Introduction
Retinal detachment is the term that means the retina (the thin coating at the back of your eye) becomes loose. This disease must be treated urgently to preserve sight, typically through surgery.
Causes
The most common cause of retinal detachment is PVD or posterior vitreous detachment. Posterior vitreous detachment is a condition increasingly likely with age and is caused by variations in the vitreous gel which is a clear gel-like substance that fills the space between the lens and retina in the eyeball. This cause of retinal detachment does not present with pain and rarely causes sight loss; PVD commonly causes symptoms of black “floaters” obstructing vision and what patients have described as flashing lights. Over time, the brain adapts to the symptoms caused by PVD, learning to ignore them, and sight returns to the same condition as before the disease manifested. It is paramount that anyone who experiences symptoms of PVD consults an ophthalmologist or optometrist as 1 in 10 cases of the disease will result in a retinal tear and could trigger retinal detachment which requires emergency surgery.
Although most cases of PVD can be left to resolve themselves, and most do not result in retinal detachment, you are more likely to experience complications if:
- You are short-sighted
- Have had eye surgery before
- Have experienced eye trauma
- Have a family history of detachment
Tests
- Retinal Examination: An optometrist or ophthalmologist can inspect the back of the eyeball, including the retina, by using a bright light and a variety of special lenses which allows for a detailed view of the whole eye, showing any tears of the detachment of the retina
- Ultrasound: medics can also perform an ultrasound test on the eye to check for tears or possible detachment if the vision of the retina is otherwise blocked by bleeding.
If no tear or detachment is diagnosed on the first examinations, the doctor may ask for you to return a short time later to check for delayed tears due to the vitreous separation. It is common for both eyes to be examined even if the patient is only symptomatic in one.
Treatments for Retinal Tears
As retinal tears are usually a precursor for complete detachment, doctors may try to treat the occurring tear to prevent it from progressing and preserve sight. There are two mains ways this can be done:
- Laser Surgery (Photocoagulation): A laser beam is concentrated at a point in the eye through the pupil. The surgeon can burn around the tear using the laser, prompting the retina to rejoin or “weld” to the scarred tissue.
- Freezing (Cryopexy): Surgeons can use a freezing probe on the outer surface of the eye, under local anesthetic, and directly over any tears. Similar to laser surgery, this causes scarring which allows the retina to be reattached to the eye’s wall.
Both treatments for retinal tears can be done within one day at an outpatient clinic with minimal recovery time. The surgeon would likely advise you to avoid anything which could jar the retina (such as jumping, sudden movements, or sports) for a few weeks to allow the tear to weld.
Treatments for Retinal Detachment
Retinal detachment must be treated in only days after diagnosis to allow for eyesight to be preserved. The type of treatment depends on the severity of the detachment and 3 main surgeries can be performed:
- Pneumatic Retinopexy: an air bubble or bubble of gas is inserted into the vitreous cavity and, if it is in the correct positioning, it can push the area containing holes against the wall of the eye, preventing the flow of liquids behind the retina. Any fluid collected under the retina is absorbed by itself, allowing the retina to attach to the wall. You will be required to keep your head in the same position for a couple of days after surgery to allow the bubble to stay in the right position.
- Scleral Buckling: silicone material can be sutured to the sclera surrounding the area containing the holes. This causes an indent in the eye’s wall, relieving the effects of the force provoked by the vitreous pulling on the retina. If the detachment is severe, or many tears and holes have occurred, a scleral belt can be placed around your eye which will remain in position permanently but not obstruct vision.
- Vitrectomy: The vitreous and any tissue pulling on the retina can be removed by a surgeon and then air, gas, or silicone-based oil can be injected to flatten the surface of the retina. Eventually, the substance injected is absorbed and the vitreous space can be filled again with body fluid. This procedure is often paired with scleral buckling in severe cases of detachment.
Although surgery can be successful, some people will require multiple procedures before their detachment has been fully repaired. Detachment can be a recurring problem so it is vital that, if you redevelop symptoms, you consult an ophthalmologist or optometrist. In some cases, vision cannot be fully restored but most treatment plans and combinations can help preserve a large proportion of vision.
Sophie Farr, Youth Medical Journal 2021
References
NHS England, Retrieved 16/12/20 “Detached Retina” https://www.nhs.uk/conditions/detached-retina-retinal-detachment/
Mayo Clinic, Retrieved 16/12/20 “Retinal Detachment”
https://www.mayoclinic.org/diseases-conditions/retinal-detachment/diagnosis-treatment/drc-20351348
Youth Medical Journal 