A phone-based clinical risk scoring system can determine the urgency of appointments for patients with symptoms of posterior vitreous detachments (PVDs), according to findings published in Ophthalmology Retina. The triaging system seeks to distinguish low-risk PVD from retinal tears or rhegmatogenous retinal detachment (RT/RD).
Researchers tested a questionnaire at the Michigan Medicine Kellogg Eye Center with 193 qualifying patients (mean age, 55.49±1.09 years) calling with symptoms consistent with a symptomatic PVD. The study then followed up with them to determine how many developed RT/RDs and how they responded to the phone questionnaire.
The risk factors most predictive of having a RT/RD during the add-on visit were determined using multivariable logistic regression, and risk factor odds ratios were used to develop a RT/RD risk score.
In this study, 8 patients (4%) had a retinal tear and 6 patients (3%) had a retinal detachment. Slightly more patients with an RT/RD were men and they were less likely to have concurrent diabetes or uveitis, the study shows. Of the patients who did end up being diagnosed with RT/RDs, more than half called within 24 hours of symptom onset. A significantly higher percentage of patients who did have an RT/RD reported constant blurred vision (as opposed to intermittent blurred vision) or a curtain/veil in their field of view when compared with patients who had nonurgent symptomatic PVD.
Additionally, details about flashes and floaters in these patients may help predict outcomes, the study shows. For instance, while patients who had more floaters had more instances of RT/RD, those who had more flashes did not. The researchers also found that patients who describe their floaters as “tiny dots” were significantly more likely to have an RT/RD than those who used other descriptors (50% vs 21.78%). Patients who reported a combination of floaters and flashes of light were not more likely to have an RT/RD.
The researchers highlight that, although many studies in the past have shown key risk factors predicting the presence of a RT/RD in symptomatic PVDs, no other study has attempted to judge the risk entirely from questions that don’t require knowledge of the patient’s history or their exam.
“We have established the first phone triage questionnaire and associated clinical risk scoring system that can be quickly executed by non-physician personnel and accurately predicts which patients with symptoms of a PVD should be seen urgently versus routinely,” the researchers explain.
Study limitations include a relatively small sample size, its lack of independent validation, and the fact that not all participants received a scleral depressed exam or B-scan, the gold standard for determining the presence of a RT/RD.
Balikov DA, Zhou Y, Miller JML. A phone triage system for patients calling with symptoms of a posterior vitreous detachment. Ophthalmol Retina. Published online January 9, 2023. doi:10.1016/j.oret.2023.01.003