Detachments anterior to the equator of the eye cannot be detected with visual field testing. Detachment posterior to the equator can be isolated with visual field testing, but the patient usually is unaware of a defect until it involves the posterior pole and macula. Inferior retinal detachment can be a long-standing condition that progresses without symptoms until the detachment reaches the fovea. When a patient has an extensive detachment, inquiring about the initial symptoms of the visual field loss is helpful to assist in localization of the tear. Onset of decreased visual acuity dates the duration of fovea involvement of the detachment, which correlates with the prognosis for recovery of the central vision.
Metamorphopsia is distortion of a visual image and is commonly described by patients as waviness.
Fluid disrupting the normal position of the retina within the macular area results in metamorphopsia. Inquire about history of trauma, including whether it occurred several months before the symptoms or coincided with the onset of symptoms. Documentation of head or ocular trauma may be subject to legal investigation. Note previous surgery, including cataract extraction, intraocular foreign body removal, and retinal procedures. Question the patient about previous conditions, such as uveitis, vitreous hemorrhage, amblyopia, glaucoma, and diabetic retinopathy.