Retinal Detachment

The retina is the delicate lining at the back of the eye where the image you see of the world is formed and transmitted to the brain.

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Under certain conditions, especially with advancing age, the clear gel-like fluid which fills the eye can begin to break down and separate from the retina. As it does, it sometimes pulls the retina along with it, tearing holes in the fragile membrane.

Left untreated, fluid seeps through these holes causing the layers of the retina to separate and detach. Depending on the degree of detachment, partial or total blindness may be the result.

Among those most at risk for retinal detachment are older adults and people with severe nearsightedness or a family history of the condition. A severe blow to the eye, tumours or complications from diabetes can also cause the retina to detach.

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What to look for

The symptoms of retinal tears sometimes include sudden, unexplained flashes of light and/or moving black spots in the vision called “floaters.” In most cases, these symptoms do not indicate serious eye problems; they can however indicate a substantial shrinking of the vitreous and attendant retinal tears.

If you experience floaters or flashes, please call to arrange an eye examination. New retinal tears may be easily treated with laser before they lead to a more severe retinal detachment.

Symptoms of detachment

When part of the retina detaches, the rods and cones are pushed and pulled out of their normal orientation and no longer work properly. The result can often be the rapid appearance of a dark shadow starting at the edge of the field of vision. This can progress to loss of central vision.

Some detachments can occur very suddenly, causing the patient to experience total loss of vision in the affected eye.

Detection and Diagnosis

There are numerous tools and techniques your doctor may use to examine the retina.

The ophthalmoscope is used to examine both the central and peripheral retina. In both procedures, your pupils will first be dilated, allowing the retina to be examined under bright light and magnification.

The slit lamp combines a microscope with strong illumination. It is often used with a hand-held lens, allowing doctors to see portions of the retina in greater detail.

Treatment of Retinal Tears

Usually, retinal tears are at the edges of the eye and affect only your peripheral vision; doctors may monitor small breaks without treatment.

If treatment is determined to be appropriate, however, your doctor will recommend either laser or cryotherapy treatment.

Lasers treatment uses an intense beam of green light to “spot weld” layers of the retina in place. It is performed using eye drops for anaesthetic, sitting in a chair in the consulting rooms.

In cryotherapy, a local anaesthetic is applied by injection to the eye and the small area around the break is frozen with a probe. As the frozen area heals, it forms scar tissue which reattaches the retinal layers at the point of the break. This requires admission for day surgery.

Treatment for Detachment

Once the retina is detached, an operation is needed to fix the problem. Drops, tablets or laser alone are insufficient. The surgery required is extremely specialised and admission to hospital is required, sometimes urgently.

The operation aims to close the holes in the retina that have caused it to detach. Most commonly, a vitrectomy is performed and the retina is put back in place by inflating the eye with air. The eye is left gas filled, which splints the retina until the breaks heal. There are important instructions to follow in terms of bedrest, not driving, travel up mountains and most importantly not traveling in an airplane until the gas clears. A scleral buckle may be used in combination with a vitrectomy or on its own. Here a piece of silicone rubber is sutured onto the white of the eye (it is not visible from the outside) so that it presses on the retinal hole, to give it support.

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What to expect

The vast majority of all retinal detachments can be repaired using modern surgical techniques. However, the degree of vision which returns varies depending on a number of factors.

The most important factor is whether the macula had been involved by the detachment. Most patients with detachments not involving the macula retain close to their previous vision. Once the macula has been damaged by the detachment, following repair, there is a degree of visual impairment affecting the clarity, size and shape of the image. These improve slowly over a year or two, but are never expected to make a complete recovery.

The most common unexpected problem is for the retina to detach again. This affect about one person in ten and usually occurs within 3 months.

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