title: What made you wait so long? Delays in presentation of retinal detachment: knowledge is related to an attached macula.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.|Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Eva S V
authors.initials: ES
authors.lastname: Eijk
authors.affiliation: Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Jan J V
authors.initials: JJ
authors.lastname: Busschbach
authors.affiliation: Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Reinier
authors.initials: R
authors.lastname: Timman
authors.affiliation: Monteban Value Services, Amerongen, The Netherlands.
authors.forename: Helma C
authors.initials: HC
authors.lastname: Monteban
authors.affiliation: Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jan M H
authors.initials: JM
authors.lastname: Vissers
authors.affiliation: Rotterdam Eye Hospital, Rotterdam, The Netherlands.|Department of Ophthalmology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Jan C
authors.initials: JC
authors.lastname: van Meurs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057210:Delayed Diagnosis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017075:Laser Coagulation; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012163:Retinal Detachment / Q000175:diagnosis* / Q000601:surgery*; D012591:Scleral Buckling; D011795:Surveys and Questionnaires; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014792:Visual Acuity; D014821:Vitrectomy
keywords: attitudes; health knowledge; health services research; patient education as topic; practice; questionnaires; referral and consultation; retinal detachment; time to treatment; vitreoretinal surgery