If Symptoms/Retina Detachment/ Dr. John Hagen

Dear Dr. Hagen,
When an opthamologist encounters symptoms that may be that of retinal detachment (such as heaviness of eye, troubling flashes or reflections, an increase in number and size of floaters AND a dark shadow or curtain increasing in size from inside corner of eye toward center) what action, tests or otherwise, would a conscientious physician take if he does not see anything during his initial exam with the ophthalmoscopy? Would he recommend a second opinion and if so, from whom (what eye care specialist)?  How much care, skill or technique is involved with the use of the ophthalmoscopy? Aren't there other means to rule out a serious condition such as RD now using ultrasound, MRI, and other? Thanks    Duke49

[John C Hagan III, MD, FACS, FAAO]

The situation you describes occurs all the time. Most do what I do.
1. A complete medical dilated exam of the peripheral retina
2. A discussion of the symptoms of RD
3. Explain posterior vitreous detachment PVD
4. Tell them if they have a sudden increase of flaoters, light flashes or loss of peripheral vision come in immediate.
5. If flashes ask they to avoid heavy bending, stooping, lifting till flashes stop
6. Schedule a follow up visit in our retina clinic in 7-14 days. If flashes persist come in for re-exam. If they stop call and cancel the appointment
7. Ultrasound, OCT, CT and MRI are not helpful for retinal detachment is an eye where the back is visible

JCH MD

[Duke49]

After cataract surgery, if you were to develop all the classic symptoms of RD (including the dark curtain that is increasing in size) AND your opthamologist could not see any complication with the ophthalmoscope, what would you do?  Would you go to a retina specialist who might be more skilled or have more experience with  ophthalmoscopy especially knowing time is of the essence and symptoms should normally be treated as a medical emergency??? Anything else?

I thought I had read somewhere in the forums that there were other tests or diagnostic procedure.  After some research I wondered if it might be one or more of the following: diagnostic contacts lens, slit-lamp biomicroscopy, ultrasound, B-Scan ultrasonography, Optical Coherence Tornography, CT, MRI or other.

[John C Hagan III, MD, FACS, FAAO]

Yes I would get a second opinion from a retina Eye MD. Find one at www.aao.org or ask your general ophthalmologist to refer you.

JCH MD