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April 14, 2010

Acute-Onset Floaters and Flashes and Risk for Retinal Detachment

JAMA. 2010;303(14):1369-1370. doi:10.1001/jama.2010.392

To the Editor: In the review of acute-onset floaters and flashes by Dr Hollands and colleagues,1 I have some concern about the premise of having primary care or emergency department physicians perform dilated eye examinations, stating that “[t]here are no absolute contraindications . . . aside from known allergy to a given drop.” Ophthalmologists assess each patient for the safety of dilation to minimize the risk of causing an acute attack of angle-closure glaucoma. If the patient is at increased risk, but dilation is necessary, arrangements are in place to handle acute glaucoma if it should occur. This is why it is also improper to state that, “Measurement of intraocular pressure . . . is not necessary.” Not knowing what the pressure is before dilation puts the patient at risk.