Extended ophthalmoscopy is a must for diagnosing, treating vitreous floaters

Article

Vitreous floaters are a common patient complaint, but because floaters are typically benign and the treatment options are limited, most can be managed with proper patient education and reassurance.

"The important thing that optometrists can do is to be knowledgeable and competent doing the history and make sure to do a good differential diagnosis. Don't be too dismissive of floaters," Dr. Schoen said. "This could be a floater that the patient has had for 2 decades the majority of time, but your history should tease that out."

The nature of floaters

Posterior vitreous detachment symptoms may include new or increasing floaters as well as photopsia. Occurrence in one eye foreshadows increasing probability of occurrence in the fellow eye. Myopia is associated with peripheral vitreous detachment as well, Dr. Schoen explained.

"For example, patients with lid ptosis, dry eye, or collarets may report particles in their vision. It's part of our job in taking a good history to tease those out," he said.

Doing the work-up

"Don't look through the vitreous; look at the vitreous," Dr. Schoen said. So he advised against initially relying upon untrasound, optical coherence tomography, and other newer diagnostic technologies. Dilated fundus examination extending out to the equator of the globe and beyond is the gold standard, he said. Pay attention to the vitreous base as a potential location for hemorrhage and utilize scleral depression to do surveillance for occult flaps and tears of the peripheral retina.

"The biggest lapse clinicians are guilty of is failing to do a meticulous evaluation of the peripheral retina through a dilated pupil. Just dilate the patient and look, and do so very carefully," he said. "If the floaters are so thick that it's difficult to visualize the posterior pole, consider ordering an ultrasound. This will offer you an image and give you an idea of what is going on."

He noted most experts advise doing dilated extended ophthalmoscopy as soon as possible, particularly when a patient has persistent photopsia, clouded vision, or sudden onset of either one or two large floaters or myriad smaller floaters.

Recent Videos
In 2 weeks, the study participant's dry eye symptoms improved from 76 to 43 on a 0-100 rating scale, according to Marc-Matthias Schulze, PhD, Dipl Ing.
Eye care practitioners reported moderate to high satisfaction with lifitegrast's ability to improve signs of dry eye, according to Melissa Barnett, OD, FAAO, FSLS.
Neda Gioia, OD, CNS, FOWNS, details the positive feedback gained so far from other optometrists that have been prescribing the NutriTears supplement to their dry eye patients.
Damaris Raymondi, OD, FAAO, highlighted the importance of building patient-doctor trust to learn about these practices, which can include non-traditional treatments like chamomile or manuka honey eye drops.
Noreen Shaikh, OD, Magdalena Stec, OD, FAAO, and Brenda Bohnsack, MD, PhD, emphasize that collaboration and communication are key to proper diagnosis and treatment.
Cecilia Koetting, OD, FAAO, DipABO, cited data from a recent student that found that presbyopia treatment with 0.4% pilocarpine led to up to 86% of patients achieving 20/40 or better.
Kerry Giedd, OD, MS, FAAO, was 1 of 20 investigators around the country for a study evaluating the daily disposable contact lens.
According to A. Paul Chous, MA, OD, FAAO, optometrists have an important opportunity to educate patients in their chairs about diabetes.
David Geffen, OD, FAAO, gave a poster presentation titled "Revolutionizing Comfort: Unveiling the Potential of Perfluorohexyloctane Eyedrops for Contact Lens Wearers" at this year's Academy meeting.
Jessica Steen, OD, FAAO, Dipl-ABO, discussed ophthalmic considerations for patients undergoing treatment with antibody drug conjugates for gynecologic cancers at this year's conference.
© 2024 MJH Life Sciences

All rights reserved.