What is retinal detachment?
The retina is the light-sensitive layer of tissue that lines the inside of the eye like wallpaper. It sends visual messages through the optic nerve to the brain. The most common type of retinal detachment is a rhegmatogenous detachment usually due to an abnormal adherence of the vitreous gel to the retina, similar to wallpaper lining the inside wall of the eye. When the vitreous shrinks and separates, the abnormal adherence causes the retina to tear. If the tear is not promptly treated, it may lead to leakage through the tear and the retina then detaches from its normal position. As it separates from the inner lining of the eye, it loses its blood supply from the wall of the eye and causes a shadow corresponding to the detached area. If not promptly treated with surgery, the retinal detachment progresses and can cause permanent vision loss.
Who is at risk for retinal detachment?
A retinal detachment can occur at any age, but it is more common in people over age 40 and usually occurs in people 50-70 years old when the vitreous normally shrinks and pulls free from the retina. It affects men more than women, and Whites more than African Americans.
Risk factors for retinal detachment include:
- High degree of myopia (extremely nearsighted)
- Retinal detachment in the other eye
- Family history of retinal detachment
- Following cataract surgery
- Following YAG laser for membrane after cataract surgery
- Lattice degeneration
What are the symptoms of retinal detachment?
- New or an increase in floaters
- Flashing lights
- A shadow or curtain obscuring a portion of the vision
- There is a painless loss of vision in one eye
A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see a retina specialist immediately and limit activities as much as possible.
How is retinal detachment treated?
Retinal detachments are treated with surgery and regardless of the procedure, patients must limit activities for 8-11 days after laser or cryopexy to allow for the retina to adhere to the wall of the eye. If a gas bubble is used, it may be necessary for you to position yourself as instructed. Bubbles last from several days to 6 weeks or more and when present, certain general anesthetic gases must be avoided and you cannot fly until the bubble is reabsorbed. Over 90% of typical retinal detachments can be repaired with one or more operations. The visual outcome may be quite excellent but if the central vision is compromised before surgery with the shadow involving the macula then reading vision may not be restored.
Depending on the location of the retinal tear(s), some patients may be treated in the office with a gas bubble procedure called pneumatic retinopexy. Although this procedure has the lowest success rate, it is the easiest and gives the best visual results. If unsuccessful, it does not handicap the results of additional surgery.
In some cases, a scleral buckle, a permanent tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. This is an outpatient procedure that takes under 2 hours and takes about 6 weeks to fully heal. It is usually performed with cryopexy and may be combined with an intraocular gas and or vitrectomy.
If necessary, an outpatient vitrectomy may also be performed, usually with local anesthesia with sedation. During a vitrectomy, the retina specialist works inside the eye with a small sucking-cutting instrument to remove the vitreous that pulled on the retina and ripped it. Gas is often injected to into the eye to replace the vitreous and holds the retina back against the wall of the eye until it adheres. The gas bubble resorbs in 1-6 weeks depending on which gas is used and replaced with the normal fluid within the eye.
What are the possible complications of retinal detachment?
- Need for multiple surgeries - With modern therapy, over 90 percent of those with a retinal detachment can be successfully treated, although sometimes multiple surgeries are needed.
- Return of partial vision - Once the retina is attached and the bubble reabsorbs the vision will start to improve with most of the improvement within 3 months and some up to one year. A change in glasses may be required. If the shadow involves the center of the vision, the macula was detached and not all the vision will return. Visual results are best if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches.
- Proliferative vitreoretinopathy (PVR) scar tissue. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails due to proliferative vitreoretinopathy when scar tissue occurs and vision may eventually be lost.
- Double vision
- Progression of cataract
- Complete loss of vision or a shrunken eye
- Extrusion of a scleral buckle