Flashes and floaters: a survey of Canadian ophthalmology residents' practice patterns

Can J Ophthalmol. 2017 Oct;52(5):453-457. doi: 10.1016/j.jcjo.2017.03.007. Epub 2017 Apr 21.

Abstract

Background: Residents are often the first point of contact in assessing patients who present with "flashes and floaters" in the emergency ophthalmology clinic. Most often, these symptoms are attributed to a posterior vitreous detachment (PVD), which may be associated with a retinal tear in up to 14% of cases. A proper peripheral retinal exam is, thus, imperative, and techniques other than scleral depression may not be sufficient. We conducted a cross-sectional survey of Canadian ophthalmology residents-in-training to understand the current resident practice patterns for examination of the peripheral retina.

Methods: Anonymous electronic survey of all Canadian ophthalmology residents (postgraduate years 2-5).

Results: On average, residents (n = 47) perform a peripheral retinal examination 5 to 7 times per day in the emergency clinic and on call. Reported techniques for assessing the peripheral retina include scleral depression with indirect ophthalmoscopy alone (45.7%), scleral depression combined with the 3-mirror (15.2%) or panretinal lens (10.9%), or each of these techniques alone (23.9% and 4.3%, respectively). The major factors deterring resident use of scleral depression include history of recent trauma (47.5%), patient discomfort (16.3%), personal discomfort (16.3%), or lack of time (13.8%).

Conclusions: Although scleral depression is the recommended standard of care for assessment of flashes and floaters, residents in training may routinely use alternative techniques as a result of extrinsic and intrinsic factors.

MeSH terms

  • Canada
  • Cross-Sectional Studies
  • Diagnostic Techniques, Ophthalmological*
  • Education, Medical, Graduate / statistics & numerical data*
  • Female
  • Humans
  • Internship and Residency / standards*
  • Male
  • Middle Aged
  • Ophthalmology / education*
  • Ophthalmoscopy
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Retinal Diseases / diagnosis*
  • Risk Assessment
  • Surveys and Questionnaires
  • Vision Disorders / diagnosis
  • Vitreous Detachment / diagnosis*