What is a Retinal Detachment?
A retinal detachment is a separation of the retina from the back wall of the eye, which often leads to initial loss of peripheral vision and eventual loss of central vision if left untreated. The retina is the thin layer of tissue that lines the inside of the eye and acts like the film in a camera. It contains over a million neurons including specialized vision cells called photoreceptors. If not treated in a timely manner, permanent loss of sight may occur.
Causes and Associations
There are different kinds of retinal detachments: rhegmatogenous, tractional, and exudative. Rhegmatogenous retinal detachment is the most common type of retinal detachment and is caused by a hole or tear in the retina, which then allows fluid from the middle of the eyeball (vitreous cavity) to track under the retina and detach it from the eye wall. A retinal tear and associated detachments of the retina are usually unpredictable, spontaneous events.
Although a retinal detachment can occur due to trauma, it is usually caused by the separation of the vitreous gel from the retina related to aging. Over time, the vitreous gel liquefies with the fluid pockets then dissecting between the remaining more viscous vitreous gel and the retina (posterior vitreous detachment). Since this gel is firmly attached to the retina in certain locations, it can pull on areas of the thin retinal tissue, leading to a retinal hole or tear.
Risk factors for developing retinal tears and detachment include myopia (near-sightedness), particularly thin patches within the peripheral retina (lattice degeneration), family history, previous eye surgery, and trauma
Detached Retina Symptoms
Patients with rhegmatogenous retinal detachments often notice the sudden onset of floaters (black dots, strings, or cobwebs in their vision) and/or flashing lights, often described as short but repetitive arcs or bursts of light similar to lightning or camera flashes. A dark shadow or curtain progressing from one’s peripheral vision may develop next and is often the main symptom of the retina detaching.
The rate of progression of the retinal detachment can vary from hours to weeks depending on many factors such as patient age and size, location and the number of retinal tears.
Prognosis
Retinal detachments often cause some degree of permanent visual field or central vision loss, even after successful retinal reattachment. Final visual outcomes are best if the detachment is detected and treated before it involves the center of the retina (macula). If the macula detaches, it is common to notice persistent distortion with objects sometimes appearing to be tilted or smaller compared to the uninvolved eye even after successful repair.
Longstanding retinal detachments and those with associated scar tissue (proliferative vitreoretinopathy) typically have a poorer visual prognosis. A minority of patients may also develop scar tissue after the initial successful repair which can redetach the retina and require additional surgeries to preserve vision. A change of glasses after healing from retinal detachment surgery may or may not improve the vision.
Prevention and Treatment
Getting a prompt retinal detachment diagnosis is the first step in treatment. If a retinal tear is detected prior to the development of a large retinal detachment, laser or cryotherapy (freezing) to the retinal tear is often successful in sealing the tear and preventing a detachment. However, once a larger retinal detachment develops, one or more of the following retinal reattachment procedures is typically necessary:
Pneumatic Retinopexy is an office-based procedure. It involves the injection of a temporary gas bubble to close the retinal tear and flatten (reattach) the surrounding detachment. The gas injection is coupled with either a freezing treatment (cryotherapy) or laser photocoagulation to permanently seal the causative retinal tear. After the procedure, patients are required to maintain a certain head position for about a week to ensure that the gas bubble properly closes the retinal tear until it is adequately sealed by the laser or freezing treatment.
Scleral buckle surgery is performed in the operating room. It consists of attaching a soft piece of silicone to the outer eye wall (sclera) in such a way as to indent the sclera, which supports and helps to close the retinal tear. This is coupled with either cryotherapy or laser photocoagulation. A gas bubble is sometimes used to facilitate reattachment of the retina. In some cases, a scleral buckle may be combined with vitrectomy surgery.
Vitrectomy surgery is also performed in the operating room. As the name implies, it involves surgical removal of the vitreous gel which, in turn, relieves the traction or pulling on the retinal tear that is causing the detachment. Like the other procedures, laser is then used to seal the retinal tears. At the end of this surgery, the eye is filled with either a gas or silicone oil bubble. Gas goes away slowly on its own, but oil does not. Silicone oil may be removed at a later time with another vitrectomy surgery or left in the eye permanently depending on the visual prognosis. The use of silicone oil is usually reserved for complex retinal detachments such as those associated with scar tissue or very large retinal tears.
Your surgeon will review the risks, benefits, and alternatives of the treatment options with you in further detail and make tailored recommendations based on the unique findings of your eye.
If you are experiencing symptoms of a possible retinal tear or detachment, find a Wills Eye Physician – Mid Atlantic Retina clinic near you today and book an appointment to meet with one of our world-renowned retinal specialists for top-quality care. Our team can work with you to ensure proper diagnostics and treatment procedures are undertaken in a timely fashion.
