Know When A Retinal Condition Requires Specialist Oversight

In “Refer or Relax: Retina,” presented at the Southeastern Educational Congress of Optometry (SECO) 2021 meeting, Steven Ferrucci, OD, offers guidance on more than 10 retina conditions to help optometrists decide how to manage patients in their clinics, and when to send them to a specialist. Dr Ferrucci is an educator at Marshall B. Ketchum University.

The first topic he reviewed was lattice degeneration, a condition that leads to abnormal thinning of the peripheral retina. It occurs in 5% to 10% of the general population and in 30% of retinal detachment (RD) cases: “But, less than 1% of all lattice results in RD,” Dr Ferrucci’s slide outlined. It’s most common in superior and inferior retina. Risk factors can include myopia >3.00D (especially if the patient is younger than 30 years old) or myopia >6.00D at any age. If the fellow eye underwent an RD, or the patient has a family history of RD, these could also be risk factors, as are any new symptoms, such as floaters, flashing lights, blurry vision or change in vision. Follow-up varies according to different aspects of lattice degeneration. In those cases with lattice that have risk factors for RD and lattice with breaks at the margin of the lesion, the presentation recommends considering a retinal consult.

Another condition the presentation walked attendees through is RD itself. The rule-of-thumb for macula-off RD is to repair it in the same amount of time it was off—”so if off for 4 days, best to try repair within 4 days,” the presentation points out—and for macula on, this is considered an emergency. It requires a same day referral to a retinal specialist. “Remind patient NPO until sees a specialist in case same-day surgery,” Dr Ferrucci said in the presentation. 

According to Dr Ferrucci, when selecting the best procedure for patients, it’s key to know if they are phakic/pseudophakic, where the tear is, and its size. Also key: The experience of the retinal surgeon is essential, so “do your homework!” when referring.

One of the last conditions presented offers guidance on central serous retinopathy (CSR). This common disorder of unknown etiology impacts males, 20 years to 45 years old, at a 10:1 ratio of men to women. Patients often experience new onset of blurred visual acuity (VA) in one eye with a scotoma, micropsia, or metamorphopsia, and it’s unilateral in 70% of cases. 

Treatment options are varied and include (but are limited to) observation and medication. About 80% to 90% of patients undergo spontaneous resolution, and get back to normal (or near normal) VA within 1 to 6 months, and >60% resolve back to 20/20. But it’s rare to have vision stay <20/40. About 40% will experience recurrence.

The presentation emphasized that you should be concerned/refer central serous retinopathy cases when: VA is worse than 20/70; patient demographics are not supportive; the condition doesn’t resolve within 6 months; it worsens; fluorescein angiography/optical coherence tomography doesn’t support diagnosis; the patient says it “just doesn’t feel right”; and the patient doesn’t accept their vision or prognosis.

Reference

Ferrucci S. Refer of relax: retina. Presented at: Southeastern Educational Congress of Optometry (SECO) 2021 Annual Meeting; April 28-May 2, 2021; Atlanta, GA. Course 112.