Tag: retinal tear

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Retinal Detachments

NFL Coach Zimmer Gets Retinal Detachment | What Can We Learn?

Retinal Detachment | Jireh Designs

Retinal Detachment | Jireh DesignsNFL coach of the Minnesota Vikings, Mike Zimmer, just had a retinal detachment to his right eye.

He has had several “surgeries” over the past 30 days to the same eye.  While the exact details are not known, there is a lot we can learn from his recent experience.

What we do know is;

  1.  A retinal tear was discovered and treated around October 31.
  2. A second operation was performed a week later.
  3.  Emergency surgery for a retinal detachment was performed on November 30.

Retinal Tears Cause Retinal Detachment

All retinal detachments start with a retinal tear.  It has been my experience that most retinal tears simply “happen” and without trauma.

Retinal tears can happen to anyone.  Retinal tears usually, but not always, are associated with sudden onset flashes and floaters, but they can be asymptomatic.

This may have happened with Coach Zimmer.  Several accounts stated that his retinal tear was discovered after he scratched his cornea.

No, corneal abrasions can not cause retinal tears.

Treatment of Retinal Tears

The ideal treatment of a retinal tear is laser.  If laser is not an option, due to the location of the retinal tear, cryotherapy, or freezing, is an excellent treatment.

Both work equally well in treating retinal tears in situations where there is no element of retinal detachment.  Cryotherapy may be more uncomfortable.

I do not know if the second surgery was needed because additional tears were discovered or he developed a retinal detachment.

What is important to highlight is that additional retinal tears can occur and/or a retinal detachment could develop after treatment of an initial tear.

Treatment of Retinal Detachments

There are several ways to treat a retinal detachment.  Depending upon the location of the retinal tear causing the detachment, intraocular gas may be injected into the eye which requires specific head positioning afterwards to keep the gas pushing on the retinal tear.  This is an “in office” procedure.

Two other ways to fix a retinal detachment include a vitrectomy and/or scleral buckle.  These may be used along with intraocular gas, too.

Regardless of the procedure, if intraocular gas is used to repair the retinal detachment, airplane flight or traveling to higher elevations is not possible.

Too rapid a decrease in atmospheric pressure can lead to expansion of the gas inside the eye.  If this occurs too rapidly, the eye can not adjust to the increase in eye pressure caused by the expanding gas.  The high pressure could prevent normal blood flow into the eye.

This explains a few remarks about his driving to Florida for the game against the Jaguars.  No remarks about head positioning.

“Emergency Surgery”

Not all retinal detachment surgery is an emergency.  A retinal detachment starts off small and can spread.  If the macula, the functional center of the retina is attached, but may become detached by waiting, it can be an emergency.

I wish Coach Zimmer well.  I wanted to highlight his retinal detachment to emphasize a few points about retinal detachments in keeping with the headlines.

 

 

 

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My Opinion Retinal Detachments

Excercise After PVD is Safe

Retinal Detachments and Retinal Tear

I believe exercise after sustaining a posterior vitreous detachment (PVD) to be safe.  Many doctors recommend a “no exercise” period after a PVD to decrease the risk of retinal tear and retinal detachment.  This does not make sense to me.

PVD Causes Retinal Tear

A retinal tear may occur after a posterior vitreous detachment, but in my opinion, the chance of a tear occurring is the same whether or not you exercise.

The vitreous normally separates, or detaches, from the retinal surfaces with age.  It happens to everyone as we get older.  A PVD will occur earlier in life due to increased nearsightedness, previous eye surgery, certain trauma, etc.  After a PVD occurs, there are physical changes within the eye.

The vitreous now occupies less space within the eye.  The vitreous does not separate completely from the retinal surface and remains adherent in certain areas.  The vitreous moves back and forth with eye movement, yet tethered to the retina in the areas which remain attached.  This is where the retina can tear.

Statistically, a retinal tear will occur during the first six weeks of onset of a PVD.

Does Exercise Increase the Chance of Retinal Tear

The concern about exercise is related to increased motion/bouncing of the eye.  The thought is that increased movement increases the chance of retinal tear.

This might be a valid concern except for two arguments;  1) each evening during REM sleep (a necessary stage of sleep), the eyes beat back and forth faster than any activity we perform while awake, and 2) after the six week period, there is no known “healing” of the retina.

REM (rapid eye movement) occurs every evening and involves continuous beating of your eye back and forth.  While the speed of the eye movements (think of what your eyes do when you reach the end of a sentence) approaches that of reading, the extent to which the eyes move and the duration supersede these reading movements.

Thus, every night your eyes sustain greater forces during REM than while you are awake.

Also, there are no known physical changes to either the retina or vitreous after six weeks.  For instance, the retina does not become stronger or thicker after a PVD, hence the chance of tearing should be the same.

Weightlifting is definitely safe.

What Does this Mean?

Remember, this is my opinion.  If  you were my patient (and I remind  you that you are not my patient just by reading this article), I’d advise you exactly as I’ve written here.  For the rest of you, I think my arguments allowing exercise are pretty valid and you should discuss with your own doctor.

Lastly, if we are at risk for developing a tear, wouldn’t you want it to occur while we are being vigilant?

Randy

Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia
www.TotalRetina.com
www.RetinaEyeDoctor.com

 

 

 

 

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“Other” Eye Conditions Retinal Detachments

Retinal Tears and Vitreous Hemorrhage

Vitrectomy for Retinal Tear to Remove Vitreous HemorrhageA vitreous hemorrhage may be caused by a retinal tear.  Sometimes there is so much blood in the eye that direct examination is impossible and we can only guess at the most likely cause.  It is the most difficult situation for me to handle as a doctor.

Patients lose significant vision as the blood in the middle of the eye physically blocks all light from hitting the retina.  While this is usually not permanent visual loss, the blood makes it difficult to make a definitive diagnosis as it can be impossible to see the retina.

Normally, without blood in the eye, a retinal tear may be easily diagnosed and treated with laser.

While there are other causes of vitreous hemorrhage, such as diabetic retinopathy, retinal vascular disease and others.  Still, a retinal tear causing the vitreous bleeding is quite likely.

Retinal Tears Cause Retinal Detachments

A retinal tear can cause a retinal detachment.  A retinal detachment is potentially blinding.

In cases of vitreous hemorrhage, the patient cant’ see “out” and I can’t see “in.”  My ability to examine the eye is hindered.

Options at this point are to observe (i.e. do nothing).  Observing the eye is okay as the blood is doing no harm.  But what if there is a retinal tear?  A retinal detachment could occur if there is an undiagnosed retinal tear.

Other tests, such as an ultrasound can often detect a large tear, but it is not as good as directly examining the eye.  Operating to remove the blood to facilitate proper examination is an option, too.

What Does This Mean?

I am getting older, more aggressive, but smarter.

As I have aged, i.e. gained more experience, I have become more comfortable operating in these cases.  When I was younger, I would often hesitate because I was uncomfortable offering surgery in a situation where surgery might not be necessary, but I’ve learned (through experience) that watching a waiting can be more problematic.

Most of the time I recommend operating to at least remove the blood and confirm a diagnosis.  The risks of modern vitrectomy are quite low, while the risk of a retinal detachment occurring while we are waiting is quite possible.

Vitrectomy surgery is usually performed as an outpatient.  If a tear is indeed present, it can be treated simultaneously.

At the very least, a diagnosis can be made and a potentially blinding condition avoided.

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My Opinion Retinal Detachments

Does Sleep Cause Retinal Detachments?

I believe that REM sleep causes retinal tears and then subsequent retinal detachments, that is, I think most of the damage occurs while you are sleeping.   While this would be hard to ever prove, there are some compelling arguments for my hypothesis.

What is REM sleep?

Rapid Eye Movement (REM) is a stage of sleep that occurs every night.  During this stage of sleep, the eyes beat back and forth, moving to and fro with great force and speed (hence “rapid”).  It is a normal physiologic stage of sleeping.  As the eyes beat back and forth, forces are created inside the eye with this rapid, repeated movement (similar to shaking a bottle soda to get it to “explode”).  These forces can not be reproduced voluntarily when awake, that is, these forces are the strongest when sleeping.

Retinal Tears Cause Retinal Detachments

Most retinal detachments start with a tear, or hole, in the retina.  The tear allows fluid to get underneath the retina, causing a retinal detachment.

A common cause of a retinal tear is the development of  a posterior vitreous detachment (PVD).   A posterior vitreous detachment occurs normally in everyone, especially as we get older.  The vitreous, the gel like material that fills the eye, normally separates from the surface of the retina.

Frequently, patients complain of new floaters or a “cob-web” developing in their vision when a PVD develops.  During the first six weeks of occurrence, patients are at highest risk for developing a retinal tear.

Why?

The gel, now separated from surface of the retina, can now “slosh” back and forth inside the eye.  Portions of the vitreous;  however, remain adherent to the retina.  While this gel moves back and forth, pulling on the retina, a retinal tear can form.

Combine REM Sleep with a PVD

A patient with a PVD undergoing REM sleep experiences tremendous new forces inside the eye as the gel is sloshing around AND the eyes are beating back and forth at a rapid rate.  Again, the forces generated inside the eye during these rapid motions can not be reproduced while awake  (i.e. you can not reproduce these forces while awake).

It may be at this time that retinal tears develop and cause a retinal detachment.

What Does This Mean? Again, this is my suspicion.  It may be hard to prove.  There is; however, a very practical side to this theory.

This means that nothing can be done to prevent a retinal tear from happening after a posterior vitreous detachment (PVD).  This means that a patient does not have to refrain from any “normal” activities when a PVD occurs.

In my view, a retinal tear is beyond the control of the patient.  A patient can not alter his or her behavior to prevent a tear from forming…unless you refrain from sleep.

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