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CMAJ. 2012 July 10; 184(10): 1175–1176.
PMCID: PMC3394829

Floater panic could cause overreferral

I enjoyed the summary, “Posterior vitreous detachment, retinal tear and retinal detachment are a spectrum of disease” by Johnson and Hollands in their article “Acute-onset floaters and flashes,”1 which is part of CMAJ’s “Five things to know about …” series.

I was a bit concerned by the assertion that “[in] 14% of cases, tractional forces … cause a full thickness retinal tear.” This is simply not true if you consider a “case” to be any patient who presents to his or her primary care physician. The data for this statement come from a meta-analysis coauthored by Hollands.2 The studies used in the meta-analysis are predominantly of patients referred to retina specialists. Thus the “cases” have been preselected. I am afraid that a naive reader may assume that in all patients presenting for initial evaluation to their family physician with only a symptom of new-onset floaters will have a 14% chance of retinal tears. Thus, the many family physicians who read CMAJ may have a significant problem with overreferral of the all-too-common phenomenon of floaters without flashes. I would love to see a study that shows how likely patients with floaters, who present only to their family physicians, are to have a retinal tear. To my knowledge there is presently no such good information. All of the studies in this area are coming from tertiary care or subspecialty settings.


1. Johnson D, Hollands H. Acute-onset floaters and flashes. CMAJ 2012;184:431. [PMC free article] [PubMed]
2. Hollands H, Johnson D, Brox AC, et al. Acute onset floaters and flashes: Is this patient at risk for retinal detachment? JAMA 2009;302:2243–9 [PubMed]

Articles from CMAJ : Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association