Features

Retinal detachment

Clinical Practice
Retinal detachment

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In order to complete this exercise, you are required to first read the following three articles:

Before the interactive exercise we need you to complete six multiple choice questions relating to the source material. You can take these as many times as you wish until you have 100% score. You will then be able to begin the interaction.

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In the survey of rhegmatogenous detachments, how many were NOT related to posterior vitreous detachment?

  • Approximately 2%
  • Approximately 12%
  • Approximately 82%
  • Approximately 22%

B

With regard to symptomatic posterior vitreous detachment, which is true?

  • The risk of a retinal detachment is 10 to 15%
  • The risk of a retinal break is 10 to 15%
  • Careful questioning about the position of photopsia in the visual field, will reveal the location of a retinal tear
  • Flashes and floaters are the only symptoms

D

Which is false?

  • Legal complaints are most likely due to a failure to respond to symptoms or asses risk factors
  • Floaters can be the result of inflammation
  • Areas of lattice retinal degeneration are thicker because of the excess pigment
  • Lattice retinal degeneration is present in over a third of atrophic round hole detachments

C

Regarding examination to exclude tobacco dust, which is false?

  • Rapid saccadic eye movements are required in order agitate the vitreous
  • There is no need to dilate because the pigment presents in the anterior vitreous close to the lens
  • Pigment is liberated at the location of the tear
  • The slit lamp is used without a Volk lens

B

Which is true?

  • You do not have to perform a dilated fundus examination if you have good quality Optos scanning laser images
  • Direct ophthalmoscopy is acceptable providing the pupils are dilated
  • Visual field testing out to 60 degrees will detect most retinal detachments
  • A reduction in IOP only occurs if a large area of neurosensory retina detaches

D

Regarding tobacco dust (Shafer’s sign) which is false?

  • Dilation is essential to exclude its presence
  • It is a dynamic test involving agitation of the vitreous by abrupt eye movements
  • If tobacco dust is detected the chance of finding a retinal tear is 70%
  • There is a relationship between training and the ability to correctly identify Shafer’s sign

C

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Now consider the following case.

Case study

A 42-year-old -3.00DS myope attends a community eye care practice at 16.30 having noticed a sudden appearance of a 'cobweb-like' disturbance in the right eye and awareness of a 'sparkling' disturbance down to their right which he says he notices 'from time to time' and can still see now. He has driven to your practice, having left work early, as is worried.

You have one more appointment slot (filled) and are due to finish at 17.00 but the practice remains open until 18.00. There are some appointment slots tomorrow.

To gain your CET point you are required to discuss the following with another GOC registered practitioner and consider the following;

  • Your non-GOC-registered support staff member consults you and asks what you wish to do. What might be your response and how would you record whatever action you might recommend? What should be their action had the patient arrived when no GOC-registered staff member was on the premises? Respond according to your professional category (optometrist or dispensing optician)
  • Are there any reasons why a patient complaining of flashes and floaters should not be dilated in community practice?

Remember, there may be a divergence of views – we simply need to know what you and your colleague think and why.

Remember, your interaction should last for at least 10 minutes (and completion of the submission will be taken as your statement that this is true) and you will be required to submit the outcome of your discussion along with the name and GOC number of the person with whom you have interacted below.

Once you submit your responses, our review team will either:

  • Confirm completion and an interactive CET point
  • Ask by email for further clarification
  • Suggest that too little information was submitted this time for a point to be awarded

NAME AND GOC NUMBER OF CORRESPONDENT <!--two boxes-->

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And the outcome of your discussion

IS THERE ANYTHING HERE TO BE ACTED UPON AND HOW?

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