janelle Ramroop, Jiangxia Wang, Kim Jiramongkolchai, James T Handa, Ingrid E Zimmer-Galler, J Fernando Arevalo; Predictive Factors in Patient History for Diagnosis of Acute Retinal Pathology. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6592.
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© ARVO (1962-2015); The Authors (2016-present)
Flashes and floaters are common ocular complaints in patients presenting to ophthalmologists and primary care providers, but little is known regarding features of the patient history that predict diagnosis of serious ocular pathology (SOP). We performed a prospective study to determine characteristics of patient history that predict the presence of SOP.
We surveyed a consecutive sample of patients presenting to the Wilmer Eye Institute Retina Division between April and October 2018 with complaints of new flashes, floaters or loss of peripheral vision (seeing a “curtain” in the visual field). Patients received a standardized questionnaire to determine the nature and timing of symptoms prior to dilated examination by a board-certified retinal specialist. Retinal examination and diagnosis were recorded as either benign ocular pathology (BOP), which included posterior vitreous detachment, vitreous syneresis, vitreous degeneration, floaters or ocular migraine or SOP, which included retinal hole, retinal tear or retinal detachment.
A total of 115 patients (age range: 21 - 89 years) completed the survey, 94 (81.7%) with BOP and 21 (18.3%) had SOP. No difference was observed in age between those with BOP and SOP (57.4 vs. 56.8 years, p=0.89). Compared to those with BOP, patients with SOP were less likely to report floaters (76% vs. 96%, p=0.010) and flashes (33% vs. 64%, p=0.014) but more likely to report loss of peripheral vision (52% vs. 24%, p=0.015) and subjective visual decrease (81% vs. 44%, p=0.003). Among patients experiencing flashes or floaters, those with BOP were just as likely to experience constant floaters when compared to SOP (32% vs. 53%, p=0.16), with a similar pattern seen for those with flashes (14% vs. 4%, p=0.30). There was no significant difference in the number of floaters experienced by those with BOP compared to SOP. On multivariate analysis, patients presenting with loss of peripheral vision had a 1.96 increased risk of having SOP (CI: 0.58, 6.66). Patients with subjective visual decrease had a 7.56 increased risk of having SOP (CI: 1.79, 31.9).
SOP has a distinct pattern of symptoms compared with BOP. Although complete dilated retinal exam remains the gold standard for diagnosis of acute retinal pathology, improved correlation between reported symptoms and the presence of SOP may aid in appropriate triage of patients presenting with flashes and floaters.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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