Acute Posterior Vitreous Detachment Appropriate Examination and Follow-up

Measure Specification

Retinal tears, if treated promptly, are less likely to result in detachment. Most retinal tears occur in the setting of an acute PVD where patient experience flashes of light and/or new onset of floaters. While the onset of PVD is generally not preventable, prompt examination is critical to identify and treat any associated retinal tears. Prompt treatment will minimize the potential for complications such as retinal detachment and improve a patient’s quality of life.

This measure is based on clinical recommendations adapted from the AAO Preferred Practice Guidelines (AAO, 2019), which are excerpted below. The eye examination should include the following elements: Examination of the vitreous for hemorrhage, detachment, and pigmented cells Careful examination of the peripheral fundus using scleral depression There are no symptoms that can reliably distinguish between a PVD with or without an associated retinal break; therefore, a peripheral retinal examination is required.

The preferred method of evaluating patients for peripheral vitreoretinal pathology is to use an indirect ophthalmoscope combined with scleral depression. Many patients with retinal tears have blood and pigmented cells in the anterior vitreous. In fully dilated eyes, slit-lamp biomicroscopy with a mirrored contact lens or a condensing lens is an alternative method in fully dilated eyes instead of a scleral depressed indirect examination of the peripheral retina.

Follow-up Evaluation: The guidelines in Table 3 are recommendations for the timing of re-evaluation in the absence of additional symptoms. Patients with new symptoms or a change in symptoms may require more frequent evaluation. Patients with no positive findings at the initial examination should be seen at the intervals recommended in the Comprehensive Adult Medical Eye Evaluation PPP.

All patients with risk factors should be advised to contact their ophthalmologist promptly if new symptoms such as flashes, floaters, peripheral visual field loss, or decreased visual acuity develop.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient during the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.