# A nurse is assessing a 65-year-old client with diabetes mellitus who reports gradual vision changes over the past year. Which assessment finding would be most concerning and require immediate ophthalmologic referral?

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> subject: Adult Health

## 문제

A nurse is assessing a 65-year-old client with diabetes mellitus who reports gradual vision changes over the past year. Which assessment finding would be most concerning and require immediate ophthalmologic referral?

## 보기

1. Complaint of difficulty reading small print that improves with reading glasses
2. Mild eye dryness and occasional irritation relieved by artificial tears
3. Gradual development of cloudy vision that improves in dim lighting
4. Sudden appearance of floaters, flashing lights, and curtain-like visual field defect **✔ 정답**

**정답: 4**

## 해설

Sudden floaters, flashing lights, and curtain-like vision loss indicate retinal detachment, an ophthalmologic emergency requiring immediate referral. Other options describe gradual or manageable changes not requiring urgent intervention.

## 심화 해설

Clinical Reasoning Analysis

This question tests your ability to triage ophthalmologic complaints by distinguishing between chronic, age-related changes and true ocular emergencies. The key to answering correctly lies in recognizing the clinical presentation of an acute vision-threatening condition versus a chronic, non-emergent one.

*   Option 1: A complaint of difficulty reading small print that improves with reading glasses is a classic presentation of presbyopia. This is a normal, age-related loss of lens elasticity that affects near vision and is easily corrected. It is a chronic, non-urgent issue.

*   Option 2: Mild eye dryness and occasional irritation relieved by artificial tears describes dry eye syndrome, a common and typically benign condition, especially in older adults. While it can affect quality of life, it does not constitute an emergency.

*   Option 3: The gradual development of cloudy vision that improves in dim lighting is highly suggestive of a cataract. Cataracts develop slowly over time, causing a progressive, painless loss of vision. The phenomenon of improved vision in dim light occurs because a dilated pupil allows light to enter around the central lens opacity. This is a chronic condition requiring eventual, but not immediate, surgical referral.

*   Option 4: The sudden appearance of floaters, flashing lights (photopsia), and a curtain-like visual field defect is the classic triad for a retinal detachment. This is an ophthalmic emergency. The "curtain-like" defect is particularly ominous, as it often signifies that the macula is threatened or has already detached. Immediate ophthalmologic referral is critical to prevent irreversible vision loss. A systematic approach to acute visual loss identifies this constellation of symptoms as a primary red flag requiring emergent evaluation [1, 2]. The rapid differentiation of such etiologies from benign conditions is the core principle of emergency eye triage [2].References (research sources)

- [2]A Five-Step Approach to Acute Vision Loss: A Practical Narrative Review for Clinicians.Research articleMaher C, Guo B, Yek J. (2026) · DOI: 10.2147/opth.s590753

## 임상 시나리오

Retinal Detachment TriageRecognizing the Ophthalmic Emergency
The classic triad for retinal detachment is the sudden onset of floaters, flashing lights (photopsia), and a curtain-like visual field defect. This is an ophthalmic emergency requiring immediate referral to preserve vision.

In contrast, presbyopia (difficulty with near vision) and cataracts (gradual cloudy vision) are chronic, age-related changes that do not require emergency intervention. Vision loss from cataracts may paradoxically improve in dim light.

CautionA patient with diabetes is at higher risk for retinal complications. Any report of sudden visual changes must be treated as a potential retinal detachment or vitreous hemorrhage until proven otherwise. Do not delay ophthalmologic consultation.

## 핵심 개념

- **Retinal Detachment** — Separation of the neurosensory retina from the retinal pigment epithelium, presenting with sudden floaters, flashes, and a curtain-like visual field defect; an ophthalmic emergency.
- **Photopsia** — The perception of flashing lights, often caused by mechanical stimulation of the retina, commonly reported in retinal detachment.
- **Presbyopia** — Age-related loss of lens elasticity causing difficulty focusing on near objects, correctable with reading glasses.
- **Cataract** — A progressive, painless clouding of the eye's natural lens, causing gradual vision loss that may temporarily improve in dim light.

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