role of ophthalmologist in posterior vitreous detachment

1. ? Predictive
? Non Predictive
? Protective

2. What Literature says:
• Acute PVD is typically accompanied by floaters (myodesopias or
entopsias) or light flashes (photopsias)
• Significant variability in the literature regarding what the presence or
absence of these symptoms implies
• studies have variably reported that photopsia symptoms are
• 1. Predictive either of a complicated PVD, nonpredictive, or protective
• The risk of RT or RRD occurring with PVD in published reports ranges
widely from 15.0% to 27.1%

3. Current concept
• Acute posterior vitreous detachment (PVD) is a critical lifetime
event that may be associated with the development of a retinal
tear (RT) or rhegmatogenous retinal detachment (RRD), which
may in turn result in permanent vision loss if not identified and
treated promptly.

4. What is the problem with current thinking?
• Prior studies evaluating acute PVD have been
typically performed in retinal specialty practices and
likely suffer from referral bias for more significant
PVD-related events

5. The Question?
• What are the risk factors for retinal tear (RT) or
rhegmatogenous retinal detachment (RRD) associated with
acute, symptomatic posterior vitreous detachment (PVD) in
a comprehensive eye care setting

6. Main Issue
• By not referring to a retina specialist, is the comprehensive
ophthalmologist correct ?
• Especially the chances of missing “Presence of RT or RRD at initial
presentation or within 1 year thereafter”.

7. Reference
• Complications of Acute Posterior Vitreous Detachment.
VOLUME 129, ISSUE 1, P67-72, JANUARY 01, 2022.
• Michael I. Seider, MDCarol Conell, PhD,Ronald B. Melles, MD

8. Rate of RT and RRD associated with acute PVD to be lower than rates
previously reported by retina subspecialty practices.
Several patient features strongly predicted the presence of initial and late
complications of acute PVD
Complications of Acute Posterior VitreousDetachment
Michael I. Seider, MD,1,2 Carol Conell, PhD,3 Ronald B. Melles, M
Ophthalmology Volume 129, Number 1, January 2022

9. “How likely is a patient to have a
complicated PVD based
on features that can be determined by a
comprehensive ophthalmologist”

10. Role of comprehensive ophthalmologist:
• Understand
• Risk of RT/RRD at presentation and within 1 year
• Evaluation of rates and risk factors
• Relate between refraction and risk of RT/RRD

11. Predictive Risk factors

12. Population distribution of 8305 patients presenting with acute symptomatic posterior
vitreous detachment (PVD). Women made up 61.2% of the cohort and presented at a
slightly earlier age than men (63.1 vs. 64.7 years, respectively).

13. Risk factors: History & Symptoms
• Blurred vision
• Age < 60 years
• Prior cataract surgery
• Prior photorefractive surgery
• Symptoms < 1 week duration
• Family history of RD
• Floaters
• Flashes

14. Risk factors: Signs
• Vitreous pigment
• Vitreous hemorrhage
• Retinal hemorrhage
• Lattice degeneration
• Vision < 20/40

15. • Initial and delayed rates of acute posterior vitreous detachment (PVD) complicated by retinal tear
(RT) or retinal detachment (RD)
• ∗High-risk factors for delayed events included any vitreous hemorrhage, lattice degeneration, or
history of RT or RD in the fellow eye

16. Highly predictive of the presence of complicated PVD

17. The median interval until a late event was 22 days after initial presentation
93 of the late complications (70.0%) occurred within 6 weeks.
Sixty of the late events (45.1%) were detected at a scheduled follow-up appointment

18. Multivariate Logistic Regression of Variables that Increase the Risk of Late Retinal Tear or Detachment

19. Refractive Error
• High myopia (-3.00D -6.0 D ) risk factor for complicated PV
• Independent of patient age
• Relatively linear relationship
• Between
• The age at presentation of PVD and refractive error
• Myopic patients presenting at a younger age
• Hyperopes at a later age, compared with emmetropes

20. Factors predictive of Late events
• More likely to occur in patients who initially presented with
• 1. Vitreous hemorrhage
• 2. Lattice degeneration
• 3. History of RT or RD in the fellow eye
• 4. Occur at a median of 22 days after presentation
• 5. Follow up closely sooner than interval of 6 weeks

21. Salient Points
• Incidence of RT during acute PVD in comprehensive ophthalmology is
substantially lower than that reported in series from retina subspecialty clinics
• Specific risk factors that can assist in predicting which patients are at highest
risk of complicated PVD both at triage and the time of initial examination

22. Predictive Factors of Late events
• Vitreous hemorrhage
• Lattice degeneration,
• History of RT or RRD in the fellow eye
• Patients with any of these key characteristics should be observed closely

23. Refractive error
• Close relationship among refractive error, patient age at PVD, and
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