What made you wait so long? Delays in presentation of retinal detachment: knowledge is related to an attached macula

Abstract

ABSTRACT.Purpose: In rhegmatogenous retinal detachment, the time between first symptoms and reattachment surgery is critical to prevent macular detachment. We explored which determinants discriminate between 'macula-ON' and 'macula-OFF' retinal detachments to improve timely treatment. Methods: Eight-hundred patients with rhegmatogenous retinal detachment admitted for surgery at the Rotterdam Eye Hospital in the Netherlands were eligible to complete a questionnaire to explore the following determinants: (i) patient's delay and doctor's delay; (ii) patient-reported causes for delay; (iii) symptoms as early warning signals; (iv) patient's prior knowledge about retinal detachment; and (v) trait anxiety. Results: Five hundred and twenty-one questionnaires (65%) were analysed. Median interval between first symptoms and surgery was 14 days. Macula-ON/OFF ratio was 46/54. Patient's delay in macula-ON patients (median 3 days) was shorter than in macula-OFF (5 days, p = 0.026). No difference was found in doctor's delay except for 'waiting time for surgery': macula-ON patients were operated on faster (median 1 day) than macula-OFF (median 5 days, p < 0.001). Macula-ON patients more often attributed symptoms to retinal problems. Except floaters, no symptoms were determined as early warning signals for macula-ON. Macula-ON patients more often reported knowing that prognosis would be worse when treated later, even when controlled for previous experience with retinal detachment. Conclusion: Macula-ON patients seem to self-refer faster to a healthcare provider, seem more sensitive to floaters and seem more informed. This suggests that increasing awareness, especially about floaters, might increase the proportion of patients with macula still on at the moment of referral to the ophthalmologist.

Clinical Presentation of Rhegmatogenous Retinal Detachment during the COVID-19 Pandemic

“…As previous studies have shown, worse patient education and comprehension of retinal detachment symptoms and morbidity correlates to delayed presentation. 17 , 18 Patients established with a retina practice may be more educated on the signs, symptoms, and morbidity of retinal detachments. Moreover, particularly in the setting of limited outpatient healthcare availability, established patients may also face fewer logistical barriers to evaluation upon symptom onset, tilting the patient’s risk-benefit analysis towards a lower threshold for presentation.…”

Improving eye drop adherence: a simple technique using a cable tie

“…From a larger study on delays of presentation of retinal detachment (Eijk et al 2016), we tried to develop a selection of questions believed to help pinpoint the moment the macula came off.…”

Optical coherence tomography evaluation of patients with macula‐off retinal detachment after different postoperative posturing: a randomized pilot study

“…Rhegmatogenous retinal detachment (RRD) is defined as a separation of the neurosensory retina from the retinal pigment epithelium (RPE), which is caused by at least one retinal break with subsequent shift of intraocular fluid into the subretinal space. When the macula is involved (macula-off), patients usually complain of a significant visual loss (Eijk et al 2016). Surgical techniques to treat this condition can be different, but nowadays the first choice is often represented by PPV, especially in pseudophakic patients and if multiple breaks or significant vitreous traction is present (Heimann et al 2007;Miller et al 2008;Kobashi et al 2014;Hajari 2016;Poulsen et al 2016).…”