A retinal detachment is always considered an emergent situation. The retina is the neurosensory tissue of the eye that transmits the optical images we see into the electrical images our brain understands. A retinal detachment occurs when the neurosensory retinal cells are separated from the underlying layer of blood vessels that supply oxygen and nourishment to the retina. The longer the retina is detached the greater the risk of permanent vision loss which is why it is important to call an ophthalmologist immediately if you are experiencing any of the symptoms of a retinal detachment.
What are the symptoms of a retinal detachment?
Symptoms of a retinal detachment may include:
- Flashes and floaters in vision
- A veil or curtain causing a shadow over vision, usually in one quadrant of the eye
- The sudden appearance of tiny, dark specks floating in your vision
If you are experiencing any of these symptoms, please call our office at 215-699-7600.
RETINAL DETACHMENT
What are the causes of retinal detachment?
There are three types of retinal detachment:
- Rhegmatogenous (reg-ma-TODGE-uh-nus) retinal detachment:
A rhegmatogenous retinal detachment, or RRD is the most common retinal detachment. About 80% of the eye is filled with vitreous humor. The vitreous humor is made up mostly of water, yet it has a firm jelly-like consistency. The vitreous helps to hold the spherical shape of the eye and helps to keep the retina in place. As we age, the vitreous starts to liquify and partially detach from the retina causing a partial posterior vitreous detachment. This process is normal, however, sometimes the vitreous may tug on the retina as it detaches causing a hole or tear in the retina. The vitreous fluid then leaks under the retina causing the neurosensory retina to detach from the underlying blood vessels that bring oxygen and nourishment to the retina. Without this nourishment, vision loss occurs. The longer the retina is detached, the greater the chance of permanent vision loss.
- Tractional retinal detachment:
A tractional retinal detachment, or TRD is caused by scar tissue that forms on the retina. The scar tissue then contracts, pulling away and causing traction on the retina. Vitreous fluid then leaks into the retina separating the neurosensory cells from the retinal pigment epithelium causing a retinal detachment. A TRD most often occurs in patients with diabetic retinopathy. Therefore, diabetics should be followed by an ophthalmogist annually. Any change in vision should be evaluated. The longer the retina is detached, the greater the chance of permanent vision loss.
- Exudative retinal detachment:
An exudative or serous retinal detachment is the rarest of the three types of retinal detachment. It occurs when fluid collects under the retina without a tear or hole present. This fluid separates the neurosensory retina from the retinal pigment epithelium. This type of retinal detachment may occur in patients with uveitis or other inflammatory diseases. The longer the retina is detached, the greater the chance of permanent vision loss.
Who is at risk of a retinal detachment?
Retinal detachment can occur at any age and is painless. However, a retinal detachment is most prevalent in Caucasians over the age of 40.
Some risk may factors include:
- People with significant nearsightedness (myopia)
When a person is nearsighted, or myopic, the eye is longer than average, either due to the curvature of the cornea or the length of the eye itself. In some people, myopia may alter the structure of the vitreous and retina. In these circumstances, the retina may be more at risk for vitreous detachment, retinal tears, and retinal detachment. - People with a family history of retinal detachment
- People with previous eye disorders such as uveitis, degenerative myopia, lattice degeneration, and retinoschisis.
- Patients who have had cataract surgery
- People with previous eye injury
What can I expect during a visit to evaluate a retinal detachment?
After a comprehensive, dilated eye examination is performed by your ophthalmologist, a series of diagnostic tests may be ordered to better evaluate the health of your retina. These tests include, but are not limited to:
- Fundus Photography
- Optical Coherence Tomography (OCT)
- Optical Coherence Tomography Angiography (OCT-A)
- Intravenous Fluorescein Angiography (IVFA)
- B (Bright) Scan Ultrasonography
Along with a comprehensive eye examination, diagnostic testing directly correlates in the assistance of each patient’s individual plan of care. Once diagnostic tests are performed, your physician can better map your retinal needs in order to best preserve your vision.
What are the treatment options for retinal detachment?
Laser therapy
Small holes or tears can often be treated in the office utilizing laser therapy treatment. The ophthalmologist may use laser light therapy to weld the surrounding retina around the hole or tear in order to stabilize the area from further detachment. This process helps secure the retina to the wall of the eye.
Cryotherapy
Small holes or tears can often be treated in the office utilizing cryotherapy. Cryotherapy involves freezing the surrounding area of concern which causes scar tissue to form, blocking the retinal detachment from progressing. This process helps secure the retina to the posterior wall of the eye.
Outpatient surgical procedures
If a retinal detachment is substantial and cannot be treated in the office, a surgical procedure may be recommended in an outpatient hospital or surgery center. This procedure is done under anesthesia and involves a vitrectomy. The surgical physician will remove the vitreous humor and replace it with a salt solution with a balance much like the vitreous itself. The physician may also fill the vitreous with a gas bubble that will be absorbed over a period of time. If a gas bubble is utilized, the patient may be instructed to position their head face-down to aid in restoring the retina to its underlying, posterior wall. Multiple devices are available to assist in daily activities to aid in a face down position post operation. If a gas bubble is utilized, flying will be restricted until the physician is certain the bubble has been 100% absorbed.
Silicone oil may be used to fill the vitreous in some cases of retinal detachment. Silicone oil is a temporary fill and does not get absorbed by the body. Therefore, a second surgery would be necessary to remove the oil at a later date.
In some cases, a scleral buckle may accommodate the best surgical outcome. In these cases, a scleral buckle, much like a silicone or rubber waist buckle would be surgically inserted into the white part of the eye, or sclera to help keep the retina attached.
After surgery, your physician will make a 1 day and 1-week post-operative appointment with you. Eye drops may be prescribed to aid in the healing process and to help prevent infection.
Your ophthalmologist will discuss with you which course of treatment is best for you.