A detached retina occurs when the retina peels away at the back of the eye or detaches from its underlying supporting tissue layer. The retina is a thin layer of nerve cells at the back of the eye, which are light sensitive. We need to have a healthy retina so we can see clearly.
At first, detachment will only affect a small part of the retina, but without treatment, the entire retina will peel off, and vision from that eye will be lost.
A detached retina, or retinal detachment, usually occurs only in one eye. It is a medical emergency.
People with severe myopia, people with diabetes, patients with complicated cataract surgery and anyone with a blow to the eye are all more susceptible to this condition.
Symptoms
An individual with a damaged retina can have symptoms of many kinds.
These include:
- Photopsia, or sudden, brief flashes of light outside the central part of their vision, or peripheral vision. The flashes are more likely to occur when the eye moves.
- A significant increase in the number of floaters, the bits of debris in the eye that make us see things floating in front of us, usually like little strings of transparent bubbles or rods that follow our field of vision as our eyes turn. They may see what looks like a ring of hairs or floaters on the peripheral side of the vision.
- A heavy feeling in the eye
- A shadow that starts to appear in the peripheral vision and gradually spreads towards the center of the field of vision
- A sensation that a transparent curtain is coming down over the field of vision
- Straight lines start to appear curved
It is not usually painful.
Causes
The retina is the tissue layer which line the inside of the eye. It is sensitive to light, and its function is to send visual signals through the optic nerve to the brain.
When we see, light passes through the eye’s optical system and reaches the retina, like in a nondigital camera.
This produces an image when the light hits the retina which is translated into neural impulses and sent to the brain via the optic nerve.
In other words, an image focuses on the retina, the information is processed by nerve cells and it is sent to the brain by electrical impulses through the optic nerve.
This can affect a person’s ability to see if the retina is damaged.
Retinal detachment occurs when pulling this layer out of its normal position. The retina also features small tears. These, too, can induce detachment in the retina.
There are three types of detached retina:
Rhegmatogenous retinal detachment is a break, tear, or hole in the retina. This hole allows the passage of liquid from the vitreous space into the subretinal space between the sensory retina and the epithelial retinal pigment. The epithelium pigment is a pigmented layer of cells just below the neurosensory retina.
Secondary retinal detachment is also known as retinal exudative detachment or retinal serous detachment. This occurs when inflammation, vascular defects or damage causes fluid under the retina to build up. No hole, no break, or no tear.
Tractional retinal detachment is when an injury, inflammation, or neovascularization causes the fibrovascular tissue to pull out the retinal pigment epithelium from the sensory retina.
Surgery
Surgery is required to locate and seal all retinal breaks and to alleviate present and future vitreoretinal traction, or pulling. There is a high chance of complete loss of vision without the surgery.
Options for surgery include:
- Laser surgery, or photocoagulation: A laser beam is directed through a contact lens or ophthalmoscope. The laser burns around the retinal tear, resulting in scarring tissue that then fuses the tissue back together.
- Cryotherapy: Cryosurgery, cryopexy, or freezing, involves applying extreme cold to destroy abnormal or diseased tissue. The procedure produces a delicate scar that helps connect the retina to the wall of the eye.
- Scleral buckling: In the area where the retina has detached, very thin bands of silicone rubber or sponge are sewn onto the sclera, the outside white of the eye. The tissue around the area may be frozen or lasers may be used to scar the tissue.
- Vitrectomy: The vitreous gel is removed from the eye and a gas bubble or silicon oil bubble is used to hold the retina in place. The wound is stitched. Silicon oil needs to be removed 2 to 8 months after the procedure.
- Pneumatic retinopexy: This can be used if the detachment is uncomplicated. The surgeon freezes the tear area, using cryopexy, before injecting a bubble into the vitreous cavity of the eye. This pushes the retina back against the tear and the detached area, preventing further flow of fluid behind the retina. After some days, the pressure eventually makes the retina reattach itself to the wall of the back of the eye.
An individual who has a gas bubble in his or her eye may be advised to keep the head for some time in a particular way, and they will not be able to fly. If an oil bubble is used, flying is allowed.
Researchers have been researching the use of silicone oil to treat proliferative vitreoretinopathy (PVR), a complication of retinal detachment surgery that may result in further detachment of the retina.
The National Eye Institute estimates that approximately 90 percent of retinal detachment treatments are successful, though some people will need further treatment.
Often, reattaching the retina is not possible, so the person’s vision will begin to deteriorate.
A few weeks after treatment, the patient ‘s vision should return. If the macula is involved in the detachment, the sight of the person may never be as clear as it was before. The macula is the part of the eye which helps us to see what is directly in front of us.
The cost of retinal detachment surgery depends on the type of procedure involved. Research published in 2014 suggests that “treatment and prevention of RD is extremely cost-effective compared to other retinal disease treatments, irrespective of the treatment modality.”
The research, published in the journal Ophthalomology, balanced medical costs against the benefits of high sight and quality of life.
After surgery, the risk of complications is small. That include medication allergies, eye bleeding, double vision, cataracts , glaucoma and eye infection.
As eye conditions such as this can often be detected in the early stages, having regular eye tests can help to minimize the risk of retinal detachment.
Treatment
Treatment options for a detached retina, as mentioned above, are all kinds of surgery.
Diagnosis
When a doctor suspects retinal detachment, the patient should usually be referred for precise diagnosis to an eye specialist, or an ophthalmologist.
The ophthalmologist will examine they eye after dilating, or widening, the pupils with eye drops. An ultrasound may provide more detail.
Risk factors
Factors which may increase the risk that retinal detachment may develop include:
- genetics, for example, if a close family relative has had retinal detachment
- middle and older age
- extreme nearsightedness
- previous cataract surgery, especially if it was complicated
- previous retinal detachment
- eye conditions, such as uveitis, degenerative myopia, lattice degeneration, and retinoschisis
- trauma, for example, a blow to the eye
- diabetes, especially if the diabetes is poorly controlled
Anyone with these risk factors should be mindful of the potential for a damaged retina.Anyone with these risk factors should be aware of the possibility of a detached retina.
