Value of subjective visual reduction in patients with acute-onset floaters and/or flashes

To quantify the association between subjective visual reduction (SVR) and retinal pathology in patients with acute-onset monocular floaters or flashes, or both.

Prospective cohorts study involving all new patients referred for acute-onset floaters or flashes, or both, to a tertiary care emergency eye clinic in Kingston, Ontario, between July 1, 2011, and June 29, 2012 (n = 333).

All patients were evaluated for the presence of SVR in a standardized fashion, as well as other known risk factors for retina pathology including a family history of retinal tear or retinal detachment, a personal history of retinal tear or detachment, high myopia, and ocular trauma. Our major outcome was urgent retinal pathology, defined as retina pathology requiring a same-day referral to a retina specialist for evaluation, management, or both.

SVR was strongly associated with retinal pathology (likelihood ratio 7.9, 95% CI 5.2-12.1).

Patients with SVR are at increased risk for urgent retinal pathology and should be triaged for urgent ophthalmologic examination.