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  • A Simple Phone Survey to Assess PVD Risk

    By Lynda Seminara
    Selected by Andrew P. Schachat, MD
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    Journal Highlights

    Ophthalmology Retina, June 2023

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    Balikov et al. aimed to create a brief telephone questionnaire for patients who report symptoms of posterior vitreous detachment (PVD) to gauge the risk of a retinal tear (RT) or retinal detachment (RD). Among the initial set of 23 questions and 70 possible answers considered for the questionnaire, the authors determined that RT/RD risk could be derived from just seven ques­tions and 15 possible answers. “The simplified questionnaire can be admin­istered quickly by telephone operators without any reference to physical examination or the patient’s chart,” they said.

    Their research was based on con­versations with patients who called the Kellogg Eye Center during a four-month period to report symptoms of PVD, such as flashes, floaters, or cur­tain/veil. During each call, a triage staff member administered a comprehensive survey to assess risk factors for RT/RD. Using multivariable logistic regression, the researchers identified risk factors that were most predictive of RT/RD at the follow-up visit, which occurred within 1.5 months of the phone call.

    Of 193 callers, approximately 74% were established patients of the retina clinic or the comprehensive clinic, and 26% were new patients. At the follow-up visit, RT or RD was observed in 7%. The answers to seven questions were key to determining RT/RD risk:

    • Are your symptoms in one or both eyes? (one eye = 5 points, both eyes = 1 point)
    • When did your symptoms start? (<24 hours ago = 6 points, 24-72 hours ago = 3 points, >72 hours ago = 1 point)
    • Do you have a nonmoving curtain, veil, or shadow in the side of your vision, or have you experienced blurred vision (aside from floaters)? If so, would you characterize it as constant or intermit­tent? (“yes” or “constant” = 14 points, “no” and “none” or “intermittent” = 1 point)
    • When you were a young adult (be­fore any procedure to the affected eye), did you need glasses to see to drive? (“yes” = 3 points, “no” = 1 point)
    • Have you had a prior tear or detachment of either retina? (“yes” = 10 points, “no” = 1 point)
    • Are you diabetic? (“yes” = 1 point, “no” = 5 points)
    • Have you ever gone to the OR for retinal surgery in either eye? (“yes” = 10 points, “no” = 1 point)

    A total score of at least 17 denoted an increased risk for RT or RD. The higher the score, the greater the risk. In the final multivariable analysis, area under the curve exceeded 0.90 for the risk-scoring model. Using a conserva­tive risk score, the researchers estimat­ed that about 50% of the callers could be safely seen nonurgently.

    This risk-scoring system can help determine the urgency of a clinic visit, said the authors. They concluded that this tool “will simplify scheduling de­cisions about one of the most common triage questions that ophthalmology practices face.” To their knowledge, this is the first PVD-related triage tool for use by nonphysicians. 

    The original article can be found here.