New-onset vitreous floaters may represent a stronger warning sign of retinal detachment (RD) than flashes in primary care, according to a retrospective cohort study published in Annals of Family Medicine.
Researchers based at Radboud University Medical Center in Nijmegen, The Netherlands, analyzed 1,181 episodes of patients aged 18 years or older presenting with floaters, flashes, or both across seven family practices in the Netherlands between 2012 and 2021. The study aimed to quantify the absolute and relative risks of RD in a primary care setting, where early identification is critical to preventing vision loss.
The findings showed that RD occurred in 6.1% of patients presenting with floaters alone, compared with 4.7% of those presenting with flashes alone. Patients reporting both floaters and flashes had the highest risk, with an absolute risk of 8.4%.
Risk increased further in specific subgroups. Patients with acute symptoms (≤14 days) or those reporting many floaters (defined as 10 or more, or described as a “cloud, a haze, or a curtain”) had significantly higher relative risks of RD. For example, patients with many floaters had a more than fourfold increased risk compared with those presenting with flashes alone.
Floaters and flashes were both relatively common presentations in the cohort, with incidence rates of 5.5 and 2.7 per 1,000 patient-years, respectively. Overall, RD was observed to develop in 6.5% of episodes presenting with these symptoms.
While current Dutch primary care guidelines emphasize flashes and vision loss as key warning signs for RD requiring urgent referral to an ophthalmologist, less emphasis is placed in the guidelines on floaters. However, these findings suggest that floaters – particularly when acute or numerous – may warrant greater attention as an alarm symptom.
As such, the study authors recommend that patients presenting with recent-onset or multiple floaters be considered for urgent referral to ophthalmology to confirm or exclude RD. At the same time, clinicians should balance this with the recognition that many cases may have benign causes and provide appropriate safety-net advice.
Overall, the study supports a more evidence-based approach to evaluating visual symptoms in primary care, with floaters playing a more prominent role in risk assessment for retinal detachment.
Disclosures: The study authors reported no conflicts of interest.
Source: Annals of Family Medicine.
Researchers based at Radboud University Medical Center in Nijmegen, The Netherlands, analyzed 1,181 episodes of patients aged 18 years or older presenting with floaters, flashes, or both across seven family practices in the Netherlands between 2012 and 2021. The study aimed to quantify the absolute and relative risks of RD in a primary care setting, where early identification is critical to preventing vision loss.
The findings showed that RD occurred in 6.1% of patients presenting with floaters alone, compared with 4.7% of those presenting with flashes alone. Patients reporting both floaters and flashes had the highest risk, with an absolute risk of 8.4%.
Risk increased further in specific subgroups. Patients with acute symptoms (≤14 days) or those reporting many floaters (defined as 10 or more, or described as a “cloud, a haze, or a curtain”) had significantly higher relative risks of RD. For example, patients with many floaters had a more than fourfold increased risk compared with those presenting with flashes alone.
Floaters and flashes were both relatively common presentations in the cohort, with incidence rates of 5.5 and 2.7 per 1,000 patient-years, respectively. Overall, RD was observed to develop in 6.5% of episodes presenting with these symptoms.
While current Dutch primary care guidelines emphasize flashes and vision loss as key warning signs for RD requiring urgent referral to an ophthalmologist, less emphasis is placed in the guidelines on floaters. However, these findings suggest that floaters – particularly when acute or numerous – may warrant greater attention as an alarm symptom.
As such, the study authors recommend that patients presenting with recent-onset or multiple floaters be considered for urgent referral to ophthalmology to confirm or exclude RD. At the same time, clinicians should balance this with the recognition that many cases may have benign causes and provide appropriate safety-net advice.
Overall, the study supports a more evidence-based approach to evaluating visual symptoms in primary care, with floaters playing a more prominent role in risk assessment for retinal detachment.
Disclosures: The study authors reported no conflicts of interest.
Source: Annals of Family Medicine.
