Question:
A friend of yours has a spectacle correction of -6.0 D and -8.0 D. He telephones you one morning and tells you that he has started seeing some opacities floating in front of his eyes and that his vision has decreased slightly over the last few days. As an intern in the ophthalmology section, what would you do?
A friend of yours has a spectacle correction of -6.0 D and -8.0 D. He telephones you one morning and tells you that he has started seeing some opacities floating in front of his eyes and that his vision has decreased slightly over the last few days. As an intern in the ophthalmology section, what would you do?
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New floaters and vision drop in a high myope suggest a retinal tear; check the far periphery with indirect ophthalmoscopy.
Updated On: Jul 8, 2026
- Reassure
- Refraction and prescribe a new spectacle
- Direct ophthalmoscopy
- Indirect ophthalmoscopy
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The Correct Option is D
Solution and Explanation
Step 1: Identify the risk in this patient.
The friend has high myopia, with corrections of -6.0 D and -8.0 D. Highly myopic eyes are longer than normal and have a thinner, more stretched retina, which puts them at much higher risk of retinal tears and retinal detachment.
Step 2: Read the new symptoms as warning signs.
New floaters (the opacities floating in front of his eyes) along with a drop in vision over a few days are classic early symptoms of a posterior vitreous detachment that has pulled on the retina, possibly causing a retinal tear or an early detachment. In a high myope, these symptoms must be treated as an emergency until proven otherwise.
Step 3: Decide what examination is needed.
Retinal tears and early detachments usually start in the far periphery of the retina, an area that needs a wide field of view and some scleral depression to see properly. Indirect ophthalmoscopy, done with a headset and a condensing lens, gives this wide, stereoscopic view of the entire peripheral retina, so it is the correct examination to look for a tear or detachment.
Step 4: Rule out the other options.
Simply reassuring the patient risks missing a retinal tear that could progress to a full detachment and permanent vision loss. Refraction and a new spectacle only address the focusing power of the eye and would not detect a retinal problem, so it is not an appropriate first response to these symptoms. Direct ophthalmoscopy gives a narrow, high magnification view that mainly shows the back of the eye and cannot examine the far peripheral retina well, so it is not adequate here.
Step 5: Final Answer.
Indirect ophthalmoscopy is done to fully examine the peripheral retina for a tear or detachment. \[ \boxed{\text{Indirect ophthalmoscopy}} \]
The friend has high myopia, with corrections of -6.0 D and -8.0 D. Highly myopic eyes are longer than normal and have a thinner, more stretched retina, which puts them at much higher risk of retinal tears and retinal detachment.
Step 2: Read the new symptoms as warning signs.
New floaters (the opacities floating in front of his eyes) along with a drop in vision over a few days are classic early symptoms of a posterior vitreous detachment that has pulled on the retina, possibly causing a retinal tear or an early detachment. In a high myope, these symptoms must be treated as an emergency until proven otherwise.
Step 3: Decide what examination is needed.
Retinal tears and early detachments usually start in the far periphery of the retina, an area that needs a wide field of view and some scleral depression to see properly. Indirect ophthalmoscopy, done with a headset and a condensing lens, gives this wide, stereoscopic view of the entire peripheral retina, so it is the correct examination to look for a tear or detachment.
Step 4: Rule out the other options.
Simply reassuring the patient risks missing a retinal tear that could progress to a full detachment and permanent vision loss. Refraction and a new spectacle only address the focusing power of the eye and would not detect a retinal problem, so it is not an appropriate first response to these symptoms. Direct ophthalmoscopy gives a narrow, high magnification view that mainly shows the back of the eye and cannot examine the far peripheral retina well, so it is not adequate here.
Step 5: Final Answer.
Indirect ophthalmoscopy is done to fully examine the peripheral retina for a tear or detachment. \[ \boxed{\text{Indirect ophthalmoscopy}} \]
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