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  • Rates and Predictors of PVD in Comprehensive Ophthalmic Practice

    By Lynda Seminara
    Selected by Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, January 2022

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    In an effort to aid comprehensive eye care clinicians who are presented with cases of acute posterior vitreous detachment (PVD), Seider et al. explored rates and risk factors for com­plicated PVD in a large comprehensive care practice. The researchers included an examinaton of the relation­ship between refractive error and the risk of retinal tear or rhegmatogenous retinal de­tachment (RRD) in patients with symptoms of acute PVD. They found that rate of retinal tear or RRD linked to PVD was lower than that previously reported in retina subspecialty settings, although it remains clinically signifi­cant. The strongest predictor of retinal tear and detachment was the presence of vitreous pigment.

    For this research, the authors compiled data for adult patients in the Kaiser Permanente Northern California Healthcare System who were seen in 2018 by an ophthalmologist or optom­etrist and were diagnosed as having PVD, vitreous degeneration, vitreous floaters, vitreous flashes, vitreous hem­orrhage, retinal tear, or RRD.

    The patients’ medical records were reviewed to capture acute symptom­atic PVD events, to document patient history and eye exam findings, and to confirm diagnoses. The main outcome measure was the presence of retinal tear or detachment at initial presentation or subsequently within one year of presentation.

    Altogether, 8,305 patients met the study criteria. The diagnosis was retinal tear in 448 (5.4%) and RRD in 335 (4.0%). Preexisting factors associated with heightened risk of retinal tear or detachment were blurred vision (odds ratio [OR], 2.7), male sex (OR, 2.1), younger age (<60 years; OR, 1.8), and previous ker­atorefractive or cataract surgery (OR, 1.6 and 1.4, respectively). Flashes were found to be mildly protective (OR, 0.8).

    Exam variables that raised the risk of retinal tear and RRD included vitreous pigment (OR, 57.0), vitreous hemor­rhage (OR, 5.9), lattice degeneration (OR, 6.0), and visual acuity worse than 20/40 (OR, 3.0).

    Late retinal tear or detachment occurred in 12.4% of patients who had vitreous hemorrhage, lattice degener­ation, or a history of retinal tear/RRD in the fellow eye at initial presentation; only 0.7% of patients had none of these three risk factors.

    The original article can be found here.