title: Optometrists' examination and referral practices for patients presenting with flashes and floaters.
abstract: BACKGROUND
  Patients experiencing flashes and floaters commonly present to their optometrist. Some of these patients may have significant pathology, yet there is a great deal of variability with regard to examination technique and referral practice.
  
  
  METHODS
  A questionnaire survey was undertaken to determine the current management of patients presenting to their optometrist with flashes and floaters. All practising community optometrists within Southern Derbyshire received a questionnaire and 74 (56.9%) completed replies were received.
  
  
  RESULTS
  Optometrists estimated that an average of 14 patients per month per optometrist presented with symptoms of flashes and/or floaters. Mydriasis was utilised routinely for examination in approximately half of the patients. Mean relative confidence was 2.0 at identifying a vitreous haemorrhage and 6.5 for vitreous pigment (complete confidence = 0, complete lack of confidence = 10). Eight percent of responders were unfamiliar with the clinical sign of vitreous pigment, and 17% identifying this sign did not refer all such patients to the hospital services.
  
  
  CONCLUSIONS
  Patients presenting to their optometrists with flashes and/or floaters make up a sizeable part of the community optometrist's workload and the management of these patients is highly variable. A large proportion of these patients are examined without mydriasis, even in the presence of various risk factors for retinal detachment. There is a relative lack of confidence amongst optometrists with regards the detection of vitreous pigment and the prognostic implications of this finding. Educational measures such as study days may help the level of understanding and heighten the appreciation of the implications of flashes and floaters and the various clinical signs encountered.
authors.affiliation: Department of Ophthalmology, Derbyshire Royal Infirmary, Derby, UK. amaralwitry@aol.com
authors.forename: A
authors.initials: A
authors.lastname: Alwitry
authors.forename: H
authors.initials: H
authors.lastname: Chen
authors.forename: S
authors.initials: S
authors.lastname: Wigfall
mesh_terms: D002983:Clinical Competence; D004739:England; D005128:Eye Diseases / Q000175:diagnosis*; D006801:Humans; D009184:Mydriatics / Q000008:administration & dosage; D009907:Optometry / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012163:Retinal Detachment / Q000175:diagnosis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014822:Vitreous Body
chemical_list: D009184:Mydriatics