Is retinography (retinal photography) safe for patients with Posterior Vitreous Detachment (PVD)?

Safety of Retinography in Patients with Posterior Vitreous Detachment (PVD)

Retinography (retinal photography) is safe for patients with Posterior Vitreous Detachment (PVD) and can be used as a complementary diagnostic tool, though it should not replace a thorough clinical examination with slit-lamp biomicroscopy and indentation indirect ophthalmoscopy for detecting retinal tears. 1

Understanding PVD and Its Diagnostic Evaluation

Posterior vitreous detachment (PVD) is a separation of the posterior vitreous cortex from the internal limiting membrane of the retina. This separation may be complete or partial 1. Patients with PVD typically present with symptoms including:

• Light flashes (photopsias)
• Floaters (myodesopias)
• Blurred or missing vision (in cases with retinal tears or detachment) 2

Diagnostic Methods for PVD:

1. Clinical Examination (Gold Standard):

   • Slit-lamp biomicroscopy
   • Indentation indirect ophthalmoscopy (critical for detecting peripheral tears) 2

2. Imaging Techniques:

   • Ultrasonography: Shows thin, highly reflective membrane that moves with eye movements; useful for detecting PVD 3, 4
   • Optical Coherence Tomography (OCT): Provides detailed imaging of the vitreoretinal interface 4
   • Retinography (Ultra-wide-field imaging): Can detect many retinal tears but is not as sensitive as clinical examination 5

Safety and Efficacy of Retinography in PVD

Retinography is generally safe for PVD patients and can serve as a useful adjunctive tool. A 2023 study using ultra-wide-field imaging with the Zeiss Clarus 700 found:

• Sensitivity values of 0.79-0.89 for detecting retinal tears
• Specificity values of 0.86-0.93 5

However, the study concluded that "routine clinical examination is still the only valid method for the detection of retinal tears today" 5. This emphasizes that while retinography is safe, it should not replace comprehensive clinical examination.

Important Clinical Considerations

Risk Factors for Complications:

Patients with PVD who have the following risk factors require especially careful evaluation:

• Myopia (higher risk of retinal tears) 1
• History of cataract surgery 1
• History of ocular trauma 1
• Prior retinal detachment in fellow eye (10% increased risk) 1
• Vitreous hemorrhage (indicates higher likelihood of retinal tear) 1

Follow-up Recommendations:

For patients with PVD symptoms:

• Initial comprehensive examination with slit-lamp biomicroscopy and indentation indirect ophthalmoscopy
• If no retinal tears are found, follow-up examination within 4-6 weeks
• If retinal tears are detected, prompt treatment with laser photocoagulation or cryotherapy 1, 2

Common Pitfalls to Avoid

1. Relying solely on retinography: About 15% of retinal tears are only visible on indentation indirect ophthalmoscopy and not on slit-lamp biomicroscopy 2, suggesting that an even higher percentage might be missed by retinography alone.

2. Assuming absence of PVD based on absence of Weiss ring: A Weiss ring (epipapillary glial tissue torn from the optic nerve head) is absent in 32% of eyes with retinal tears 2.

3. Failing to recognize Anomalous PVD (APVD): When gel liquefaction exceeds the degree of vitro-retinal dehiscence, it can result in various pathologies including retinal tears, macular holes, and vitreo-macular traction syndrome 6.

4. Inadequate peripheral examination: The preferred method for evaluating peripheral vitreoretinal pathology is indirect ophthalmoscopy combined with scleral depression 1.

In conclusion, while retinography is safe for patients with PVD and can provide useful information, it should be used as a complementary tool to—not a replacement for—thorough clinical examination with slit-lamp biomicroscopy and indentation indirect ophthalmoscopy.