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Knowing the Retina
The retina is a thin layer of tissue on the back side of the eye. It consists of the cells detect light and millions of other optic nerves that convert light to signals sent to the brain so that we can see things. If we compare the eye to a camera, the retina is like the film. If the film deteriorates, the picture will not be sharp. Likewise, if the retina degenerates, our vision will be less sharp.
Retinal detachment is a condition which the retina detaches from the back of the eyeball. If the retina does not receive enough nutrients and oxygen, it will not be able to function properly. If left untreated for a long time, the optic cells will degenerate and die due to lack of blood flow. The affected area will be damaged permanently.
Types of Retinal Detachment
There are three types of retinal detachments:
- Rhegmatogenous Retinal Detachment or RRD is the most common type. The tear or hole in the retina causes the vitreous fluid to leak under the retina leading to retinal detachment. In this case, it is only mentioned because it is a common occurrence and requires immediate treatment.
- Tractional Retinal Detachment or TRD occurs when the scar tissue or fibrosis pulls on the retinal surface causing it to detach from the eyeball. It is not very common, but often found in diabetic patients with advanced diabetic retinopathy where abnormal blood vessels formed and bleeding occurs in the vitreous. It can also be found in patients with severe inflammation in the vitreous or retina or patients who had eye injury or rupture.
- Exudative Retinal Detachment or ERD tends to be caused by inflammation, eye tumor, or eye trauma which lead to fluid leakage from the blood vessels that collect under the retina.
Rhegmatogenous Retinal Detachment (RRD)
RRD occurs when the fluid or vitreous gel leak under the retina. As a person ages, the vitreous gel becomes more fluid causing shrinkage and detachment from the retina. It usually does not cause any problems known as posterior vitreous detachment or PVD.
In some cases, the vitreous gel may collect quite a bit thereby causing retinal tear, particularly around the area with lattice degeneration, which often occurs in the peripheral area of the retina that can be easily torn. If the vitreous gel leaks through the hole or tear and collects under the retina, it will cause retinal detachment.
Risk Factors for Retinal Detachment
- History of retinal detachment in the other eye
- Family history of retinal detachment
- Extreme nearsightedness
- Previous history of eye surgery, such as cataract or glaucoma treatment
- Severe eye trauma or injury
- Lattice degeneration
Symptoms of Retinal Detachment
Retinal detachment usually occurs acutely. Some patients may not even notice in the beginning. If the detachment advances, symptoms will be clearer. These include:
- Seeing many black floaters in the eye acutely
- Flashing lights in one or both eyes
- Blurred vision
- Dark shadows like curtains that partially or completely block vision
Diagnosis of Retinal Detachment
If you experience any abnormal vision, it is best to consult an optometrist for a complete eye exam. After iris dilation, the optometrist will use special tools and lens to examine around the retina. If tears or holes are not detected without any detachment, the next appointment will be within the next 1 – 2 weeks. This is to make sure that there really is no tear or detachment. Once the iris has been dilated, patients may experience blurred vision and light sensitivity for 4 – 6 hours until the iris returns to normal. If you experience another episode of abnormal vision or worsening condition, please consult your optometrist immediately.
If the optometrist cannot observe the retina with standard equipment due to conditions like internal eye bleeding, ophthalmic ultrasound may be necessary to diagnose retinal detachment.
Treatment of Retinal Detachment
Retinal tear or hole can be treated with laser photocoagulation or cryotherapy around the tear to prevent fluid from leaking out. An outpatient procedure can be performed without hospital stay. After treatment, avoid any activities that may impact the affected eye for at least 1 – 2 weeks so that it can completely heal.
Retinal detachment may require surgery. Treatment method depends on the nature and severity of the detachment and may require several types of treatment:
- Laser Photocoagulation may only work on small affected area near the periphery. If the detachment is wide, laser treatment may not be enough.
- Pneumatic Retinopexy in conjunction with laser or cryotherapy may be necessary in certain cases. This will require proper positioning for several days to close the tear and wait for the leaky fluid to be reabsorbed.
- Surgery entails two types:
- Scleral buckle surgery using silicone sponge
- Pars plana vitrectomy or PPV is currently the most popular method to remove fibrosis (if any is present) to repair the detachment. Laser or cryotherapy followed by pneumatic retinopexy where gas bubbles are injected into the eye to push the retina into place. The patient will need to lie face down for at least 3 – 4 weeks. The gas will be absorbed until it is all gone. If lying face down is not possible, silicone oil can be applied instead of the gas, but another surgery will be necessary to remove the silicone oil once the retina has reattached.
Risks during Surgery
Risks that can occur during surgery include
- Internal eye bleeding
- High eye pressure leading to glaucoma
- May require more than one surgery
- Unsuccessful surgery and retina will not reattach
- Recurrence of retinal detachment
- If gas was injected into the eye, it is imperative that the patient lies face down or stay in a certain position as directed by the optometrist for at least 2 – 4 weeks to allow the retina to attach properly. This will also reduce the risk of complications after surgery, such as cataract. Avoid air travel or stay at high altitude where there is low air pressure until all the gas has dissipated from the eye. This is because gas will expand more and push the eye acutely causing pressure and rupture in the eye blood vessels, which can lead to lack of blood flow and optic nerve damages. Patients may experience severe eye pain and blindness.
- Observe black floaters in the eye about 1 – 2 weeks after surgery. If the pneumatic retinopexy was performed, there might be dark shadows from the gas bubbles, which will eventually get better and disappear within approximately 4 weeks.
- Surgery may cause eye irritation or discomfort. Avoid rubbing the affected eye. Eye drops may be used to alleviate the condition. Eye ache may be treated with pain relievers. Most patients will not experience severe pain after surgery. If such event occurs, please contact your optometrist.
- During the first week after surgery, there might be inflammation and swelling around the affected eye, which occurred due to the prone position after surgery. Use eye drops as directed by your optometrist. If there are lots of gunks, severe eye ache or worsening vision, please contact your optometrist immediately.
- Use an eye patch for 2 – 4 weeks or as directed by your optometrist. Sunglasses may be used during the day
- Avoid getting water into the affected eye for at least 2 – 4 weeks after surgery to prevent infection
- Avoid sneezing, coughing or high pressure which may cause internal eye bleed
- Get plenty of rest and refrain from exercise or activities that may impact the affected eye
- Your vision may not improve immediately after surgery. If the surgery was a success and the retina attaches properly, vision may improve within 4 – 6 weeks. Some patients may require 2 – 3 months to recuperate.
Lower the Risk of Retinal Detachment
- Get regular eye exam and iris dilation at least once a year, especially those patients who have extreme nearsightedness or other risk factors
- Prevent eye injury by wearing safety goggles when playing certain sports or activities
- See your optometrist as soon as possible when you experience abnormal vision
Retinal detachment can be considered an emergency that needs to be treated as soon as possible so that your vision may return to normal. How well your vision improves after surgery depends on the duration of retinal detachment. If it occurs quite some time ago, the retina may have started to degenerate and there may have been tissue scarring. In such case, surgery may not be as effective even though the retina may have reattached. Some patients may require more surgery or if the retina cannot reattach, vision may not improve, especially if the tear affects a wide area to cover the focal plane. Therefore, if you experience irregular vision, please see your optometrist soon and get both eyes checked out thoroughly since about 10% of patients who have retinal detachment in one eye may have detachment in the other eye as well.