A retinal detachment is potentially blinding and will require surgical repair. Despite “success,” visual outcomes will vary depending upon the length of time the retina has been detached and the area of involvement.
The retina is the portion of your eye that contains photoreceptors that respond to light and send visual signals to the brain. Without a functioning retina the brain loses its connection to visual signals from the eye.
The retina can be detached by a traumatic eye injury, but the most common cause is aging changes such as a thinning retina (lattice degeneration) or changes within the eye’s vitreous humor.
The vitreous humor is a clear gelatinous substance that fills the eye. The vitreous is integral to the normal embryonic development of the eye and its structures. As we age the vitreous humor can shrink and change consistency. As a posterior vitreous detachment (PVD), it can sometimes pull on the retina and tear it. Diabetes and some retinal diseases can also cause retinal detachment.
Retinal Detachment is an Emergency
Whatever the cause, a detached retina is an emergency and must be reattached soon after the detachment to preserve vision. It is an emergency because the retina begins to deteriorate if it is detached too long and every attempt is to prevent the retinal detachment from involving the macula, the functional center of the retina.
Chronic and large detachments have a much worse visual prognosis despite successful anatomic repair.
Symptoms of Retinal Detachment
- Sudden appearance of many new “floaters” (floating shapes) in your field of vision. It can appear as a shower of black dots, which are blood cells from the retinal tear.
- Flashes of bright light
- Loss of vision as though a black curtain has come down across a portion of your field of view
Retinal Detachment Surgery
If there is no retinal detachment, but only a small retinal hole or retinal tear in your retina your eye doctor can repair it with a laser or a sub-freezing probe. This procedure can be done in your eye doctor’s office.
If the retina has detached, you will need surgery to reattach it. There are three common surgeries used to reattach the retina:
Pneumatic retinopexy is also a relatively simple fix even though it is a surgical procedure. It can also be done in your eye doctor’s office. Your eye is numbed, and a gas bubble is injected into your eye that will press against the retina and hold it in place. A laser or sub-freezing probe is also used to seal the retina at the margin of the tear.
Scleral buckling is a surgery to band (retain) the outside of the eye (sclera) from top to bottom. This banding will compress the eye and push the retina back into place where it will reattach to its blood supply.
Vitrectomy is the surgical removal of the vitreous humor. The surgeon will remove any scar tissue and seal retinal tears and then fills the eye with saline, air or a gas bubble. The vitreous does not regenerate, but your eye can function with the substitute for it.
A retinal specialist may often use a combination of these techniques to perform surgery for retinal detachment.
More than 90% of retinal reattachments are successful. If the detachment has not detached the central portion of the retina (macula) that is responsible for fine-detail vision, the restored vision will return to near normal. One reason a detached retina is an emergency is to repair it before the macula detaches.
There is no way to prevent age-related retinal detachments, but if you are middle-aged or older a yearly, comprehensive, dilated eye examination may be able to identify eye problems in their early stages.
Diabetics should avoid wide swings between high and low blood sugar levels as a preventive measure for retinal detachments caused by diabetic retinopathy. Diabetics should have a comprehensive, dilated eye exam at least once a year and every six months if retinopathy is detected.
Randall V. Wong, M.D.
Virginia and Washington D.C.