What made you wait so long? Delays in presentation of retinal detachment: knowledge is related to an attached macula

Eva S van Eijk, Jan J van Busschbach, Reinier Timman, Helma C Monteban, Jan M H Vissers, Jan C van Meurs

Research output: Contribution to journalArticleResearchpeer-review

Abstract

PURPOSE: In rhegmatogenous retinal detachment, the time between first symptoms and reattachment surgery is critical to prevent macular detachment. We explored which determinants discriminate between 'macula-ON' and 'macula-OFF' retinal detachments to improve timely treatment.

METHODS: Eight-hundred patients with rhegmatogenous retinal detachment admitted for surgery at the Rotterdam Eye Hospital in the Netherlands were eligible to complete a questionnaire to explore the following determinants: (i) patient's delay and doctor's delay; (ii) patient-reported causes for delay; (iii) symptoms as early warning signals; (iv) patient's prior knowledge about retinal detachment; and (v) trait anxiety.

RESULTS: Five hundred and twenty-one questionnaires (65%) were analysed. Median interval between first symptoms and surgery was 14 days. Macula-ON/OFF ratio was 46/54. Patient's delay in macula-ON patients (median 3 days) was shorter than in macula-OFF (5 days, p = 0.026). No difference was found in doctor's delay except for 'waiting time for surgery': macula-ON patients were operated on faster (median 1 day) than macula-OFF (median 5 days, p < 0.001). Macula-ON patients more often attributed symptoms to retinal problems. Except floaters, no symptoms were determined as early warning signals for macula-ON. Macula-ON patients more often reported knowing that prognosis would be worse when treated later, even when controlled for previous experience with retinal detachment.

CONCLUSION: Macula-ON patients seem to self-refer faster to a healthcare provider, seem more sensitive to floaters and seem more informed. This suggests that increasing awareness, especially about floaters, might increase the proportion of patients with macula still on at the moment of referral to the ophthalmologist.

Original languageEnglish
Pages (from-to)434-40
Number of pages7
JournalActa Ophthalmologica
Volume94
Issue number5
DOIs
Publication statusPublished - Aug 2016

Keywords

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Delayed Diagnosis
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Laser Coagulation
  • Macula Lutea/pathology
  • Male
  • Middle Aged
  • Referral and Consultation
  • Retinal Detachment/diagnosis
  • Scleral Buckling
  • Surveys and Questionnaires
  • Time-to-Treatment/statistics & numerical data
  • Visual Acuity
  • Vitrectomy

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