What is Retinal Detachment?
The retina lines the inside of the eye like wallpaper. A retinal detachment occurs when the retina is pulled away from its normal position in the back of the eye. The retina sends visual images to the brain through the optic nerve. When detachment occurs, vision is blurred. A detached retina is a very serious problem that almost always causes blindness unless it is treated.
The retina normally lies smoothly and firmly against the inside back wall of the eyeball and functions much like the film in the back of a camera. Millions of light-sensitive retinal cells receive optical images, instantly "develop" them, and send them on to the brain to be seen. If any part of the retina is lifted or pulled from its normal position, it is considered detached and will cause some vision loss.
Who gets retinal detachment?
Retinal detachment develops in approximately 1 in 10,000 people per year. Certain conditions increase the likelihood of retinal detachment, including retinal breaks, posterior vitreous detachment, nearsightedness, eye injury, eye surgery, or a history of retinal detachment in family members. If a person has a retinal detachment in one eye, there is a 10% chance of eventually developing a detachment in their other eye.
What are the symptoms?
Symptoms of retinal detachment include painless:
Floaters are spots which patients perceive to be suspended or floating in their field of vision. Many patients describe these as a glob, a strand, a fly, pepper grains, or a web in their vision. They are best visualized against a white background and continue to float past the center vision after an eye movement
Flashes are like streaks of lightning which recur several times a day for several days. The flashes are a warning sign that something is happening to your retina. The vitreous (the gel like substance that fills your eye) can sometimes pull on the retina and cause an electrical signal to go to your brain. This signal lets you know that something different is happening in your eye.
A curtain of visual loss that spreads across the field of vision. This may be transparent or opaque.
Vision loss can progress rapidly. Untreated, retinal detachment usually causes permanent blindness.
What is the cause?
Most retinal detachments develop after the gel (vitreous) in the cavity of the eye peels from the retina. Peeling of the vitreous gel (posterior vitreous detachment) is a normal age-related change that usually occurs after the age of 50. The vitreous gel can peel earlier in eyes that are very nearsighted, that recently underwent surgery, or have had a significant traumatic injury. A retinal tear can develop during the peeling of the gel due to an abnormal adhesion between the gel and the retina. A retinal tear allows fluid in the eye cavity to go through the tear to the space behind the retina where it can push the retina off the wall of the eye.
Breaks in the retinal tissue (retinal holes and retinal tears) are normally found in approximately 10% of people. In a small minority of persons with retinal breaks, liquid vitreous leaks beneath the retina, separating it from the eye-wall and causing a retinal detachment. A sudden separation of the vitreous from the retina (posterior vitreous detachment) is often the inciting event causing a retinal break or detachment. Macular pucker can also develop following a vitreous detachment.
How is it diagnosed?
Anyone who has sudden flashes, floaters, or peripheral vision loss needs an urgent examination by an eye doctor familiar with retinal diseases. A careful dilated retinal examination is necessary to diagnose retinal breaks or detachment.
A billowing retinal detachment surrounds the macula.
The retinal tear (arrow) causing this detachment is seen in the inferior retinal periphery.
How are retinal breaks and detachment treated?
Retinal breaks and tears
Retinal breaks and tears will usually need to be treated with laser surgery or cryotherapy (freezing), to seal the retina to the back wall of the eye again. These treatments cause little or no discomfort and may be performed in your ophthalmologist's office. This treatment will usually prevent progression to a retinal detachment. Occasionally retinal tears are watched without treatment.
Once the retina separates from the eye-wall it must be surgically pushed back into place; the causative retinal breaks are then "glued" with laser photocoagulation or cryotherapy. There are several surgical options available for repairing retinal detachment. Scleral buckling pushes the "wall against the wallpaper" whereas pneumatic retinopexy and vitrectomy push the "wallpaper against the wall." Surgery is usually performed within a day or two of diagnosis, particularly if the macula and central vision are not yet affected.
A scleral buckle or flexible band is placed around the equator of the eye to counterbalance any force pulling the retina out of place. Often the ophthalmologist will drain the fluid from under the detached retina allowing the retina to return back to its normal position against the back wall of the eye. This procedure is performed in the operating room, usually on an outpatient basis.
Pneumatic retinopexy describes the injection of a gas bubble into the vitreous space inside the eye enabling the gas bubble to push the retinal tear back against the wall of the eye and close the tear. Laser or cryo-surgery is used to secure the retina to the eye wall around the retinal tear. Your ophthalmologist will ask you to maintain a certain head position for several days. The gas bubble will gradually disappear. Sometimes this procedure can be done in the ophthalmologist's office.
A gas bubble is injected into the vitreous with your head held steady in the right position, the gas bubble holds the retinal tear closed
Vitrectomy may be necessary to remove any vitreous gel which is pulling on the retina. This may also be necessary if the vitreous is to be replaced with a gas bubble. Your body's own fluids will gradually replace this gas bubble, but the vitreous gel does not return. Sometimes a vitrectomy may be combined with a scleral buckle and or laser treatment.
What is the risk of surgery?
Retinal detachment is a sight threatening condition and surgery is necessary to repair the retina. Retinal detachment surgery is a complex procedure and may require different levels of treatment. Each person’s surgery may require more than one type of treatment. Your surgeon will review your options as well as the risks of surgery with you.
Will Your Vision Improve?
All retinal detachments are different. In general, if a retinal detachment can be fixed before the macula has detached, the visual prognosis is good. Several months may pass, however, before vision returns to its final level. The final outcome for vision depends on several factors. Therefore, close follow-up by your ophthalmologist is required. Patients usually need to have their glasses changed several months after retinal reattachment surgery.