Work-up of Isolated Acute-Onset Photopsia

Abstract

Many patients presenting with photopsia alone will report that something is wrong with one of their eyes. This study aimed to determine if ophthalmologists are aware of the need of a bilateral examination in such patients. Two validated questions were randomly sent to 300 ophthalmologists. The first question investigated if a patient with isolated photopsia in the right eye needs to have dilated fundus examination of his left eye if a dilated fundus examination on the right is normal. The second question explored how probable in such a situation it is that the left eye is affected. A 74.3% of the 300 ophthalmologists responded. They had been practising on average for 20.7 ± 9.1 years; 31.8% were female. A 14.8% (33 out of 223; 95% confidence interval [CI] 10.7%–20.1%) gave the correct answer to the first question and 6.8% (15 out of 219; 95% CI 4.2%–11.0%) thought that the probability that the left eye might be affected was higher than 50%. A logistic regression revealed that the answers to our first question were not influenced by gender or number of years in practice (p > 0.1 for each). Patients claiming to have photopsia in one eye will be found to have a traction on the nasal retina of the ipsilateral eye or the temporal retina of the contralateral eye and, therefore, not necessarily in the eye they claim the symptoms originate from. The majority of ophthalmologists are not aware of this fact and, thus, are at risk of overlooking potentially treatable conditions.

Keywords::

• diagnostic techniques
• entoptic phenomena
• floaters
• ocular examination techniques
• photopsia
• posterior retinal detachment

ACKNOWLEDGEMENTS

We would like to thank Georg Eisner (Bolligen, Switzerland) for providing significant inputs for this study.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.