C53730: PVD and retinal detachment, an optometric approach - management

This series has so far looked at the nature of retinal detachment and posterior vitreous detachment, the various risk factors and causes, and how it might be best identified and assessed. This final article looks now at the various management options available to the eye care professional.

The challenge

Patients with new onset flashes and floaters commonly present initially to their optometrist. Prompt diagnosis and appropriate co-management with secondary care in the Hospital Eye Service (HES) is essential. Pathways have been developed in Scotland and Wales, but the situation in England is much more varied. Some districts have a protocol initiated by the local eye unit (eg Norfolk & Norwich Hospital¹) but in many areas there is still no structure to support optometrists and allow them to play a role in relieving some of the pressure on secondary care. The need for this was highlighted in the recent NHS England eye health summit ‘Immediate solutions to address demand and capacity pressures in the Hospital Eye Service’.² Fortunately the profession has, for some time, been developing Minor Eye Condition Services (MECS) and an increasing number of clinical commissioning groups (CCGs) are making use of these local schemes. A report³ on the original Welsh Pears scheme listed the most common reasons for patients to present to an accredited optometrist in Wales. Flashes and floaters were the third most common symptom after red eye and discomfort/ irritation. The challenge is for optometrists to take on the role of triaging patients with PVD symptoms to exclude retinal detachment or tears.