This handout is for retinal detachment & acute pvd / retinal tear (vitreoretinal lens). Your care team identified this based on: new-onset floaters and/or photopsia (flashes) — symptomatic posterior vitreous detachment until proven otherwise; ~14% harbour a retinal tear on first dilated exam (hollands jama 2009 rce, pmid 19934426).
Other reasons your team may use this plan: progressive peripheral "curtain" / shadow / field defect ± central vision drop — rhegmatogenous retinal detachment; macula-on vs macula-off pivot drives timing (hillier pivot ophthalmology 2019, pmid 30468761); sudden shower of floaters with subjective visual reduction (± "raining soot") — high-risk for retinal tear / vitreous haemorrhage (subjective visual reduction lr 5.0; vitreous haemorrhage lr 10 — hollands jama 2009 rce, pmid 19934426); prior rd in fellow eye, high myopia, pseudophakia/post-cataract, lattice degeneration, stickler/marfan, or ocular trauma — elevated-prior detachment substrate (aao ppp posterior vitreous detachment / retinal detachment).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| urgent_dilated_fundus_examination_with_scleral_depression_both_eyes | — | — | — | Hollands JAMA 2009 RCE (PMID 19934426) — ~14% of symptomatic acute PVD harbour a retinal tear on the first dilated exam (95% CI 12-16%); a clean exam still carries ≈3.4% delayed tear within 6 weeks, so a scheduled re-exam is mandated. Vitreous haemorrhage (LR 10) and vitreous pigment (Shafer sign) up-triage; absence of vitreous pigment is the best negative finding (LR− 0.23). |
Plan: Acute flashes-floaters-curtain → tear prophylaxis → RRD repair (procedure ladder)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Fellow-eye surveillance is the long-tail deliverable: prior/contralateral RD, high myopia, pseudophakia, lattice and Stickler/Marfan substantially raise fellow-eye risk (AAO PPP Retinal Detachment) — schedule dilated fellow-eye exams and counsel lifelong symptom awareness. Post-RRD refraction/cataract follow-up (PPV accelerates cataract in phakic eyes — Hillier PIVOT Ophthalmology 2019 PMID 30468761). Tractional/exudative causes → long-term disease control owned by the routed engine (diabetic-retinopathy / uveitis / systemic cause). Low-vision rehabilitation for irreversible macula-off loss.
Guideline: Hollands et al, JAMA 2009 — Rational Clinical Examination "Acute-onset floaters and flashes: is this patient at risk for retinal detachment?" + AAO Preferred Practice Pattern (Posterior Vitreous Detachment, Retinal Breaks & Lattice Degeneration / Retinal Detachment, current cycle) + Hillier et al, Ophthalmology 2019 — PIVOT RCT (pneumatic retinopexy vs vitrectomy) + Heimann et al, Ophthalmology 2007 — SPR study (scleral buckling vs primary vitrectomy) + Wilkinson, Cochrane 2014 — interventions for asymptomatic retinal breaks & lattice (symptomatic-vs-asymptomatic pivot) + Kim et al, Retina 2013 — macula-off symptom-duration timing