Patient awareness of emergency eye problems is low

Serious eye problems like retinal detachment can come on suddenly and require immediate care, but few people are aware of these conditions much less how they’re treated, a small U.S. study finds.

Of more than 200 patients surveyed at an internal medicine clinic in 2015, just a handful were aware of the symptoms or treatment of retinal detachment, acute angle-closure glaucoma, giant cell arteritis or central retinal artery occlusion

“Health literacy in the United States tends to be poor generally, and literacy about eye disease even poorer,” said senior author Dr. Albert Y. Wu of Icahn School of Medicine at Mount Sinai in New York City. “Moreover, the diseases we studied are rare, and so our hypothesis for this study was that awareness and knowledge about them would also be low.”

But these four diseases can cause permanent vision impairment or even blindness, if treatment is not sought quickly, he told Reuters Health by email.

Retinal detachment often presents with the perception of flashing lights or dark or light specks floating in one's vision, or a curtain of darkness in the visual field, Wu said. Acute angle-closure glaucoma commonly presents as a combination of severe pain in the affected eye, possible headache, blurry vision, nausea and vomiting.

“Giant cell arteritis (also called temporal arteritis) can be tricky to diagnose, because the symptoms vary widely between patients, and vision may not be affected initially,” but features can include fever, headache over one's temple, scalp tenderness, jaw pain while chewing and vision loss, he said.

Central retinal artery occlusion causes painless, sudden vision loss in the affected eye.

Wu and his coauthors surveyed 237 patients, mostly men, over 30 days in the waiting rooms of the outpatient internal medicine clinic at Mount Sinai Hospital. Written questionnaires asked whether the patient knew what each of the four emergency conditions is, and included a question about what physical pathology is involved in each disease, a question about symptoms and a question about treatment options.

About 28 percent said they were aware of retinal detachment, 15 percent knew of acute angle-closure glaucoma, 5 percent knew of giant cell arteritis and 4.6 percent knew of central retinal artery occlusion.

Less than 15 percent were knowledgeable about the features, symptoms or treatment of retinal detachment, and less than 1 percent knew any more about the other three conditions, according to the results in JAMA Ophthalmology.

“These diseases are uncommon, which likely contributes to the problem we identified in our study: public lack of awareness and knowledge about them,” Wu said.

People who are very near-sighted are at increased risk for retinal detachment, and people with diabetes are at increased risk for central retinal artery occlusion, he said. “Although we believe it is important for everyone to be aware of the symptoms of retinal detachment and central retinal artery occlusion, these patients in particular should be aware,” he said.

Visual prognosis for these diseases depends on prompt treatment, Wu said. “That, in turn, depends on patients recognizing their symptoms, appreciating their severity and seeking treatment quickly.”

Lessons learned from stroke awareness campaigns may be applicable to the emergent ophthalmic diseases, he said.

“Since the diseases we studied are rare, perhaps a variation of a mass media campaign that focuses broadly on concerning eye symptoms, rather than on a particular emergent eye disease, would be more practical and effective,” he said. “Another important piece of the puzzle is to encourage doctors and healthcare providers, including non-ophthalmologists, to educate to their patients about these important diseases.”