Clinicolegal aspects of vitreous and retinal detachment

Failure to diagnose retinal detachment is an important cause of professional liability claims involving optometrists. To comply with medical standards, dilation of the pupil and examination of the retinal periphery are required, both for patients who are at risk for retinal detachment and for patients who are symptomatic. Important risk factors include a history of previous detachment, myopia, lattice retinal degeneration, aphakia and pseudophakia, YAG capsulotomy, treatment of primary open-angle glaucoma with miotic drugs, blunt ocular trauma, and the proliferative retinopathies. Patients with the symptoms of acute posterior vitreous detachment must receive a dilated fundus examination, evaluation of the retinal periphery, and assessment of the vitreous. If examination results are negative, the patient should be warned of the symptoms of retinal detachment and scheduled for reevaluation in 4 to 8 weeks. Examination findings, warnings, recall appointments, and referral for treatment should be documented in the patient's record of care.