The Royal Australian and New Zealand College of Ophthalmologists
Recommendations from the Royal Australian & New Zealand College of Ophthalmologists on visual fields, vitamins, alpha-1 blockers, intravitreal injections & retinal detachment. The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) is the leading medical eye specialist organisation in Australia and New Zealand. RANZCO’s mission is to drive improvements in eye health care through continuing exceptional training, education, research and advocacy.
In general there is no indication to perform prophylactic retinal laser or cryotherapy to asymptomatic conditions such as lattice degeneration (with or without atrophic holes), for which there is no proven benefit.
Lattice degeneration and related asymptomatic retinal conditions are frequently found in eyes with retinal detachment. Intuitively one would expect that prophylactic treatment of such visible areas of abnormality would reduce the risk of retinal detachment, and such treatments used to be commonplace. The available evidence has however failed to demonstrate any convincing benefit, and there are also significant potential side effects to such treatment. One reason for the absence of demonstrated benefit is the frequent occurrence of retinal breaks outside areas of visible abnormality. With occasional exceptions, there is no justification for such treatment in asymptomatic eyes, and it has been a recommendation of the American Academy of Ophthalmology for many years that such treatment is not indicated. Counselling and follow-up of at-risk patients is likely more effective, and far more cost-effective, in preventing loss of vision due to retinal detachment.
- Blindbaek S, Grauslund J. Prophylactic treatment of retinal breaks- a systematic review. Acta Ophthalmologica 2014;93(1):3-8.
- Wilkinson CP. Evidence-based analysis of prophylactic treatment of asymptomatic retinal breaks and lattice degeneration. Ophthalmology 2000;107(1):12-5; discussion 5-8.
- Chauhan DS, Downie JA, Eckstein M, Aylward GW. Failure of prophylactic retinopexy in fellow eyes without a posterior vitreous detachment. Archives of Ophthalmology 2006;124(7):968-71.
- Lewis H. Peripheral retinal degenerations and the risk of retinal detachment. American Journal of Ophthalmology 2003;136(1):155-60.
- Kazahaya M. Prophylaxis of retinal detachment. Seminars in Ophthalmology 1995;10(1):79-86.
- Folk JC, Bennett SR, Klugman MR, Arrindell EL, Boldt HC. Prophylactic treatment to the fellow eye of patients with phakic lattice retinal detachment: analysis of failures and risks of treatment. Retina 1990;10(3):165-9.
- Folk JC, Arrindell EL, Klugman MR. The fellow eye of patients with phakic lattice retinal detachment. Ophthalmology 1989;96(1):72-9.
- Mastropasqua L, Carpineto P, Ciancaglini M, Falconio G, Gallenga PE. Treatment of retinal tears and lattice degenerations in fellow eyes in high risk patients suffering retinal detachment: a prospective study. British Journal of Ophthalmology 1999;83(9):1046-9.
- American Academy of Ophthalmology Preferred Practice Pattern: Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration - 2014. Available at: http://www.aao.org/preferred-practice-pattern/posterior-vitreous-detachment-retinal-breaks-latti-6
RANZCO has undertaken a multi-stage consultation process to ensure that the entire spectrum of medical eye specialists in Australia and New Zealand can contribute to the process of identifying and refining the top five recommendations. The first stage included a survey of fellows to identify possible recommendations, which were then narrowed down and by a dedicated “Choosing Wisely” committee of RANZCO members. A second survey was then sent to all members to provide feedback on the list of five and received a high response rate. Based on the extensive feedback received via the survey, RANZCO’s “Choosing Wisely” committee crafted the final wording of the top five recommendations. Finally, the RANZCO board discussed and approved the recommendations.
- 1 In the absence of relevant history, symptoms and signs, ‘routine’ automated visual fields and optical coherence tomography are not indicated.
- 2 AREDS-based vitamin supplements only have a proven benefit for patients with certain subtypes of age-related macular degeneration. There is no evidence to prescribe these supplements for other retinal conditions, or for patients with no retinal disease.
- 3 Don't prescribe tamsulosin or other alpha-1 adrenergic blockers without first asking the patient about a history of cataract or impending cataract surgery.
- 4 Intravitreal injections may be safely performed on an outpatient basis. Don't perform routine intravitreal injections in a hospital or day surgery setting unless there is a valid clinical indication.
- 5 In general there is no indication to perform prophylactic retinal laser or cryotherapy to asymptomatic conditions such as lattice degeneration (with or without atrophic holes), for which there is no proven benefit.
- 6 Do not use corneal cross linking for every patient with keratoconus.
- 7 Do not use topical antibiotics pre or post intravitreal injections.
- 8 Do not investigate systemically well patients with a first, uncomplicated episode of acute anterior uveitis.
- 9 Topical steroids should not be used unless infection has been ruled out in any patient with red eye.