title: Photopsias: A Key to Diagnosis.
abstract: OBJECTIVE
  To assess the character and cause of photopsias in vitreoretinal patients.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  A total of 169 consecutive patients (217 eyes) with vitreoretinal disease presenting with a history of photopsias.
  
  
  METHODS
  A total of 217 eyes with photopsias in 169 patients were evaluated. Photopsia assessment included (1) laterality (unilateral, bilateral but not simultaneous, bilateral, and simultaneous); (2) morphology (flash, zig-zag, strobe, scintillating scotoma, twinkling, other); (3) color (white, silver, yellow, combination, other); (4) location (temporal, central, other); (5) duration (quick, prolonged, constant, other); (6) frequency; (7) diurnal appearance (day, night, both); (8) stimuli (turning head or eyes, hypoglycemia, hyperglycemia, other); and (9) associated systemic or ocular signs and symptoms (headache, numbness, weakness, vertigo, syncope, diplopia, hypotension, floaters, other).
  
  
  METHODS
  Clinical photopsia features correlated with the causes of photopsias.
  
  
  RESULTS
  Thirty-two photopsia causes were identified. The top 16 included posterior vitreous detachment (PVD) in 39.7% of eyes; retinal tear in 8.9% of eyes; neovascular age-related macular degeneration (AMD) in 7.9% of eyes; rhegmatogenous retinal detachment (RRD) in 7.5% of eyes; classic and ophthalmic migraine in 6.5% of eyes; hypoglycemia in 2.8% of eyes; vertebrobasilar insufficiency in 2.8% of eyes; non-AMD choroidal neovascularization in 2.3% of eyes; retinitis pigmentosa in 1.9% of eyes; severe cough in 1.9% of eyes; central serous chorioretinopathy in 1.4% of eyes; intraocular lens reflections in 0.9% of eyes; blue field entoptic phenomenon in 0.9% of eyes; Charles Bonnet syndrome in 0.9% of eyes; digitalis in 0.9% of eyes; and metastatic adenocarcinoma to the brain in 0.9% of eyes. The photopsias associated with PVD are typically quick (96%), with lightning/flash morphology (96%), white (87%), temporally located (86%), associated with new-onset floaters (85%), preferentially seen in dark (90%) rather than lighted environments (29%), and often initiated by head/eye movements (60%). Retinal detachment had a similar profile, but with more nontemporal photopsias (40%) (P = 0.01). The photopsias from neovascular AMD are more centrally located (83%), quick and repetitive (79%), seen in light (73%) and dark (63%) environments, have no inciting stimuli (84%), and are more likely to be nonwhite (40%).
  
  
  CONCLUSIONS
  A pointed history for photopsias can reveal a cause that may not initially seem apparent. Thus, the history can play a key role in management decisions.
authors.affiliation: Retina Service, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania; Mid-Atlantic Retina, Plymouth Meeting, Pennsylvania; Eye Research Institute, Philadelphia, Pennsylvania; Center for Value-Based Medicine, Flourtown, Pennsylvania. Electronic address: gbrown@valuebasedmedicine.com.
authors.forename: Gary C
authors.initials: GC
authors.lastname: Brown
authors.affiliation: Research Unit, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania; Eye Research Institute, Philadelphia, Pennsylvania; Center for Value-Based Medicine, Flourtown, Pennsylvania.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Brown
authors.affiliation: Retina Service, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania; Mid-Atlantic Retina, Plymouth Meeting, Pennsylvania.
authors.forename: David H
authors.initials: DH
authors.lastname: Fischer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005128:Eye Diseases / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000175:diagnosis* / Q000209:etiology; D010719:Phosphenes; D012164:Retinal Diseases / Q000150:complications / Q000175:diagnosis*; D014786:Vision Disorders / Q000175:diagnosis* / Q000209:etiology; D014822:Vitreous Body / Q000473:pathology*