Moneo writes: To prevent or not prevent

Last week I had a patient turn up at my practice because she had noticed a new floater in her vision. She was aware of her increased risk or retinal tears due to her high myopia and the fact that previous imaging of the far periphery of her retinas had revealed areas of innocuous pigment clumping which, as we all know, are notorious for developing into holes or tears with vitreous traction. She was duly dispatched to the local acute eye clinic for laser treatment and all is well I am glad to say.

In a bout of reflective thinking following this incident, and in discussion with a colleague, we began to think about preventative care. Nowadays it is common place to refer patients with narrow anterior chamber angles and a high proportion of these, on the evidence of the narrowness of the angle alone then go on to have peripheral iridotomies as a hedge against future possibility of those angles closing and causing an angle closure attack. As we all know peripheral degenerations such as lattice degeneration and snailtracking, as well as the innocuous pigment clumping, are very common occurrences and hence there are many people walking around with greatly increased risk of retinal tearing or retinal detachment, possibly an even higher number than those at risk of angle closure. However were we to refer these patients to an eye clinic for preventative laser retinopexy it is highly unlikely that any preventative treatment would be carried out. It is more likely that the patient will be told of the signs and symptoms of retinal tears and detachment and then told to contact either their optometrist or eye casualty should these arise. Why then does one scenario frequently end in treatment to prevent the possibility of further trouble whilst the other does not?