What are the warning signs of a detached retina. How is a detached retina diagnosed and treated. Can a detached retina lead to permanent vision loss. What are the risk factors for developing a detached retina.

Understanding Retinal Detachment: A Serious Eye Condition

Retinal detachment is a severe eye condition that occurs when the retina, a crucial layer of tissue at the back of the eye, becomes separated from its supporting structures. This separation can lead to vision loss if not promptly treated. To comprehend the gravity of this condition, it’s essential to understand the retina’s role in vision.

The retina functions like the film in a camera, collecting light that enters the eye and converting it into signals sent to the brain for interpretation. For proper functioning, the retina must remain attached to the back wall of the eye, where it connects to blood vessels that supply it with oxygen and nutrients.

The Consequences of Retinal Detachment

When the retina detaches, it loses its connection to these vital blood vessels. As a result, the detached portion of the retina can become damaged or even die due to lack of nourishment. This damage can lead to permanent vision loss in the affected area if not addressed quickly.

Recognizing the Warning Signs of Retinal Detachment

Early detection of retinal detachment is crucial for successful treatment and prevention of vision loss. There are three primary changes in vision that may indicate a detached retina:

1. New floaters: These appear as small black dots, specks, strings, or cobwebs that drift across your field of vision.
2. Flashing lights: You may see brief flickers of light, typically in your peripheral vision.
3. A gray or black curtain over part of your visual field: This symptom can be particularly alarming and may indicate a more advanced stage of detachment.

If you experience any of these symptoms, it’s crucial to seek immediate medical attention from an eye care professional. Prompt diagnosis and treatment can significantly improve the chances of preserving your vision.

What Causes Retinal Detachment?

Retinal detachment can occur due to various factors, but the most common type is rhegmatogenous retinal detachment. This occurs when the vitreous, a gel-like fluid filling the eye, breaks down and pulls away from the retina as part of the natural aging process.

In most cases, this separation of the vitreous from the retina (known as posterior vitreous detachment) is harmless. However, in some instances, it can create a hole or tear in the retina. Fluid can then seep through this opening, pushing the retina away from the back of the eye and causing detachment.

Other Types of Retinal Detachment

While rhegmatogenous retinal detachment is the most common, there are two other types:

• Tractional retinal detachment: Caused by scar tissue growth on the retina’s surface, pulling it away from the back of the eye.
• Exudative retinal detachment: Results from fluid buildup behind the retina due to leaking blood vessels or inflammation.

Risk Factors for Developing a Detached Retina

While retinal detachment can affect anyone, certain factors increase the risk of developing this condition:

• Advanced age
• Severe nearsightedness (myopia)
• Previous cataract surgery
• Severe eye injury
• Previous retinal detachment in the other eye
• Family history of retinal detachment
• Certain eye diseases, such as retinoschisis or lattice degeneration

Understanding these risk factors can help individuals and their healthcare providers take appropriate preventive measures and ensure regular eye examinations for early detection of potential problems.

Diagnosing Retinal Detachment: A Closer Look

When retinal detachment is suspected, an eye care professional will perform a comprehensive examination to confirm the diagnosis. The primary diagnostic tool is a dilated eye exam, where special eye drops are used to widen the pupil, allowing the doctor to thoroughly examine the retina.

During this exam, the eye doctor will look for signs of retinal detachment, such as tears, holes, or areas where the retina has separated from the back of the eye. In some cases, additional diagnostic tests may be necessary to obtain a clearer view of the retina’s condition.

Advanced Diagnostic Techniques

If the dilated eye exam doesn’t provide sufficient information for a definitive diagnosis, the eye doctor may employ additional diagnostic tools:

• Ultrasound: This non-invasive imaging technique uses sound waves to create detailed images of the eye’s internal structures, including the retina.
• Optical Coherence Tomography (OCT): This advanced imaging method uses light waves to capture high-resolution, cross-sectional images of the retina, allowing the doctor to visualize each layer in detail.

These advanced diagnostic techniques help eye care professionals accurately assess the extent of retinal detachment and plan the most appropriate treatment approach.

Treatment Options for Retinal Detachment

The treatment of retinal detachment aims to reattach the retina to the back of the eye and prevent further vision loss. The choice of treatment depends on several factors, including the type and extent of detachment, the location of the detachment, and the patient’s overall health.

Surgical Interventions

There are several surgical procedures used to treat retinal detachment:

1. Pneumatic retinopexy: This minimally invasive procedure involves injecting a gas bubble into the eye to push the detached retina back into place.
2. Scleral buckle: In this procedure, a flexible band is placed around the eye to gently push the wall of the eye against the detached retina.
3. Vitrectomy: This more complex surgery involves removing the vitreous gel and replacing it with a gas bubble or silicone oil to hold the retina in place.

The choice of surgical approach depends on the specific characteristics of the retinal detachment and the surgeon’s expertise. In some cases, a combination of these techniques may be used for optimal results.

Post-Treatment Recovery and Follow-up

After retinal detachment surgery, patients typically need to maintain a specific head position for several days to ensure proper healing. Follow-up appointments are crucial to monitor the recovery process and address any potential complications.

While most retinal detachment surgeries are successful, some patients may require additional procedures to achieve complete reattachment or address secondary issues. The recovery period and visual outcomes can vary depending on the severity of the detachment and the timeliness of treatment.

Preventing Retinal Detachment: Proactive Measures

While not all cases of retinal detachment can be prevented, there are steps individuals can take to reduce their risk:

• Regular eye exams: Routine check-ups can help detect early signs of retinal problems before they progress to detachment.
• Protective eyewear: Wearing appropriate eye protection during sports or hazardous activities can prevent eye injuries that may lead to retinal detachment.
• Managing underlying conditions: Properly controlling conditions like diabetes can help prevent complications that may increase the risk of retinal detachment.
• Awareness of symptoms: Being vigilant about changes in vision and seeking prompt medical attention when warning signs appear can lead to earlier diagnosis and treatment.

For individuals with known risk factors, such as high myopia or a family history of retinal detachment, more frequent eye examinations may be recommended to monitor for early signs of retinal problems.

Living with Retinal Detachment: Long-term Considerations

Following successful treatment for retinal detachment, patients often wonder about the long-term implications for their vision and eye health. While many individuals regain good vision after treatment, the extent of visual recovery can vary depending on several factors.

Factors Affecting Visual Recovery

The prognosis for vision restoration after retinal detachment treatment depends on several key factors:

• Duration of detachment: The longer the retina remains detached, the greater the risk of permanent vision loss.
• Extent of detachment: More extensive detachments may result in greater vision impairment.
• Involvement of the macula: If the macula (the central part of the retina responsible for detailed vision) is affected, visual outcomes may be less favorable.
• Timeliness of treatment: Prompt intervention generally leads to better visual outcomes.
• Pre-existing eye conditions: Other eye problems may influence the recovery process and final visual acuity.

It’s important for patients to have realistic expectations about their visual recovery and to work closely with their eye care team throughout the rehabilitation process.

Ongoing Care and Monitoring

After treatment for retinal detachment, patients require ongoing care and monitoring to ensure the best possible outcomes:

1. Regular follow-up appointments: These visits allow the eye doctor to monitor healing progress and detect any potential complications.
2. Vision rehabilitation: Some patients may benefit from vision therapy or low vision services to maximize their remaining visual function.
3. Lifestyle adjustments: Patients may need to make temporary or permanent changes to their daily activities to protect their eyes during the recovery period and beyond.
4. Monitoring the fellow eye: Individuals who have experienced retinal detachment in one eye are at increased risk for detachment in the other eye, necessitating vigilant monitoring.

By adhering to their doctor’s recommendations and maintaining regular eye care, patients can optimize their visual outcomes and reduce the risk of future eye problems.

Advancements in Retinal Detachment Research and Treatment

The field of ophthalmology continues to evolve, with ongoing research aimed at improving the diagnosis, treatment, and prevention of retinal detachment. These advancements offer hope for better outcomes and reduced risk of vision loss for patients affected by this condition.

Emerging Diagnostic Technologies

New diagnostic tools are being developed to enhance the early detection and monitoring of retinal detachment:

• Ultra-widefield imaging: This technology allows for a more comprehensive view of the retina, enabling earlier detection of peripheral retinal problems that may lead to detachment.
• Artificial intelligence (AI): Machine learning algorithms are being developed to analyze retinal images and assist in the early detection of retinal abnormalities.
• Handheld OCT devices: These portable devices may improve access to advanced diagnostic imaging, particularly in emergency or remote settings.

These technological advancements have the potential to improve the speed and accuracy of retinal detachment diagnosis, leading to more timely interventions and better visual outcomes.

Innovative Treatment Approaches

Researchers are exploring new treatment modalities to enhance the effectiveness of retinal detachment repair and reduce the risk of complications:

1. Biodegradable scleral buckles: These may offer the benefits of traditional scleral buckle surgery without the need for permanent implants.
2. Stem cell therapy: Researchers are investigating the potential of stem cells to regenerate damaged retinal tissue and improve visual outcomes after detachment.
3. Nanoparticle drug delivery: This technology could allow for more targeted and efficient delivery of medications to treat and prevent retinal detachment.
4. Robot-assisted surgery: The use of robotic systems in retinal surgery may enhance precision and reduce surgical trauma.

While many of these innovative approaches are still in the experimental stages, they represent promising avenues for improving the treatment of retinal detachment in the future.

Genetic Research and Personalized Medicine

Advances in genetic research are shedding light on the hereditary factors that may contribute to retinal detachment risk. This knowledge could lead to more personalized approaches to prevention and treatment:

• Genetic screening: Identifying genetic markers associated with increased risk of retinal detachment may allow for more targeted preventive strategies.
• Pharmacogenomics: Understanding how an individual’s genetic makeup influences their response to treatments could help tailor therapeutic approaches for better outcomes.
• Gene therapy: In the future, it may be possible to correct genetic defects that contribute to retinal detachment risk or improve retinal healing after detachment.

As our understanding of the genetic basis of retinal detachment grows, it may become possible to develop more targeted and effective prevention and treatment strategies based on an individual’s genetic profile.

The Impact of Retinal Detachment on Quality of Life

While the primary focus of retinal detachment treatment is on preserving vision, it’s important to consider the broader impact of this condition on an individual’s quality of life. The experience of retinal detachment and its treatment can have significant psychological, social, and economic implications for patients and their families.

Psychological and Emotional Aspects

The sudden onset of vision changes and the fear of permanent vision loss can be emotionally distressing for individuals experiencing retinal detachment. Common psychological reactions may include:

• Anxiety and depression
• Fear of recurrence or detachment in the other eye
• Grief over potential vision loss
• Frustration with the recovery process and activity restrictions

Providing psychological support and counseling as part of the treatment process can help patients cope with these emotional challenges and maintain a positive outlook during recovery.

Social and Occupational Considerations

Retinal detachment and its treatment can have significant impacts on a person’s daily life and professional activities:

1. Temporary or permanent changes in vision may affect the ability to perform certain tasks or hobbies.
2. The recovery period may require time off work or adjustments to work responsibilities.
3. Driving restrictions during recovery can impact independence and mobility.
4. Social interactions may be affected by changes in vision or self-consciousness about eye appearance after surgery.

Occupational therapy and vocational rehabilitation services can help individuals adapt to these changes and maintain their independence and productivity.

Economic Impact

The financial burden of retinal detachment treatment and recovery can be significant:

• Medical costs associated with surgery and follow-up care
• Lost income due to time off work for treatment and recovery
• Expenses related to vision aids or home modifications
• Potential long-term costs if permanent vision loss occurs

Understanding these potential economic impacts can help patients and their families plan accordingly and explore available financial assistance options.

Support and Resources for Patients

A comprehensive approach to retinal detachment care should include connecting patients with appropriate support services and resources:

• Patient support groups for individuals with retinal detachment or vision loss
• Low vision rehabilitation services to maximize remaining visual function
• Educational resources about retinal detachment, treatment options, and recovery expectations
• Information on assistive technologies and adaptive devices for those with permanent vision changes

By addressing the holistic needs of patients experiencing retinal detachment, healthcare providers can help ensure better overall outcomes and improved quality of life for those affected by this condition.

What Is a Detached Retina? Symptoms, Causes, Diagnosis, Treatment, and Prevention

By Becky UphamMedically Reviewed by Laura J Martin, MD

Reviewed: November 3, 2021

Medically Reviewed

The retina is a piece of tissue that sits on the back wall of the eye, says Brian VanderBeek, MD, an ophthalmologist at Penn Medicine and assistant professor of ophthalmology at the Hospital of the University of Pennsylvania in Philadelphia.

“If you think of your eye as a camera, the retina is the film in the camera; it collects the light that enters the eye, turns it into a signal, and sends it your brain. Your brain interprets that signal, and that’s how you see,” Dr. VanderBeek says.

For the retina to function properly, it has to sit on the back wall of the eye — that’s where it connects to the blood vessels that supply it with oxygen and other nutrients, says VanderBeek.

“When the retina detaches, it actually comes off the back wall of the eye. It can no longer get the nourishment it needs; it becomes damaged, and parts of it can even die,” he says.

Signs and Symptoms of a Detached Retina

Three main changes in your vision signal that you may have a detached retina, says VanderBeek:

New Floaters A floater is a little black dot that moves around in your vision. It can look like black or gray specks, strings, or cobwebs that drift around when you move your eyes and appear to dart away when you try to focus directly on them.

New Flashing Lights This looks like a little flicker of light, usually off to the side, says VanderBeek.

Gray or Black Curtain Over Part of Your Visual Field “When this happens, it can be pretty scary,” he says.

If you experience any of these three symptoms, you should get checked out right away, says VanderBeek. “This could signal retinal detachment, which could cause permanent vision loss if it goes untreated,” he says.

Causes and Risk Factors of a Detached Retina

The vitreous is a gellike fluid that fills the eye, says VanderBeek. “It’s a normal part of aging for that gel to break down and pull off the retina. When it does, it tends to clump, and when light comes in and hits it, it casts a shadow on the eye or the retina. That’s what you see when you see a floater moving around,” he says.

For most people, this doesn’t cause any major problems, he says. “It’s a nuisance to see floaters, but it’s usually not a bit deal. However, in a small percentage of people, when the gel pulls off the retina, it causes a hole or tear,” says VanderBeek. When that happens, the fluid that goes through the hole pushes the retina off the back wall of the eye and causes the detachment, he explains.

This is called a rhegmatogenous retinal detachment, and it is the most common type of retinal detachment. In addition to happening as a result of older age, it can occur in people with abnormal thinning in the peripheral retina (called lattice degeneration), eye injuries, or nearsightedness.

Tractional retinal detachment is caused when scar tissue grows on the surface of the retina and pulls it away from the back of the eye. It can be caused by diabetic retinopathy, an eye condition that develops in some people with diabetes, as well as by eye infections, swelling in the eye, and other eye diseases.

Exudative retinal detachment is the result of fluid buildup in the back of the retina that can be caused by leaking blood vessels or swelling in the back of the eye. If there are no tears or breaks in the retina, the fluid gets trapped and can push the retina away from the back of the eye.

This can be caused by injury or trauma to the eye, age-related macular degeneration, tumors in the eye, diseases that cause inflammation inside the eye, or Coats disease, a rare eye disorder.

Anyone can get a detached retina, but the most common reason is advancing age, says VanderBeek. Other risk factors for retinal detachment include the following:

• Nearsightedness, or myopia (The more nearsighted you are, the greater your risk, says VanderBeek. )
• Previous cataract surgery
• Severe eye injury
• Previous retinal detachment in the other eye
• Family history of retinal detachment
• Eye diseases, including retinoschisis (when the retina separates into two layers) or lattice degeneration (thinning of the retina)

How Is a Detached Retina Diagnosed?

If a retinal detachment is suspected, an eye doctor will perform a dilated eye exam. Special eye drops are used to dilate, or widen, the pupil so the doctor can see the retina at the back of the eye.

If the eye doctor isn’t able to make a diagnosis from the dilated eye exam, an ultrasound or optical coherence tomography scan (OCT) of the eye may be performed to see the exact position of the retina. An OCT is a noninvasive test that uses light waves to take cross-section pictures of the retina so that each layer is visible.

Prognosis of a Detached Retina

With prompt diagnosis and treatment, the prognosis can be good for retinal detachment. Retinal detachment repairs are successful in 9 out 10 cases, though sometimes more than one procedure is necessary to successfully reattach the retina.

“In the central part of your retina, there’s an area called the macula. The macula is where you do all your fine seeing — it’s necessary for driving, reading, and seeing fine detail,” says VanderBeek.

In cases when the center of the retina was not detached prior to surgery, postsurgery vision tends to be about the same as preoperative vision. If the central retina was detached prior to surgery, vision often improves after a successful reattachment, but some degree of permanent vision loss can occur.

If the retina cannot be reattached, the eye will continue to lose sight and eventually become blind.

If the detachment is more severe, or if it isn’t diagnosed and treated promptly, it can cause significant vision loss or even blindness.

Treatment and Medication Options for a Detached Retina

If you have any symptoms of retinal detachment, you should seek medical care right away, says VanderBeek.

“If there’s a problem with the retina, it needs to be treated fairly soon, depending on what your doctor sees. Once the detachment moves through the macula, then you have about a week to have it repaired. It’s not an emergency for which you have to go to the operating room right away, but it still needs to be corrected sooner rather than later,” he says.

Surgical Options

In nearly all cases, surgery is used to repair a retinal tear, hole, or detachment. If the retina isn’t fully detached, laser surgery or freezing can be used to create a scar that keeps the retina attached to the eye wall.

The most common surgical methods of repairing a detached retina include the following:

Pneumatic Retinopexy In this procedure (often performed in an office setting), a gas bubble is inserted inside the eye to push the retina into place, and then a freezing device seals it against the back wall of the eye. People who have this surgery have to keep their head in a specific position for eight hours or more to have the eye heal properly and reduce the chances of complications.

Scleral Buckle A scleral buckle is a piece of silicone sponge, rubber, or semihard plastic that is placed on the outside white part of the eye (the sclera) while a person is under local or general anesthesia. It’s then sewn to the eye, where it typically stays throughout a person’s life.

The component pushes in, or “buckles,” the sclera toward the middle of the eye to keep the retina in place. Freezing (often), heat (less common), or laser therapy are used to scar the retina and hold it in place prior to the surgery to prevent a retinal tear from happening again.

Vitrectomy A vitrectomy is similar to a pneumatic retinopexy, but the surgery is more involved and is usually performed in a hospital rather than a doctor’s office. Numbing drops, shots, or general anesthesia are used to make sure there is no pain during the procedure. During the surgery, very small openings are made in the eye wall, and most of the vitreous (the gellike fluid that fills the eye) is removed.

After that, the surgeon may inject an air or gas bubble into the eye to hold the retina in place and may use a laser or freeze the retina to reattach or repair it. The vitreous may be replaced with a clear fluid.

Alternative and Complementary Therapies

There are no alternative or complementary therapies to fix a detached retina, says VanderBeek.

Prevention of a Detached Retina

There is no way to prevent aging, which is a major risk factor for getting a detached retina, says VanderBeek. Wearing protective eye gear while you participate in any risky activities, such as playing sports, can help reduce your chances of injury.

Complications of a Detached Retina

If a detached retina isn’t treated, it usually results in permanent severe vision loss or even blindness.

As with any surgery, there are risks of complications for retinal repair, which include bleeding, infection, high pressure inside the eye, or cataract. In some cases, the initial surgery isn’t successful, and a second surgery is needed. If the retina isn’t able to be surgically repaired, the vision in the eye will continue to worsen, and eventually the eye will become blind.

Research and Statistics: How Many People Have a Detached Retina?

“The average person walking down the street has a 1 in 12,000 chance of having a retinal detachment. It’s more common in middle-aged and older people,” says VanderBeek.

The lifetime risk for retinal detachment in normal eyes is about 1 out 300 people.

Related Conditions to a Detached Retina

A couple of eye conditions predispose the people who have them to developing a detached retina:

Myopia (Nearsightedness) In myopia, you can see objects close to you clearly, but distant objects are out of focus and blurry. It’s caused by the shape of the eye; in a person who is nearsighted, the light coming into the eye bends incorrectly, focusing images in front of the retina rather than on the retina.

People with severe myopia — sometimes called high myopia — have longer eyes, which means the retina is stretched and more prone to peripheral retinal tears. High myopia is also associated with degeneration of the vitreous, making it more likely to collapse and separate from the retina, which also increases the risk of a tear.

Diabetic Retinopathy People with diabetes can develop diabetic retinopathy, in which high blood sugar levels cause damage to blood vessels in the retina, causing them swell, leak, or close. Sometimes abnormal new blood vessels can grow on the retina.

The abnormal blood vessels can stimulate the growth of scar tissue, which can pull the retina away from the back of the eye.

Resources We Love

American Academy of Ophthalmology

This professional association of eye doctors and surgeons has as its mission to protect sight and empower lives through patient advocacy, education, and advancing the profession of ophthalmology. The association provides information for patients about detached retina as well as other eye conditions and diseases on EyeSmart.

EyeCare America

This program of the American Academy of Ophthalmology offers free eye exams for eligible people over age 65 or those who are at risk for glaucoma.

National Eye Institute (NEI)

The NEI was first established by Congress to protect and prolong the vision of the American people. The NEI supports eye disease research through grants and training. It also offers information about eye health for adults and children.

Editorial Sources and Fact-Checking

• Eye Floaters. Mayo Clinic. August 28, 2020.
• Retinal Detachment. American Society of Retina Specialists. 
• Retinal Detachment. National Eye Institute. December 18, 2020.
• Retinal Detachment Risk Factors. Stanford Health Care.
• What Is Optical Coherence Tomography? American Academy of Ophthalmology. June 28, 2021.
• Detached Retina (Retinal Detachment). Kellogg Eye Center, University of Michigan Health.
• Retinal Detachment. Mayo Clinic. August 28, 2020.
• Pneumatic Retinopexy. Johns Hopkins Medicine.
  
• Scleral Buckling Surgery for Retinal Detachment. University of Michigan Health, Michigan Medicine. August 31, 2020.
• Vitrectomy. National Eye Institute. December 23, 2020.
• Gariano RF, Kim CH. Evaluation and Management of Suspected Retinal Detachment. American Family Physician. April 2004.
• Nearsightedness. Mayo Clinic. April 2, 2020.
• Williams K, Hammond C. High Myopia and Its Risks. Community Eye Health Journal. 2019.
• Diabetic Retinopathy. Mayo Clinic. June 24, 2021.

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Detached Retina (Retinal Detachment) | Kellogg Eye Center

Your Questions about Retinal Detachment Answered: To view all 9 of the videos in this series, click on the icon in the upper left of the video screen.

What Is a Detached Retina (Retinal Detachment)?

A detached retina occurs when the retina is pulled away from its normal position in the back of the eye. The retina sends visual images to the brain through the optic nerve. When detachment occurs, vision is blurred. A detached retina is a serious problem that can cause blindness unless it is treated.

The retina normally lies smoothly and firmly against the inside back wall of the eyeball and functions much like the film in the back of a camera. Millions of light-sensitive retinal cells receive optical images, instantly “develop” them, and send them on to the brain to be seen. If any part of the retina is lifted or pulled from its normal position, it is considered detached and will cause some vision loss.

Symptoms

• Floaters
• Flashing lights
• Gray curtain or veil moving across your field of vision

The symptoms described above may not necessarily mean that you have a detached retina. However, if you experience one or more of these symptoms, contact your ophthalmologist for a complete exam.

Causes

The vitreous is the clear collagen gel that fills the eye between the retina and the lens. As we get older, the vitreous may pull away from its attachment to the retina at the back of the eye. Usually the vitreous separates from the retina without causing a problem. But sometimes the vitreous pulls hard enough to tear the retina in one or more places, causing the retinal detachment. Fluid may pass through the retinal tear and lift the retina off the back of the eye like wallpaper can peel off a wall.

Risk Factors

A detached retina can occur at any age, but it is more common in midlife and later. Conditions that can increase the chance of a retinal detachment include nearsightedness; previous cataract surgery; glaucoma; severe trauma; previous retinal detachment in your other eye; family history of retinal detachment; or weak areas in your retina that can be seen by your ophthalmologist.

Treatment and Drugs

• Retinal Tears Retinal holes or tears will usually need to be treated with laser treatment or cryotherapy (freezing), to seal the retina to the back wall of the eye again. These treatments cause little or no discomfort and may be performed in your ophthalmologist’s office. This treatment will usually prevent progression to a retinal detachment. Occasionally retinal tears are watched without treatment.
• Detached Retina Retinal detachments may require surgery to return the retina to its proper position in the back of the eye. There are several ways to fix a detached retina. The decision of which type of surgery and anesthesia (local or general) to use depends upon the characteristics of the retinal detachment. In each of the following methods, your ophthalmologist will locate any retinal tears and use laser surgery or cryotherapy (freezing) around them to seal the tear.

Surgery for a Detached Retina

• Pneumatic retinopexy
  Pneumatic retinopexy describes the injection of a gas bubble into the vitreous space inside the eye enabling the gas bubble to push the retinal tear back against the wall of the eye and close the tear. Laser or cryosurgery is used to secure the retina to the eye wall around the retinal tear. Your ophthalmologist will ask you to maintain a certain head position for several days. The gas bubble will gradually disappear. Sometimes this procedure can be done in the ophthalmologist’s office.
• Scleral buckle
  A scleral buckle or flexible band is placed around the equator of the eye to counterbalance any force pulling the retina out of place. Often the ophthalmologist will drain the fluid from under the detached retina, allowing the retina to return back to its normal position against the back wall of the eye. This procedure is performed in the operating room, usually on an outpatient basis.
• Vitrectomy
  A vitrectomy is a surgical procedure to remove the vitreous gel that pulls on the retina. This may also be necessary if the vitreous is to be replaced with a gas bubble. Your body’s own fluids will gradually replace this gas bubble, but the vitreous gel does not return. Sometimes a vitrectomy may be combined with a scleral buckle.

After Surgery

You can expect some discomfort after surgery for a detached retina. Your ophthalmologist will prescribe any necessary medications for you and advise you when to resume normal activity. You will need to wear an eye patch for a short time. If a gas bubble was placed in the eye, your ophthalmologist may recommend that you keep your head in special positions for a time.  If a gas bubble is used, you will be restricted from air travel, scuba diving, and certain types of anesthesia until after the bubble is gone. A change of glasses may be necessary after the retina has been reattached.

What Are the Risks of Surgery?

Any surgery has risks; however, an untreated retinal detachment will usually result in permanent severe vision loss or blindness. Some of these surgical risks include infection, bleeding, high pressure inside the eye, or cataract. Most retinal detachment surgery is successful, although a second operation is sometimes needed. If the retina cannot be reattached, the eye will continue to lose sight and ultimately become blind.

Will Your Vision Improve?

Vision may take many months to improve and in some cases may never fully return. Unfortunately, some patients, particularly those with chronic retinal detachment, do not recover any vision. The more severe the detachment, and the longer it has been present, the less vision may be expected to return. For this reason, it is very important to see your ophthalmologist at the first sign of trouble. 

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symptoms and causes – health articles

Retinal detachment is a disease characterized by separation of the neuroepithelium from the reticular layer due to the appearance of retinal rupture and accumulation of excess fluid between them. Untimely diagnosis and treatment of visual pathology is fraught not only with a strong decrease in visual function, but also with its complete irreversible loss.

Structure of the retina

The retina (retina) of the eye is the inner shell of the eye, consisting of 10 layers. The anterior part of the eyeball is the conjunctiva – the connective (mucous) membrane of the eye in the form of a thin transparent film covers the back surface of the eyelids and over the sclera to the cornea (forms the palpebral fissure when the eyelids are open). Outer – a very dense fibrous shell of the eyeball, to which the outer muscles of the eyeball are attached, performs a protective function and, thanks to turgor, determines the shape of the eye. It consists of an anterior transparent part – the cornea, and an opaque posterior part of a whitish color – the sclera.

The iris is located under the cornea, in the center of it there is a pupil with a lens, which, like the cornea, are responsible for focusing and refraction of the rays of light entering inside.

Next comes the fluid called the vitreous. And the layer that follows after it is the retina of the eye. It is here that the refracted rays of light are transformed into a complete picture, which is then perceived by our consciousness (brain).

The central part is occupied by the so-called yellow spot. The retina contains photoreceptor cells (highly differentiated nerve elements – rods, responsible for the ability to see in the dark, and cones, concentrated in the middle of the macula. Their functionality is the recognition of shades, as well as the detailing of objects.

Detachment is thought to be caused by retinal breaks. The retina does not move from its place if it is tight and there is no break in it. If a gap has formed, then through it the fluid from the vitreous body penetrates under the retina and exfoliates it from the choroid.

The main reason for the formation of a retinal tear is the traction of the vitreous body when its normal state changes. In the presence of diseases, the vitreous body changes, becomes cloudy, with compacted fibers that are associated with the retina. When the eye moves, the strands (fibers) pull the retina behind them, which can lead to its rupture.

Retinal breaks can also occur when retinal dystrophy (thinning). Large tears often occur with eye injuries.

More rare causes of retinal detachment are traction from the modified vitreous body without the formation of retinal breaks. This often happens with diabetic retinopathy, tumors, fluid accumulation.

Causes of retinal detachment

Retinal detachment is a serious eye pathology that can be triggered by many internal processes. We list the main causes of detachment that exist in ophthalmic practice:

• Rhegmatogenous. The most common type of retinal detachment. Rhegmatogenous (Greek regma – gap) include detachments caused by retinal rupture. This is one of the most dangerous types of retinal detachment, since it may not be diagnosed until the moment of direct rupture. For example, serious sports loads can provoke rhegmatogenous detachment
• Traction. Due to the development of pathological processes in the vitreous body. In this case, there is no retinal break, and its detachment is caused by adhesions between the retina and the vitreous body, which pull the retina. Such behavior of the vitreous body is most often found against the background of advanced diabetes mellitus, with thrombosis of the central retinal vein, with retinopathy of prematurity, after a penetrating injury to the eye, with sickle cell anemia, therefore, people with this disease are advised not to neglect their health and go to the doctor (ophthalmologist) regularly . All these diseases are accompanied by a violation of the blood flow of the retina. In response to this, newly formed vessels appear on the surface of the retina. They are very brittle and cause repeated hemorrhages. Near such vessels, a dense adhesion of the retina and vitreous body is formed. Over time, the vitreous body begins to pull on the retina, and as a result, it exfoliates from the underlying pigment epithelium
• Exudative or serous detachment – occurs without rupture of the retina and is caused by inflammatory fluid from the vessels of the choroid. The permeability of the vascular wall of the retina increases, as a result, fluid from the choroid and damaged vessels enters and accumulates under the retina
• Traumatic. This includes detachments provoked by the consequences of injuries, or due to complications from surgical intervention. The danger of this type lies in the sluggish nature of the development of the pathological process. Thus, detachment can occur immediately or several years after the injury

In addition to the above, there are also a number of secondary causes that can complement the dystrophic process:

• Old age. People over 60 are at risk
• Severe myopia. According to statistics, more than 50% of patients diagnosed with retinal detachment suffered from severe myopia
• Surgical interventions on the eyes. About 40% of patients after eye surgery faced such a complication as peeling
• Arterial hypertension. Numerous ophthalmological observations have established a connection between ocular pathology and an imbalance in blood pressure

Entering one / several of the indicated risk groups, one should not rely on luck, waiting for the development of ocular pathology. To avoid possible consequences, it is enough to visit an ophthalmologist regularly, who will be able to monitor your eye health, and in case of an onset of the disease, provide timely medical care and support.

Symptoms and signs of detachment

To avoid the most negative outcome (complete loss of vision) caused by retinal detachment, it is necessary to diagnose it in time. Let’s list the main symptoms that indicate the start of the degenerative process:

• Feeling of black dots in the eyes that prevent a full view, which do not disappear even after rest
• The appearance of flashes/glare/cloudy spots that appear “out of nowhere”
• Visual distortion of objects that begin to move (remaining static in reality) or freeze (actually being in motion)
• Rapid deterioration of visual function. With progressive retinal detachment, a person can lose sight in 2-3 hours. The places where circles appear are exfoliated areas through which light rays no longer refract, heading to the brain. The appearance of such symptoms indicates the beginning of an irreversible process of retinal detachment, which, if the patient is inactive, will subsequently lead to his complete blindness. At this stage, it is necessary to urgently visit an ophthalmologist, and also tell where the first blackouts appeared
• Narrowing of the field of vision. With retinal detachment, vision may begin to disappear from the edges. After resting, the edges temporarily regain visual ability, however, this is only an appearance, which in a couple of hours will again turn into the appearance of a “dead zone”
• Another symptom of degenerative damage can be the appearance of invisible areas in the text / phone / TV, which will disappear when the viewing angle is changed

The most insidious feature of retinal detachment is the absence of pain. When one of the above syndromes and signs of retinal detachment appears, a person can put off going to the doctor for a long time, convincing himself that what is happening is a consequence of chronic fatigue, stress, etc. And instead of making an appointment with an experienced ophthalmologist, the patient tries to sleep off, falsely noting positive dynamics in himself in the morning.

Remember: if you experience one/several of the above symptoms or signs, you should visit an ophthalmology clinic as soon as possible, where you will be arranged for timely diagnostic and surgical care.

Today, it is possible to stop the degenerative process of the retina only through emergency surgery, otherwise a person will forever lose the ability to see.

Which doctors should I contact?

Diagnosis, treatment and prevention of retinal detachment belongs to the field of ophthalmology, and therefore, if signs of eye pathology are detected, you should make an appointment with an ophthalmologist.

By organizing a comprehensive medical examination of the eyeball, an ophthalmologist will be able to accurately diagnose the stage and neglect of the retinal dystrophic process, and then select the most optimal and safe method of surgical intervention (laser coagulation, vitrectomy, extrascleral ballooning, etc. ).

By contacting the MEDSI clinic in Moscow, you will receive qualified assistance from experienced ophthalmologists who will conduct the necessary diagnostic examinations, and then, if degenerative processes of the retina are detected, they will provide timely surgical care using modern ophthalmological equipment and surgical techniques.

Diagnosis of retinal detachment

Diagnostic examinations of retinal detachment include an initial appointment with an ophthalmologist with a preliminary history taking and examination of the patient using an ophthalmoscope. As part of the examination, the doctor will be able to establish the staging and course of ongoing degenerative processes, as well as determine their localization. At this stage, the specialist checks for the presence / absence of existing retinal breaks.

As part of the diagnosis, eye examinations using special optical lenses can also be involved, which will allow assessing visual acuity and the degree of functioning of its individual sections.

When diagnosing adjacent inflammatory processes that complicate examination using ophthalmoscopic equipment or optical instruments, ultrasound examination is involved.

Intraocular pressure indicators are measured, which are then compared with the normative indicators of a healthy visual organ.

At the final stage of diagnosis, the doctor records the obtained indicators of the eyeball and its individual structures, after which a decision is made on the need to involve surgical techniques.

Ophthalmoscopy signs of detachment

Ophthalmoscope examination confirms/refutes partial/massive/complete retinal detachment. In the absence of a degenerative process inside the retina, the result of the study will be the so-called red reflex, which will confirm the presence of adequate nutrition of the retina.

When the power is stopped, the red reflex will be absent, a light shade will appear in its place, a mobile retina and, as a result, its death. To see these changes, an experienced eye of a specialist is required, who has been studying the specifics of the course of such an eye pathology for more than a year.

When the retina is filled with vitreous fluid, a voluminous bubble with cloudy contents will be visible. Such a clinic requires immediate surgical intervention.

Using an ophthalmoscope, a specialist can also detect a retinal tear, which will look like a solid red spot.

Using ophthalmoscopy as part of diagnostic studies, the doctor will be able to timely establish the staging of eye pathology, select the appropriate treatment method for the situation, and also share with the patient the prognosis of disease progression.

Treatment of retinal detachment

The treatment of this eye disease is permissible only in an operative way. To date, there are no methods of conservative or non-traditional treatment (medications, eye drops, herbal lotions, etc.) that could slow down or completely rid the patient of the resulting pathology.

Operable methods for the treatment of retinal detachment:

• Laser method. It is possible only when ruptures are detected, which often end in detachment. The duration of the operation does not exceed half an hour. The essence of the method is to solder the retina to the vascular network using a laser coagulator
• Vitrectomy. When using this method, the vitreous body is completely removed, the retina is welded with a laser and the intraocular space is filled with silicone, gas or saline
• Extrascleral method. Scleral method, in which a special filling is placed on the affected area, which prevents the progression of the peeling process
• Ballooning of the sclera in case of retinal detachment is achieved by temporarily suturing a special balloon catheter into the area of ​​the projection of the rupture, when inflated, an effect similar to filling occurs

Q&A

Is it possible to completely replace the retina?
Due to special connections with the brain, until now it has not been possible to invent a technique that would allow such an operation to be performed. Nevertheless, research on the topic of retinal transplantation is carried out regularly, which means that such an opportunity may actually appear in the near future.

Is it possible to slow down the process of retinal detachment with medication?
Retinal detachment cannot be slowed down / eliminated by any of the existing medical methods. The only effective way is emergency surgery.

Can complications occur after retinal surgery?
Modern methods of surgical treatment of eye pathologies minimize the risk of possible complications after surgery. Nevertheless, non-compliance with the rehabilitation period can result in various complications up to the complete degradation of the retina.

Author

The author of the article is a doctor of the first qualification category – Druzhinin Dmitry Aleksandrovich.

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Retinal detachment is a serious disease associated with its separation from other membranes of the eye, resulting in loss of visual fields and its partial or complete loss. The possibility of retinal detachment is due to the peculiarities of its anatomical structure.

There are three main types of detachment:

Rhegmatogenous (rhegma – gap, Greek) is the result of a through retinal defect through which fluid from the liquefied vitreous body enters under the retina. Conditions that contribute to the occurrence of a gap occur most often in myopic eyes.
Traction. The retina exfoliates from other membranes of the eye due to contraction of strands and membranes that occur in the vitreous body due to injuries, hemorrhages, and a number of common diseases, such as diabetes, hypertension.
Exudative or secondary. Detachment is caused by fluid accumulating under the retina due to inflammation or tumor growth from adjacent membranes of the eye.

Things to remember

The initial changes that occur in the retina are usually invisible to humans. Therefore, at least once a year, especially for patients with myopia, it is necessary to undergo an examination by an ophthalmologist-retinologist with the obligatory dilation of the pupils, a thorough examination of the fundus, and, if necessary, additional studies: perimetry, ultrasound scanning, electrophysiological tests, etc. .

Symptoms of retinal detachment

The first symptom of an incipient retinal detachment is the appearance of sparks or a veil in front of the eye, deformation of the objects being examined, and limitation of the field of vision, which progress over time.

How to treat detachment? Is an operation necessary?

Retinal detachment is treated with surgical methods, usually in combination with laser photocoagulation.
The goal of the intervention is to achieve adherence of the detached retina to other membranes of the eye with minimal trauma and the risk of complications. There are two main surgical methods: scleral (external) filling and endovitreal (vitreous) intervention.

Scleral buckling is a surgical procedure in which a material (usually porous silicone) is sutured to the sclera (the white of the eye) to create an inward bulge of depression, thereby restoring contact of the detached retina with other membranes.

Scleral filling is indicated in cases of “fresh” (up to 2 weeks) detachment with single tears, as well as in young people under the age of 30 years.

In other cases, as a rule, endovitreal intervention. In recent years, microinvasive vitreous and retinal surgery has made giant leaps. With the advent of new high-tech operating systems, microinstruments, fiber light guides, and endolasers, ophthalmic surgeons have the opportunity to restore vision in cases that previously seemed unpromising or hopeless.

Department of Vitreoretinal Surgery in “Lege Artis”

The department is equipped with the latest generation of surgical systems and equipment manufactured in the USA, Germany, the Netherlands. Over the years, the surgeons of the clinic have gained considerable experience in the treatment of retinal detachments, complications of diabetes mellitus, and age-related diseases of the retina.

We have established strong professional contacts with vitreoretinal surgeons from leading ophthalmological centers in the country: Moscow, Krasnodar, Volgograd.