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. Reassure
• B. Refraction and prescribe a new spectacle
• C. Direct ophthalmoscopy
• D. Indirect ophthalmoscopy

Hint:

New floaters and vision drop in a high myope suggest a retinal tear; check the far periphery with indirect ophthalmoscopy.

Answer 1

The Correct Option is D

The clue to catch here is the combination of high myopia with new floaters and dropping vision, which points toward the retinal periphery.

1. Reassure: Would be reasonable for a single old floater in a normal eye, but in a high myope with new symptoms, it risks missing a retinal tear that is still treatable at this early stage.
2. Refraction and prescribe a new spectacle: Only corrects focusing power and says nothing about the state of the retina, so it does not address the real risk here.
3. Direct ophthalmoscopy: Gives a small, magnified, straight ahead view and cannot reach the far periphery, where retinal tears in high myopes usually start.
4. Indirect ophthalmoscopy: Uses a headset and lens to give a wide, three dimensional view of the whole retina out to its far edge, with the option of scleral depression, which is exactly what is needed to find a peripheral tear or early detachment.

Because high myopia predisposes to peripheral retinal tears, and this patient now has fresh floaters with reduced vision, a full peripheral retinal check with indirect ophthalmoscopy is the right next step.

Let's summarize:

• High myopia raises the risk of retinal tears and detachment.
• New floaters plus vision loss in such a patient need a peripheral retinal exam, best done by indirect ophthalmoscopy.

So the correct action is indirect ophthalmoscopy.