Definition & Overview
The retina is a thin layer of tissue inside the eye that receives and converts light from the lens into signals that are transmitted to the brain. Retinal detachment is a serious condition wherein the retina is moved from its proper position. When this happens, the retina no longer receives the ideal amount of oxygen it needs to function.
It’s imperative that a patient with retinal detachment receives prompt treatment for the condition to prevent it from worsening. If the condition is left untreated, it will likely result in total loss of vision in the affected eye.
In most cases, retinal detachment begins as a retinal tear. The signs and symptoms of a retinal tear are clear, which is why there should be enough time for an ophthalmologist to apply treatment before it turns into a full-blown retinal detachment case.
Cause of Condition
Retinal detachment begins with a small tear or hole called a retinal tear. Fluid inside the vitreous passes through that tear and builds up underneath the retina. Eventually, the fluid forces the retina away from the blood vessels that supply it with oxygen.
Retinal tears can be caused by an injury, advanced diabetes, or inflammation within the eye. It’s important to note that inflammation disorders of the eye can also cause a fluid buildup without leading to a retinal tear. This will also result in retinal detachment.
The normal aging process can also cause retinal tears. As a person ages, the vitreous begins to shrink resulting in a common condition called posterior vitreous detachment (PVD), also referred to as a vitreous collapse.
When the vitreous shrinks, it begins to separate from the retina causing a tear. The vitreous fluid will then pass through that tear and eventually cause retinal detachment.
Retinal detachment can happen to anybody of any age, but it is more common in people over the age of 40. Those who have extreme myopia, have previously undergone eye surgery, or have experienced retinal detachment in one eye are more prone to the condition. Severe eye injury or trauma, eye disorders, and a family history of retinal detachment also increase the risk of the condition.
Recognizing the signs of retinal detachment is the key to preventing the condition from progressing. Fortunately, it’s not difficult to identify the symptoms. The most common are flashes of light in the affected eye, the appearance of floaters (small spots that affect vision), or vision beginning to blur in the affected area.
When these signs and symptoms appear, it’s imperative that you consult your ophthalmologist for immediate treatment. If the condition progresses, it’s likely that you’ll lose vision in the affected eye.
Who to See & Types of Treatment Available
Ophthalmologists are eye doctors who are qualified to perform eye surgeries, such as cataract removal and treatment for retinal detachment. The doctor will diagnose your condition by performing tests, such as ultrasonography or by using an ophthalmoscope.
An ophthalmoscope is an instrument that uses a bright light and a special lens. It provides a 3D image of the inside of the eye, which allows the doctor to view any holes or tears in the retina, or if the retina has been detached.
In ultrasonography, a device uses sound waves that are directed into the eye. A computer will then track the movement of the sound waves as this travel in the eye to create an image.
If the doctor confirms the presence of a retinal tear or retinal detachment, a treatment plan will be promptly formulated.
Surgery is the primary form of treatment for retinal detachment or retinal tear. If the tear has not progressed into retinal detachment, the doctor may opt to perform laser surgery or a procedure called freezing.
Laser surgery, also referred to as photocoagulation, involves using a laser to burn the retinal tear and create the scar to close the tear. The freezing process, called retinal cryopexy, involves using a freezing probe to freeze the tear and create a scar.
It will take time for the above procedures to take full effect. During this period, patients will be advised to avoid any strenuous activities.
If the retina has already detached, the doctor will perform other procedures, such as pneumatic retinopexy, sclera buckling, or vitrectomy.
Pneumatic retinopexy involves injecting gas or air into the eye so that it forms a bubble. The bubble will then move towards the tear and effectively seal it, preventing more fluid from leaking. In time, the tear will heal and the bubble will be absorbed. The fluid that has already collected underneath the retina will also be absorbed allowing the retina to reattach itself.
In a scleral buckling procedure, the surgeon attaches a rubber silicone to the sclera over the retinal tear. The surgeon may also use a sponge instead of silicone. The material will then create an indentation to relieve the pressure. If there are multiple tears, the material will be attached around the sclera to form a belt, which will remain in place for the rest of the patient’s life.
In a vitrectomy, fluids and other tissues that are pulling the retina are drained. Gas or air is then used to attach the retina into place. In some cases, the surgeon may opt to use silicone oil instead. Unlike gas or air, which will be absorbed by the eye, silicone oil needs to be removed after several months.
It’s important to understand that surgical procedures to reattach the retina are not guaranteed to work. There is a possibility that the procedure may fail. If the procedure does succeed, there is also a possibility that vision will not be restored to normal conditions. There is also a possibility that vision may not be restored at all.
If the procedure is successful, it will take several months before the results are noticeable. During this waiting period, your vision will still be affected. Depending on the degree of vision loss, you’ll need help in coping with your condition while you’re waiting for your vision to improve. It’s important to avoid any further eye surgeries at this point, so make sure that your home is safe or that you have somebody to help you.
American Academy of Ophthalmology Retina Panel. Preferred Practice Pattern Guidelines. Posterior vitreous detachment, retinal breaks, and lattic degeneration. San Francisco, Ca: American Academy of Ophthalmology; 2013. Accessed August 29, 2013.
Connolly BP, Regillo CD. Rhegmatogenous retinal detachment. In: Tasman W, Jaeger EA, eds. Duane’s Ophthalmology on DVD-ROM - 2013 Edition. Philadelphia, Pa: Lippincott Williams & Wilkins; 2013: vol 3, chap 27.
Wolfe JD, Williams GA. Techniques of scleral buckling. In: Tasman W, Jaeger EA, eds. Duane’s Ophthalmology on DVD-ROM - 2013 Edition. Philadelphia, Pa: Lippincott Williams & Wilkins; 2013: vol 6, chap 59.