My idea of a successful operation to repair a retinal detachment is when I don’t have to operate a second or third time. It’s not whether or not your vision improves…that is actually beyond my control! Vision can only improve if we first reattach the retina. In other words, visual improvement is a by-product of successful reattachment of the retina.
A retinal detachment means the retina becomes anatomically separated from its normal position. The goal of retinal detachment surgery is to reattach the retina and thereby achieve “anatomic” success, that is, getting the retina back to where it belongs.
Anatomic success simply means the retina has become attached…again, but there is no absolute correlation with function. Though I may achieve anatomic success, this does not always translate into restoration of vision.
From a patient’s perspective, the retinal detachment can cause loss of vision, be it central and/or peripheral vision. It is hoped that successful surgery will lead to full return of the vision, that is, improvement of function.
Anatomic success is necessary for functional improvement. In other words, the only hope of seeing better is to get the retina attached.
There are a variety of eye operations to fix retinal detachments; pneumatic retinopexy, scleral buckle and/or vitrectomy eye surgery. All have different advantages. For instance, pneumatic retinopexy can be performed in the office, a vitrectomy alone requires less “operating” on the eye, whereas a scleral buckle, the oldest remedy, is technically more challenging but has long been a favored choice.
They all have different success rates, too.
There are a variety of retinal detachments (not all retinal detachments can be fixed the same way), yet the only comparison between techniques is by the re-operation rate…how often must the procedure be repeated?
They are never compared by resultant vision.
What Does This Mean?
There are too many variables leading to the eventual decision on how to fix a retinal detachment. In short, there is no “best” way to fix a retinal detachment involving visual outcomes. Each case and patient are different. The surgeon’s objective is to use the best technique to achieve anatomic success.
Regardless, keep your expectations aligned. The vision can only be improved if anatomic success is achieved. That is the primary goal of retinal detachment surgery…getting the retina to be reattached.
Vision is not a direct goal.