Retinal Detachment

What is retinal detachment?

The retina is the layer in the back of the eye that converts light into an electrical signal that is then sent to the brain via the optic nerve to create an image you see.

Retinal detachment

When the retina detaches, it separates from the back wall of th e eye and is no longer connected to the single layer of cells cal led the retinal pigment epithelium. These cells are critical for the health of the detached “neurosensory retina” (commonly referred to as the retina), which will degenerate and lose its ability to function if it remains detached.

The center of the retina is called the macula, which is the only part capable of facilitating fine detailed vision. A healthy macula is necessary for reading and recognizing faces. If it becomes detached, central vision can be lost. For most types of retinal detachments, surgical repair provides the best chance at visual recovery.

Retinal Detachment Treatment in Maryland

Here’s what a person with normal vision sees

Retinal Detachment Treatment in Maryland

This is what that same image looks like to a to a person with a retinal detachmnet

Who is at greatest risk for a retinal detachment?

A retinal detachment can occur at any age, but it is more common in people over age 40. It is also more likely to occur in those who:

  • Are extremely nearsighted (myopia)
  • Have suffered a retinal detachment in the other eye
  • Have a family history of retinal detachments
  • Have had cataract surgery
  • Have other eye diseases or disorders, such as uveitis, degenerative myopia or lattice degeneration
  • Have had eye trauma

What are the symptoms of a retinal detachment?

Symptoms include a sudden increase in either the number of floaters― little specks that float in and around your field of vision―and/or light flashes in the eye, called photopsias. Both of these conditions can be accompanied by the sensation of looking through cobwebs. Another symptom, one that tends to manifest later, is the appearance of a “dark curtain” over part or all of the field of vision.

It’s important to realize that a retinal detachment qualifies as a medical emergency. Anyone experiencing one or more of the symptoms of a retinal detachment should see a retina specialist immediately.

How are retinal tears and detachments detected?

Retinal tears and detachments are detected during a comprehensive eye exam. After having your vision and eye pressure checked, drops are placed in your eyes to widen, or dilate, the pupils.

First, your retina specialist will use a special magnifying lens to check the health of both eyes. He or she may use a special instrument to lightly press around the outside of your eye (scleral depression) in an effort to detect any retinal tears or detachment.

An ultrasound may also be ordered if your doctor’s view of the retina is not clear. Cloudiness is often caused by bleeding during the course of the PVD (posterior vitreous detachment), and is even more suggestive of a retinal tear than a PVD without a hemorrhage. Following the exam, your close-up vision may remain blurred for several hours due to the dilating drops.

How are retinal tears treated?

Not all retinal tears need to be treated. Many people have small holes in their retina that don’t affect their vision and almost never produce associated symptoms. In general, however, if a retinal tear is discovered in association with new symptoms, or there are other high risk factors for a retinal detachment (previously described), one of two methods of treatment is indicated:

Laser (Photocoagulation)

Retinal tear following laser treatment

Treatment spots are made around the tear to create a seal and prevent fluid from accumulating underneath the retina.

Cryopexy

This technique freezes the area around the tear in order to seal the retinal break. This method is used when there is a large amount of blood and the laser cannot effectively reach the retina.

If retinal breaks are promptly identified, both treatments are highly successful in avoiding subsequent retinal detachment. Both procedures can be performed in all of The Retina Group of Washington offices.

It is unfortunate that some retinal tears progress to detachment almost immediately, sometimes without any symptoms. If this occurs, your retina specialist will recommend surgical repair.

What is retinal detachment?

Retinal detachment

A retinal detachment occurs when a tear or break in the retina develops. Fluid then seeps through the tear, lifting the retina from its normal position like a bubble underneath wallpaper.

Retinal tears are the most common cause of retinal detachments; these and other retinal breaks develop most often in the peripheral retina. Patients often describe a “curtain” or dark shadow involving the peripheral vision that enlarges as the detachment extends towards the macula (center of the retina). Central vision will be lost if the macula detaches. Without surgical repair, most retinal detachments will eventually affect the entire retina and all vision will be lost.

How are retinal detachments treated?

Retinal detachments are most often repaired surgically by a retinal specialist. Depending on the nature of your detachment, he or she will determine which specific procedure to pursue. Based on the variables, either one or a combination of the following operations is recommended:

Scleral Buckle Surgery

Scleral buckle surgery is a long-established technique used to repair a retinal detachment. It is a method of closing breaks and flattening the retina. A small, invisible synthetic band, usually made of silicone rubber, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. This relieves the traction caused by retinal breaks and also displaces some retinal fluid away from the break. Different sizes and types of scleral buckles may be used, depending on the nature of the detachment. Scleral buckles are usually left on the eye permanently.

Single operation success rates for scleral buckle are generally high. The operation is usually performed on an outpatient basis and do es not require an overnight hospital stay.

scleral buckle

A common side effect of scleral buckle surgery is increased nearsightedness. There are many less common complications that include eye infection, increased eye pressure, bleeding, injury to other parts of the eye, cataract, droopy eyelid and double vision.

Complete vision loss is very rare, but still possible as a resul t of scleral buckle surgery. Since this procedure can change the shape of the eye, you will need to have your contact lens or glasses prescription checked, and probably changed. If the initial operation is unsuccessful, additional surgery is likely to be recommended.

Pars Plana Vitrectomy

During a vitrectomy, the doctor makes three small incisions in the sclera (white of the eye). The vitreous, a gel-like substance that fills the eye, is removed using a small instrument. The fluid under the retina is then drained and laser treatment is applied to the tear and any other weak areas of the retina. Gas or silicone oil is then injected into the eye to replace the vitreous, reattach the retina and keep fluid from getting through the retinal break and detaching the retina again. The doctor may ask you to position yourself face down or on your side in order to allow the gas or oil to be most effective in preventing fluid from getting under the retina during the early post-operative period.

Gas

During the healing process, the eye produces fluid that gradually replaces the gas. Because the gas is reabsorbed spontaneously, surgery to remove the gas is not needed. Different types of gas bubbles are used, some of which can remain in the eye for up to two months. Patients with a gas bubble in their eye cannot fly in an airplane since the changes in altitude cause the gas to expand, increasing the eye pressure.

Silicone Oil

Vitrectomy instrument

This may be used in the place of gas for more complex or recurre nt detachments. Silicone oil does not reabsorb spontaneously, however, and needs to be removed as part of a second surgery. Regardless of whether gas or silicone oil is used, the single-operation success rate for vitrectomy is high. It is often performed on an outpatient basis and does not typically require an overnight hospital stay. Complications are similar to those from scleral buckle surgery, although the procedure doesn’t always create more nearsightedness. It does, however, result more predictably in cataract formation. If this procedure is unsuccessful, your doctor will likely recommend additional surgery.

Pneumatic Retinopexy

During a pneumatic retinopexy, a gas bubble is injected into the center of the eye to temporarily prevent fluid from entering through the retinal tear. Laser or cryopexy is then used to create a permanent seal. The specialized retinal pigment epithelial cells (see above) are then able to pump the existing fluid out from behind the retina. This procedure relies on the patient’s ability to position his o r her head so the small gas bubble stays directly over the retina l tear. For this reason, pneumatic retinopexy may not be the appropriate procedure for all retina detachments. In select circumstances, the success rate of this procedure is high.

Pneumatic retinopexy is typically done in your retina specialist’s office. As with the other surgical procedures to repair retinal detachments, it has potential complications that include new postoperative retinal breaks, increased eye pressure, infection, gas getting behind the retina and cataract formation. Total visual loss is rare but possible following this operation. Here again, if this procedure is unsuccessful, your doctor will likely recommend additional surgery.

Laser Barricade

A laser barricade uses a laser beam to wall off a small retinal detachment; it scars the attached retina, preventing the retinal detachment from expanding. This procedure has the lowest associated risks for retinal detachment repair and is usually performed in the retina specialist’s office. If this procedure proves to be unsuccessful, your doctor in most cases will suggest additional surgery.

Medical Health

Depending on your overall health, your retina specialist may ask you to see your primary care provider for preoperative medical clearance prior to retina surgery. Be sure to let your surgeon know if you have any serious medical conditions or allergies, and if you are taking any blood thinners or other medications that slow clotting of your blood.

Recovery

Retinal detachment surgery is an outpatient procedure. Y ou will be sent home to rest with an eye patch and may experience pain for a few hours following surgery . You should plan to have someone drive you to your follow-up doctor’s appointment after surgery. The doctor may advise you to maintain a certain position for several days after surgery to allow the gas or silicone oil to close the retinal breaks. You may see floaters, flashing lights or gas bubbles following surgery. You could also experience some pain for a few days (after the surgery your eye might be swolle n, red and/or tender for several weeks). Ask your surgeon if there is a need to restrict activities at home and/or at work for a peri od of time. You will be instructed to use eye drops several times a day for several weeks after surgery.

How soon will my vision return after surgery?

The answer depends on several factors, including which procedure was performed and how much of the retina was detached prior to the surgery. A gas-filled eye will have limited vision for several weeks until the gas bubble is naturally reabsorbed. Silicone oil allows more clarity than gas, but will still cause blurry visio n until your doctor removes it.

What should I expect in the long run?

With the use of modern therapy, over 95 percent of those with a retinal detachment can be successfully treated, even though multiple operations are sometimes needed. Many patients go on to retain excellent vision, but the visual outcome is not alway s predictable. The final visual result may not be known for as long as several months and up to a year following surgery—and even under the best of circumstances and after multiple procedures, treatment sometimes fails and vision may eventually be lost. The best results are achieved when the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, de tailed vision) detaches. That is why it is so important to contact a retinal specialist immediately if you see either a sudden or gradual in crease in the number of floaters and/or light flashes, or a dark curtain over your field of vision.

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