WHEN asked why he wished to climb Mount Everest, George Leigh Mallory (1886-1924) replied, "Because it's there." Such an attitude is commendable in mountaineers. For ophthalmologists, however, it could lead to prophylactic treatment of chorioretinal lesions and retinal breaks simply because they are there. Molehills must not become mountains. The great majority of chorioretinal lesions and even retinal breaks do not result in retinal detachment and warrant no therapy.
In a recent study1 13.7% of asymptomatic patients were found to have retinal breaks; 6% of the US population has lattice degeneration.2 Only a small percentage of these groups will develop retinal detachment, and of all cases of retinal detachment, some develop in eyes with a previously normal fundus. The approximate incidence of retinal detachment in a stable population is 0.005%3 to 0.01%.4 Obviously, cases for prophylactic treatment must be carefully selected.
Many common ocular fundus lesions
Cockerham WD, Freeman HM. Molehills, Mountains and Prophylaxis of Retinal Detachment. Arch Ophthalmol. 1968;79(6):655-656. doi:10.1001/archopht.1968.03850040657001