Macula-on retinal detachment (macula intact) achieves 90% visual recovery with emergency surgery. Macula-off detachment (macula involved) has only 40–50% chance of full visual recovery even with immediate repair. The difference is often hours. Vitreous haemorrhage prevents fundoscopy — if VA is reduced with floaters and no view of fundus, refer same-day. High myopia (>-6D) has 5–10% lifetime risk of retinal detachment vs 0.1% in general population.

The Weiss ring (circular floater) is pathognomonic of acute PVD — seen in 85% of symptomatic PVDs. Its presence alone, without other features, still requires same-day/urgent ophthalmology (15% of symptomatic PVDs have associated retinal tears). A "shower" of black dots in PVD may indicate pigment cells released from torn RPE — associated with retinal tear in 50–70% of cases. This is a high-risk feature requiring emergency referral.

All new-onset PVD requires ophthalmology assessment within 24–48 hours because retinal tear co-exists in 10–15% of cases — examination alone cannot reliably exclude this. The window for prophylactic laser photocoagulation to a retinal tear (before retinal detachment develops) is typically 24–72 hours. Once retinal detachment occurs, laser is no longer sufficient and vitreoretinal surgery is required.

GP fundoscopy misses peripheral retinal tears in up to 80% of cases — the peripheral retina requires slit-lamp biomicroscopy and indirect ophthalmoscopy with scleral indentation. A normal GP fundoscopy should never reassure against referral in new-onset flashes and floaters. RAPD indicates a significant optic nerve or retinal problem — an examiner finding that mandates same-day specialist assessment even before symptoms are fully characterised.

The primary care role is triage and VA/VF assessment — complete retinal assessment is beyond GP scope. B-scan USS in vitreous haemorrhage prevents unnecessary delay — if ophthalmologist cannot visualise the retina directly, USS confirms retinal detachment and determines surgical urgency. OCT has revolutionised macular diagnosis — macular holes and vitreoretinal traction causing visual symptoms are diagnosed on OCT that would previously be labelled "unexplained visual symptoms."

Every new-onset acute floater with flashes requires slit-lamp examination by an ophthalmologist — this is not negotiable clinically. The 24–48h window for laser photocoagulation of a retinal tear represents the difference between a 20-minute outpatient procedure and emergency vitreoretinal surgery. UK Royal College of Ophthalmologists: all acute symptomatic PVD should be referred to ophthalmology within 24 hours (2019 guidance).

Laser photocoagulation for retinal tears: 95% effective in preventing retinal detachment when performed before detachment occurs. Cost per QALY <£1,000. Retinal detachment surgery: 80–90% anatomical success rate but only 60–70% achieve pre-detachment visual acuity. The asymmetry in outcomes makes prevention paramount. Anti-VEGF injections (ranibizumab, bevacizumab) for diabetic macular oedema/neovascularisation — up to 3 lines improvement in BCVA in pivotal trials.

The NHS Diabetic Eye Screening Programme detects referable retinopathy in 8% of diabetics screened annually — before symptoms develop. Tight glycaemic control (HbA1c <7%) reduces new proliferative retinopathy by 60% and macular oedema by 26% (UKPDS/DCCT). Patient education about retinal detachment warning signs is itself a preventive intervention — rapid presentation allows macula-sparing surgery.

Late retinal tears occur in 2–3% of cases within 6 weeks of initial uncomplicated PVD assessment — this justifies the 4–6 week ophthalmology follow-up recommended by the Royal College of Ophthalmologists. Second eye PVD occurs in 25% within 2 years — proactive counselling and monitoring prevents preventable blindness. Written safety-netting advice (not just verbal) reduces delayed presentations for retinal detachment.