Eye surgery is complex and requires the using of a special microscope to focus on fine details of the eye. Both hands and both feet have to be used while operating. The hands hold delicate instruments to perform surgery while one foot controls pedals that move and focus the microscope and the other foot controls the vitrectomy or laser machine.
My favorite chef had a retinal detachment.
One of my indulgences is fine dining. When I used to work in the UK, I would save up to have a meal with my wife once every few months at a Michelin starred restaurant. One of our favorite restaurants is Le Gavrouche in London whose chef Michel Roux Jr. is a culinary genius.
Imagine my surprise to discover that he had a retinal detachment in the past!
In the article, Michel asks if there was anything that he did to have caused this potentially blinding condition like running on hard pavements or knocking his head on something.
Myopia is Risk Factor for Retinal Detachment
While trauma can rarely cause a detachment, Michel’s detachment was most likely due to his preexisting myopia. He also had a family history which increased his risk. I am glad he was treated in Moorfields Eye Hospital, where I have had the privilege of working in the past.
It is absolutely crucial that retinal detachment be treated only by trained retinal surgeons as the first operation is the most crucial in determining how well the eye can see after surgery. Thankfully, he made a good recovery from surgery and is still cooking for the public.
Common Symptoms Include Flashes and Floaters
Retinal detachment is a disease that progresses very rapidly when it occurs. Usually, there are symptoms of floaters and flashing lights to alert the patient.
If there is a retinal hole present, early treatment with laser or cryotherapy can prevent detachment. I always examine the other eye of the patient as there are often undetected holes there that require treatment.
I recently diagnosed an early retinal detachment in the good eye of a myopic patient referred to me for problems in his other eye. He had surgery the same day and has managed to retain his vision.
In patients with conditions that have a high risk of developing retinal detachment like Stickler syndrome, I usually perform laser or cryotherapy treatment on the entire periphery of the retina of both eyes even though there is no retinal hole present.
This is controversial as some retinal specialists do not believe that this can prevent a detachment from occurring and that the laser scars themselves may cause retinal detachment when the vitreous jelly detaches later on and pulls on the scars.
Any patient who is myopic needs to get their retina checked if they have any symptoms of retina detachment. Myopic patients are 4 times more likely to get a retinal detachment.
Laser Treatment Can Reduce Chance of Detachment
I often treat with laser suspicious areas in the peripheral retina called lattice degeneration. This is not a retinal hole but an area of weakness in the retina that can develop retinal holes more easily that other places in the retina.
Laser treatment helps the retina stick on harder and may prevent holes from developing there.
Finally, there is no diet, supplements or eye exercises that can prevent retinal detachment. If you suffer from myopia or have a family history, you need to seek expert advice urgently if you have any of the symptoms of retinal detachment. Rest assured that modern eye surgery is very successful and 90% of patients have their retinal detachment fixed with just one operation.
A question I am often asked is whether changes in your diet or taking supplement can prevent AMD (Age Related Macular Degeneration). There have been many studies looking at this issue but probably the most important research in this area is from the Age-Related Eye Diseases Study (AREDS).
AREDS was started more than 10 years ago to see if high dose anti-oxidants supplements were useful in preventing progression to advanced macular degeneration in patients with early dry macular degeneration. This study did show some benefit for moderate to advanced dry AMD patients.
So, eye doctors are now recommending that dry AMD patients take supplements daily to prevent their eye from developing wet AMD. Wet macular degeneration is bleeding at the macula which can cause severe visual loss.
It is important to see your eye doctor before you take any such supplements as you may not actually need to take them. Also, supplements can interact with your medications and cause side effects.
Vegetables May Improve Vision
We have always been told to eat our vegetables and our mothers were right! Colourful vegetables like carrots, beetroot, green lettuce, and tomatoes, contain carotenoids. Carotenoids are the natural pigments that give colour to egg yolks, tomatoes, green leaves, fruits, and flowers. They cannot be made internally in the body, and therefore, must be obtained from the diet.
Beta-carotene, lutein and zeaxanthin are members of the carotenoid family. Carotenoids are light-gathering pigments and protect against the toxic effects of ultra-violet radiation and oxygen.
Lutein and zeaxanthin are found in the macula, and are protect our retina from UV light damage. UV light exposure is thought to be one of the causes of AMD. Carotenoids also have antioxidant properties.
Omega-3 Fish Oils Might Slow AMD
Omega-3 fish oils are also popular food supplements for a variety of conditions. They have anti-inflammatory properties and may be helpful in AMD patients.
In AREDS, they found that patients with early AMD are were eating more two portions of oily fish a week had a lower rate of progressing to wet AMD than patients who ate less oily fish. Again, it seems like our mothers were right to nag us to eat more fish!
A new study called AREDS2 has been started and will look at whether taking lutein, zeaxathin, and fish oil supplements can help prevent or delay progression of AMD. As a retinal specialist, I look forward to the results of this study.
For further information about how diet and supplements can help in AMD, please check out my article in my regular medical column in the Star newspaper, “Food and Your Macula.”
Welcome to my medical practice website and thanks for reading.
It is the start of the Dragon Lunar New Year for Chinese people worldwide and things have been quiet at work as most colleagues and patients have taken the week off to celebrate the New Year.
As a retinal surgeon, I am still busy with my work as I am often referred urgent cases like retinal detachment. The day before the Chinese Lunar New Year started, I was in the operating room operating on a patient who had a retinal detachment in one eye.
The patient had what he called “black spots” in his vision a few days before he saw an eye doctor. These “black spots” are what most people call “floaters”. Floaters sometimes mean there is a retinal hole in the eye.
The hole can cause a retinal detachment and is usually caused by a posterior vitreous detachment (PVD). The vitreous is a transparent jelly in the middle of your eye and it is attached to the retina. As you get older, this vitreous jelly will detach from the retina and this jelly is what is seen as floaters in your eye.
Rarely, a PVD can cause a retinal hole when the vitreous separates from the retina.
When a retina hole forms, there may be symptoms of “flashing lights” seen by the patient together with the floaters. The retinal hole can then progress to a retinal detachment.
My patient then noticed a shadow in his peripheral vision which progressively got worse until his central vision was lost. This meant that the centre of the retina, the macula, was now detached.
My patient is recovering well after surgery and I am confident that he will regain his eye sight.
Have a Happy and Prosperous 2012 to everyone out there!