Many retina subspecialty practices have observed a correlation between acute posterior vitreous detachment (PVD) and both retinal tear (RT) and rhegmatogenous retinal detachment (RRD), which pose a threat of irreversible vision loss. Studies have shown the risk of RT or RRD occurring with PVD to be anywhere from 15% to 27%. However, when complication rates for patients in comprehensive eye care settings were examined in this recent study, they found that neither RT nor RRD were as common at initial examination or follow-up as previously measured in retinal sub-specialty practice settings.
Using electronic medical records from a California healthcare system, researchers looked at 8,305 patients with acute PVD symptoms to determine the rates of RT and RRD and the factors that contributed to complications. Upon initial examination, 448 (5.4%) were diagnosed with RT and 335 (4%) with RRD.
These results differed significantly from one previous study with a similar sample size that reported rates of RT or RRD of 22.2% at initial examination and a 3.6% risk of late events (subsequent RT or RRD). For the patients in this study, all seen by comprehensive ophthalmologists and optometrists, the combined RT and RRD rate was much lower at 9.7%, and the risk of late events was just 1.8%. Researchers also found many predictors of initial and late complications of acute PVD.
“Some of the features which are available during triage or telehealth and are associated with an increased risk of complicated PVD include a complaint of reduced vision, male sex, a family history of RT or RRD, and prior keratorefractive or cataract surgery,” the authors wrote. “These risk factors may be useful in identifying patients who should undergo more urgent evaluation. Other features predictive of a complicated PVD can be identified at the time of ophthalmoscopic evaluation, including the presence of vitreous pigment or hemorrhage, retinal hemorrhage, lattice degeneration, visual acuity worse than 20/40, and high myopia (whereas hyperopia is strongly protective).”
Evaluating the risk of complicated PVD in patients is a matter of taking the time to ask them a couple of questions and examine their history. “This large dataset reveals further insights into the close relationship between refractive error, patient age at PVD, and the risk of complicated PVD, with myopic eyes not only presenting at a younger age but also having an independently greater risk of associated RT or RRD,” the authors conclude.
Seider MI, Conell C, Melles RB, et al. Complications of acute posterior vitreous detachment. Ophthalmology. July 20, 2021. Epub ahead of print.