Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern®

RETINA/VITREOUS PREFERRED PRACTICE PATTERN® DEVELOPMENT PROCESS AND PARTICIPANTS

The Retina/Vitreous Preferred Practice Pattern® Panel members wrote the Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern® (PPP) guidelines. The PPP Panel members discussed and reviewed successive drafts of the document, meeting in person twice and conducting other review by e-mail discussion, to develop a consensus over the final version of the document.

Retina/Vitreous Preferred Practice Pattern Panel 2018–2019

Ron A. Adelman, MD, MPH, MBA, FACS

FINANCIAL DISCLOSURES

In compliance with the Council of Medical Specialty Societies' Code for Interactions with Companies (available at www.cmss.org/codeforinteractions.aspx), relevant relationships with industry are listed. The Academy has Relationship with Industry Procedures to comply with the Code (available at http://one.aao.org/CE/PracticeGuidelines/PPP.aspx). A majority (88%) of the members of the Retina/Vitreous Preferred Practice Pattern Panel 2018–2019 had no financial relationship to disclose.

TABLE OF CONTENTS

• OBJECTIVES OF PREFERRED PRACTICE PATTERN GUIDELINES P229

• METHODS AND KEY TO RATINGS P230

• HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE P231

• INTRODUCTION P232

• Disease Definition P232

• Patient Population P232

• Clinical Objectives P232

• BACKGROUND P233

• Posterior Vitreous Detachment P233

• Evolution of Retinal Breaks and Lattice Degeneration P234

  • Asymptomatic Retinal Breaks P234

  • Symptomatic Retinal Breaks P234

  • Lattice Degeneration P235

• Incidence of Rhegmatogenous Retinal Detachment P235

• Risk Factors for

OBJECTIVES OF PREFERRED PRACTICE PATTERN® GUIDELINES

As a service to its members and the public, the American Academy of Ophthalmology has developed a series of Preferred Practice Pattern® guidelines that identify characteristics and components of quality eye care. Appendix 1 describes the core criteria of quality eye care.

The Preferred Practice Pattern® guidelines are based on the best available scientific data as interpreted by panels of knowledgeable health professionals. In some instances, such as when results of carefully conducted clinical

METHODS AND KEY TO RATINGS

Preferred Practice Pattern® guidelines should be clinically relevant and specific enough to provide useful information to practitioners. Where evidence exists to support a recommendation for care, the recommendation should be given an explicit rating that shows the strength of evidence. To accomplish these aims, methods from the Scottish Intercollegiate Guideline Network¹ (SIGN) and the Grading of Recommendations Assessment, Development and Evaluation² (GRADE) group are used. GRADE is a

HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE

Acute horseshoe retinal tears and traumatic breaks usually require treatment.

Asymptomatic atrophic or operculated retinal breaks rarely need treatment. More generally, an eye that has atrophic round holes within lattice lesions, has minimal subretinal fluid without progression, or lacks evidence of posterior vitreous detachment (PVD) does not require treatment.

An early diagnosis of a retinal detachment is important because the rate of successful retinal reattachment is higher and the visual

APPENDIX 1. QUALITY OF OPHTHALMIC CARE CORE CRITERIA

Providing quality care is the physician's foremost ethical obligation, and is the basis of public trust in physicians.

AMA Board of Trustees, 1986

Quality ophthalmic care is provided in a manner and with the skill that is consistent with the best interests of the patient. The discussion that follows characterizes the core elements of such care.

The ophthalmologist is first and foremost a physician. As such, the ophthalmologist demonstrates compassion and concern for the individual, and utilizes

APPENDIX 2. INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES AND RELATED HEALTH PROBLEMS (ICD) CODES

Precursors to rhegmatogenous retinal detachment and related entities with the following ICD-9 and ICD-10 classifications (see Glossary):

GLOSSARY

Atrophic retinal breaks or holes: Full-thickness retinal defects, unrelated to vitreoretinal traction. These can occur within lattice lesions or in areas of the retina that appear otherwise normal.

Clinical retinal detachment: A retinal detachment that either impairs a portion of the visual field or extends more than 2 disc diameters posterior to the equator.

Cystic retinal tufts: Small congenital lesions of the peripheral retina. They are slightly elevated and usually whitish in color with

LITERATURE SEARCHES FOR THIS PPP

Literature searches of the PubMed and Cochrane databases were conducted in April 2018; the search strategies are provided at www.aao.org/ppp. Specific limited update searches were conducted after June 2019.

(Retinal Detachment/epidemiology[mh]) AND (rhegmatogenous retinal detachment[tiab])

(Retinal Detachment/etiology[MAJR:noexp] OR Retinal Perforations/etiology[MAJR:noexp] OR Vitreous Detachment/etiology[MAJR:noexp] OR Retinal Degeneration/etiology[MAJR:noexp]) AND (rhegmatogenous retinal

RELATED ACADEMY MATERIALS

Basic and Clinical Science Course

Retina and Vitreous (Section 12, 2019–2020)

Focal Points

Floaters and Flashes (2016)

Ophthalmic Technology Assessment

The Repair of Rhegmatogenous Retinal Detachments (1996; reviewed for currency 2006)

Patient Education Brochure

Detached and Torn Retina (2005)

Preferred Practice Pattern® Guidelines – Free download available at www.aao.org/ppp.

Comprehensive Adult Medical Eye Evaluation (2015)

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