Do Vitreous Floaters Predict Retinal Detachment? Retrospective Cohort Study in Primary Care

Area of Science:

• Ophthalmology
• Primary Care Medicine
• Retinal Diseases

Background:

• Vitreous floaters are often dismissed as benign but can signal serious retinal conditions.
• New-onset floaters are a potential early warning sign for retinal tears or detachment (RD).
• While ophthalmology data links floaters to retinal tears, primary care associations remain understudied.

Purpose of the Study:

• To determine the absolute risk (AR) and relative risk (RR) of retinal detachment (RD) associated with new-onset floaters in a primary care setting.
• To compare the RD risk posed by floaters versus flashes in primary care.

Main Methods:

• Retrospective cohort study of 1,181 patients aged 18+ with new-onset floaters or flashes across 7 Dutch family practices (2012-2021).
• Electronic health records were reviewed to categorize cases into floaters, flashes, or both.
• Subgroup analyses considered floaters' duration (acute ≤14 days) and quantity (many ≥10 or visual obstruction). Relative risk (RR) was calculated with flashes alone as the reference.

Main Results:

• The incidence of floaters was 5.5 and flashes 2.7 per 1,000 patient-years.
• Absolute risk (AR) of RD was 6.1% for floaters alone, 4.7% for flashes alone, and 8.4% for both.
• Both acute and numerous floaters elevated AR. RRs were significantly increased for acute floaters (2.39), many floaters (4.20), and both (6.20) compared to flashes alone.

Conclusions:

• Primary care data confirms that new-onset floaters are an important risk factor for retinal detachment (RD).
• Floaters present a greater RD risk in primary care than flashes, challenging current clinical practice.
• Findings support family physicians in evidence-based risk assessment for patients presenting with floaters or flashes.