Retinal Detachment

The retina is a light-sensitive tissue that lines the back of the eye. The retina absorbs light that enters the eye and converts it into impulses that travel through the optic nerve to the brain, where the impulses are “experienced” as the images we see. A healthy, intact retina is key to clear vision.

Retinal detachment is a sight-threatening condition with an incidence of approximately one in 10,000. As recently as the 1920s, this was a condition that permanently blinded individuals. In subsequent years, the repair of retinal detachments has undergone significant improvement. A retinal tear or a detached retina can now be repaired with a surgical procedure.

What is a posterior vitreous detachment?

A posterior vitreous detachment (PVD) is a condition of the eye in which the vitreous membrane separates from the retina. PVD can become complicated by a retinal tear or vitreous hemorrhage. These conditions can lead to further complications, such as retinal detachment or epiretinal membrane, which can result in permanent vision loss.

What is retinal detachment?

A retinal detachment happens when the retina separates from the back wall of the eye.

The middle of the eye is filled with a clear gel called vitreous that is attached to the retina. As we get older, the vitreous may shrink, causing it to pull on the retina. Usually, the vitreous moves away from the retina without causing problems. However, sometimes the vitreous pulls so hard that it tears the retina in one or more places. Fluid may pass through a retinal tear, peeling the retina off the back of the eye. When the retina is pulled away from the back of the eye, it is called a retinal detachment.

When the retina is detached from the back wall of the eye, it is no longer supplied with blood. It no longer functions properly, and vision becomes blurry. Unless it is treated with surgery, a retinal detachment is a severe problem that almost always causes blindness.

What causes retinal detachment?

Vitreous gel, the transparent material that fills the eyeball, is attached to the retina in the back of the eye. Vitreous shrinks typically as we age, and this usually doesn’t cause damage to the retina. However, various conditions may cause the vitreous to change shape and pull away from the retina. If the vitreous pulls a piece of the retina with it, it causes a retinal tear. Once a retinal tear occurs, vitreous fluid may seep through and peel the retina off the back wall of the eye, causing the retina to pull away or detach.

Who is at risk for retinal detachment?

Risk factors for retinal detachment include severe myopia (nearsightedness), retinal tears, trauma, family history, as well as complications from other eye disorders such as cataracts and glaucoma.

Trauma-related cases of retinal detachment can occur in high-impact sports or in high-speed sports. Patients with high degrees of myopia might be wise to avoid activities that have the potential for trauma, increase pressure on or within the eye itself, or include rapid acceleration and deceleration. Obesity and elevated blood pressure have also been identified as risk factors in non-myopic individuals.

If you have a condition that puts you at high risk for retinal detachment, such as nearsightedness, recent cataract surgery, diabetes, a family history of retinal detachment, or a prior retinal detachment in either eye, be sure to discuss with your ophthalmologist the benefits of having more frequent exams to detect problems in their early stages. And always wear eye protection when playing sports or engaging in any hazardous activities. If you receive a serious eye injury, see your ophthalmologist right away for an exam.

What are the symptoms of retinal detachment?

A posterior vitreous detachment gives rise to these symptoms:

Sudden and dramatic increase in size and number of floaters
Sudden appearance of flashes – very brief in the extreme peripheral (outside of the center) part of vision
Ring of floaters or hairs just to the temporal (skull) side of the central vision

Although most posterior vitreous detachments do not progress to retinal detachments, those that do produce the following symptoms:

Dense shadow appears in the peripheral (side) vision and slowly progresses towards the central vision
A veil or a curtain seems to be drawn over the field of vision
Straight lines suddenly appear curved (Amsler grid test)
Sudden decrease in your central vision

Floaters and flashes are relatively common and do not always indicate a retinal tear or detachment. However, in the event of the appearance of sudden flashes of light or floaters, your eye doctor needs to be consulted immediately. A shower of floaters or any loss of vision is a medical emergency.

How is retinal detachment diagnosed?

Some retinal detachments are found during a routine eye examination that includes dilatation. That is why it is so important to have regular eye exams. To diagnose retinal detachment, your doctor will ask you questions about your symptoms, past eye problems, and any risk factors you may have. Your ophthalmologist will also test your vision. Routine vision tests do not detect retinal detachment, but they are necessary to find issues that could lead to or result from retinal detachment.

Your doctor will perform a detailed eye exam, including a careful examination of the peripheral retina. Photographing the retina is sometimes performed to document the extent of the detached retina, and an optical coherence tomography (OCT) scan of the retina can be helpful to determine whether fluid has detached the center of the retina (the macula). When a clear view of the retina cannot be obtained by direct visualization, an ultrasound of the eye can be helpful.

Retinal examination. The doctor may use an instrument with a bright light and a special lens (ophthalmoscope) to examine the back of your eye, including the retina. The ophthalmoscope provides a highly detailed view, allowing the doctor to see any retinal holes, tears, or detachments.
Ultrasound imaging. Your doctor may use this test if bleeding has occurred in the eye, making it difficult to see your retina.

Your ophthalmologist will likely examine both eyes even if you have symptoms in just one. If a tear is not identified at this visit, your doctor may ask you to return within a few weeks to confirm that your eye has not developed a delayed tear as a result of the same vitreous separation. Additionally, if you experience new symptoms, it’s essential to consult your doctor promptly.

What are the treatments for retinal detachment?

The method for fixing retinal detachment depends on the characteristics of the detachment. The goal of treatment is to reattach the retina to the back wall of the eye and seal the tears or holes that caused the retinal detachment.

Most retinal tears require treatment by sealing the retina to the back wall of the eye. This prevents fluid from traveling through the tear and under the retina, which usually prevents the retina from detaching. These treatments cause little or no discomfort.

Photocoagulation (laser surgery)

With photocoagulation, a laser is used to create minor burns around the retinal tear. The scarring that results seals the retina to the underlying tissue, helping to prevent retinal detachment. This is generally appropriate for small detachments.
Cryopexy (freezing)

With cryopexy, a special freezing probe is used to apply intense cold and freeze the retina around the retinal tear. The result is a scar that helps secure the retina to the eye wall.
Scleral buckle

This treatment involves placing a flexible band (scleral buckle) around the eye to counteract the force pulling the retina out of place. The ophthalmologist often drains the fluid under the detached retina, allowing the retina to reattach to its normal position against the back wall of the eye. This procedure is performed in an operating room.
Pneumatic retinopexy

In this procedure, a gas bubble is injected into the vitreous space inside the eye, in combination with laser surgery or cryotherapy. The patient is asked to maintain a specific head posture for several days to position the gas bubble over the retinal tear. The gas bubble will gradually disappear. The tear itself is sealed either with a freezing treatment during the procedure or with a laser after the retina is reattached.
Vitrectomy

This surgery is commonly used to fix a retinal detachment. The vitreous gel, which is pulling on the retina, is removed from the eye and usually replaced with a gas bubble. Your body’s own fluids will gradually replace a gas bubble. Sometimes an oil bubble is used to keep the retina in place. That will need to be removed from the eye at a later date with another surgical procedure. Sometimes vitrectomy is combined with a scleral buckle.

Most retinal detachment surgeries (80-90 percent) are successful, although a second operation may be necessary. Some retinal detachments cannot be fixed. The development of scar tissue is the usual reason that a retina is not fixed. If the retina cannot be reattached, the eye will continue to lose sight and ultimately become blind.

After successful surgery for retinal detachment, vision may take several months to improve, and in some cases, it may never return to its original level. Unfortunately, some patients do not recover any vision. The more severe the detachment, the less likely it is for vision to return. For this reason, it is essential to visit your ophthalmologist regularly or at the first sign of any vision trouble.