MANAGEMENT GUIDELINES
Flashes and/or Floaters
I. GOAL – to decrease vision loss due to rhegmatogenous retinal detachment
(those detachments caused by a retinal break)
II. PROCESS
A. Screening (usually by phone but other means such as face-to-face communication also apply)
1. Patients with recent onset of flashing lights and/or floaters with or without vision loss (e.g., decreased vision or loss of peripheral vision with shadows or curtains) should be advised to come for an examination within 24 hours. If a clinic appointment is not available within that time period (e.g., a patient calls on Friday afternoon), the patient should be advised to present to the emergency room for evaluation.
B. Ophthalmology Resident or Referring Ophthalmologist Findings (based on screening information, patient history, and/or examinations of both eyes, not necessarily just the symptomatic eye)
1. Presence of a retinal tear or retinal detachment:
i. Retina fellow should be notified immediately for prompt exam and treatment
2. High risk PVD: Pigmented cells and/or hemorrhage in the anterior vitreous, intraretinal hemorrhages, presence of lattice retinal degeneration in either eye, high myopia, prior retinal tear or retinal detachment in either eye:
i. Patient should be examined by the senior resident at time of presentation, and plans made for the patient to be examined by a retina fellow or retina faculty within 48 hours if no retinal breaks are seen on exam
3. None of the pathology listed above (simple PVD):
i. Between July and December (first 6 months of the academic year), the patient should be examined by the senior resident at the time of presentation. From January to June, this exam by the senior resident can be performed at the discretion of the junior and senior resident.
ii. Patient should be examined by an attending ophthalmologist (this may include any of our comprehensive ophthalmologists or retina attendings—triage clinic should not be used for routine follow up) 4-6 weeks after the initial exam/onset of symptoms. PVD patients without any other risk factors are not required to establish care on the retina service.