Definition and Overview
The retina is the part of the eye that is responsible for receiving light from the eye lens. It then converts the light into electric signals that the optic nerve relays to the brain. To better understand, an analogy with a camera can be used. The pupil of the eye is the shutter that focuses or regulates light as it enters the eye to enable the lens to capture a clearer picture of the image that the eye is seeing. Once the lens has received this focused light or image, it sends it to the retina for saving so that the retina can process these images and send electric signals to the brain through the optic nerve.
Retinal damage is often suspected when a person has a vision impairment, like cloudy or distorted vision, changes in the way color is perceived, or seeing lights flashing in the eyes or floaters (fragments or spots that continually float within the line of vision). The damage may be affecting not just the retina, but also the macula (the central part of the retina that deals with high visual acuity) and the vitreous (the gel within the retina). Any abnormality in vision may be caused by injury, disease or aging.
When any of these signs are experienced, a retinal examination is typically prescribed. An ophthalmologist or retinal specialist will examine the retina in both eyes to determine if there are any abnormalities. The process usually involves a vision test, eye pressure measurement and the examination and testing of other parts of the eyes. In cases wherein these tests detect any abnormality, additional diagnostic tests will be performed so the specialist can make an accurate diagnosis. These tests include:
- Retinal photography – this is an advanced imaging tool that takes pictures of the retina using a high-resolution camera to see if there are problems in the retina. The photographs can also be used as a reference to track if there are any changes to the retinal tissue.
- Fluorescein angiography – This diagnostic tool focuses on the blood vessels in the eyes. A contrast dye called fluorescein is injected into the patient’s arm and travels to the vessels in the eyes, allowing the camera to capture them. The pictures are then compared to “before” shots to verify any differences.
- Optical coherence tomography – OCT is another test that gives a cross-section view of the retinal tissues. It measures the thickness of both the retina and macula and shows any swelling or fluid accumulation in the area.
If any of the diagnostic tests show any irregularity or points to retinal diseases, a retinal surgery consultation is typically the next step.
Who Should Undergo and Expected Results
A retinal surgery consultation only becomes a possibility when the ophthalmologist or retinal specialist believes that there’s an imminent threat to the eyes and retinal surgery seems to be the best treatment plan. People who have been diagnosed with the following retinal diseases are usually candidates for retinal surgery consultation:
Diabetic retinopathy – this refers to the damage to retinal blood vessels because of diabetes. Blood is what keeps the retina tissue nourished for it to do its work accurately. When blood vessels become weak because of diabetes, they fail to deliver adequate blood supply to the retina and macula. They can even leak blood and fluid causing retinal and macular edema. The breakdown of blood vessels then prompts the body to manufacture new ones and these also involve the growth of scar tissue. These new growths block the light from reaching the retina and if they grow unchecked, they can eventually cause vision loss.
Retinal detachment – Retinal detachment, as the name suggests, means that the retina is torn or detached from the eye. This is an emergency condition that needs to be treated immediately or it could lead to permanent vision loss.
Macular hole - A macular hole is formed when the vitreous tightens and pulls on the retina. People with a macular hole often experience blurred or loss of central vision.
Retinal vein occlusions – The retina is dependent on the arteries and veins to deliver and remove blood, respectively, within the eyes. Retinal vein occlusions happen when the artery crosses over a vein, thereby blocking it and preventing it from returning blood back to the heart. When the vein is blocked or occluded, the blood builds up in it and some of it can leak. In such cases, surgery is performed to release the blockage.
How Does the Procedure Work?
The procedure for retinal surgery consultation starts very much like a retinal examination. Typically, medical staff will take note and record your vital signs. You will also be asked for previous diagnostic test results, if there are any. You will receive eye drops in both eyes to dilate them for preparation for the examination. These eye drops will normally take a half hour to take effect so you may be asked to remain in the waiting room.
Different tests will be performed like retinal photography, fluorescein angiogram and ocular coherence tomography so the surgeon can properly assess the condition of your eyes. If surgery is deemed to be the best treatment method, the surgeon will proceed by explaining how the procedure will be performed, the expected results, and possible risks or complications. At this point, you will be encouraged to ask your questions to fully understand the procedure and decide for yourself if you’re going to undergo surgery. In some cases, patients would seek a second opinion before they commit to any surgical procedure.
Once both you and your surgeon are in agreement as to the treatment plan, the appointment for your retina surgery may be scheduled.
Possible Complications and Risks
There are almost no complications when it comes to retina surgery consultations. However, there may arise some concerns related to discoveries during the examinations that may mean a hindrance to the original treatment plan, like new developments in the condition or a complication with another unrelated condition.
Wolfe JD, Williams GA. Techniques of scleral buckling. In: Tansman W, Jaeger EA, eds. Duane's Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 6, chap 59.
Yanoff M, Cameron D. Disorders of the visual system. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 431.