Ophthalmology. Retina · 2025
Non-Funduscopic Slit Lamp Assessment of the Posterior Hyaloid Membrane: A Simpler and More Effective Way of Clinically Diagnosing Posterior Vitreous Detachments.
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Sood Shefali, Barra Talha A, Duong Ryan T, Khatri Imran A, Barazi Mohammed K, Osman Michael H, Abou-Samra Abdullah, Du Jeanette, Lateef Hamza A, Huang Jason Mingyi, Hooten Claudia G, Do Brian K, Levinson Joshua D, Melamud Alexander, Mathai Mariam, Ali Mohsin H
Аннотация
PURPOSE: To assess the clinical utility of a simpler method of detecting a complete posterior vitreous detachment (PVD)-visualization of the posterior hyaloid membrane at the slit lamp-which does not require expert dilated fundus examination skills, special instrumentation (fundoscopy lenses), or imaging devices (OCT or B-scan).
DESIGN: Cross-sectional case series.
PARTICIPANTS: All eligible patients presenting to the retina clinic during the study period were consecutively examined.
METHODS: All patients were examined for the presence or absence of a PVD using the posterior hyaloid membrane assessment method and Weiss ring assessment method and via OCT performed by 3 masked graders.
MAIN OUTCOME MEASURES: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operator curves, and areas under the curve (AUC) were analyzed to assess the clinical utility of the 2 methods.
RESULTS: A total of 206 eyes of 118 patients were included. The incidence of true PVDs based on OCT was 57.3%. The posterior hyaloid assessment method was more sensitive than the Weiss ring assessment method (89.8% vs. 79.7%; P = 0.04) and had a higher NPV (87.5% vs. 78.2%; P < 0.01). There was no significant difference in specificity between the posterior hyaloid membrane and Weiss ring methods (95.5% vs. 97.4%; P = 0.5) or PPV (96.4% vs. 97.3%; P = 0.2). The AUC for the posterior hyaloid assessment and Weiss ring methods were 0.93 and 0.89, respectively (chi-square = 2.84; P value = 0.09).
CONCLUSIONS: This study shows that this method of assessing the posterior hyaloid status is clinically meaningful and has a high sensitivity, specificity, PPV, NPV, and AUC. Compared with the Weiss ring method, the posterior hyaloid membrane assessment has a significantly higher sensitivity and NPV and a similarly high specificity, PPV, and AUC. Although trainees are not regularly taught this diagnostic skill, these results support that visualizing and assessing the posterior hyaloid membrane should be in every ophthalmologist's diagnostic skill repertoire.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: Cross-sectional case series.
PARTICIPANTS: All eligible patients presenting to the retina clinic during the study period were consecutively examined.
METHODS: All patients were examined for the presence or absence of a PVD using the posterior hyaloid membrane assessment method and Weiss ring assessment method and via OCT performed by 3 masked graders.
MAIN OUTCOME MEASURES: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operator curves, and areas under the curve (AUC) were analyzed to assess the clinical utility of the 2 methods.
RESULTS: A total of 206 eyes of 118 patients were included. The incidence of true PVDs based on OCT was 57.3%. The posterior hyaloid assessment method was more sensitive than the Weiss ring assessment method (89.8% vs. 79.7%; P = 0.04) and had a higher NPV (87.5% vs. 78.2%; P < 0.01). There was no significant difference in specificity between the posterior hyaloid membrane and Weiss ring methods (95.5% vs. 97.4%; P = 0.5) or PPV (96.4% vs. 97.3%; P = 0.2). The AUC for the posterior hyaloid assessment and Weiss ring methods were 0.93 and 0.89, respectively (chi-square = 2.84; P value = 0.09).
CONCLUSIONS: This study shows that this method of assessing the posterior hyaloid status is clinically meaningful and has a high sensitivity, specificity, PPV, NPV, and AUC. Compared with the Weiss ring method, the posterior hyaloid membrane assessment has a significantly higher sensitivity and NPV and a similarly high specificity, PPV, and AUC. Although trainees are not regularly taught this diagnostic skill, these results support that visualizing and assessing the posterior hyaloid membrane should be in every ophthalmologist's diagnostic skill repertoire.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.