Retinal Detachment

Retinal detachment is the separation of the retina from the back of the eye and is a medical emergency. Without urgent surgery, sight will be lost permanently. The retina is a transparent layer of nerve tissue at the back of the eye. It is probably the most important structure in your eye because it converts what you see into electrical impulses to your brain.

Retinal Hole Causes Retinal Detachment

The vitreous is a transparent jelly like structure inside the eye that is attached to the retina. As you get older, this vitreous jelly degenerates and pulls away from the retina. Sometimes, this can cause a hole in the retina. The hole allows fluid to enter underneath the retina and causes it to detach. This is like wallpaper coming off the wall when it is loose.  Most eye doctors would treat the retinal hole with laser to prevent development of retinal detachment.

Retinal detachment occurs in less than 1 in 10000 people but is more common in people with myopia, who have had previous eye trauma, or complicated cataract surgery.  It is also more common in the older age group compared to children.

Flashes and Floaters Common Symptoms

Symptoms of retinal detachment include black spots in your field of vision, flashing lights, loss of peripheral vision and finally, total loss of vision. A retinal detachment normally starts in the corner of your eye and you will notice a shadow your periphery at first. As it progresses towards the center of your eye, the macula, you finally lose your central vision. You can also listen to Dr Fong talking about floaters. 

Diagnosis of Retinal Detachment

The diagnosis can be made by an eye doctor who examines the back of your eye with an ophthalmoscope. There are no specific tests for retinal detachment. The diagnosis is quite straightforward and there is usually no doubt about it.

Retinal detachment is a medical emergency and needs to be treated by a trained retinal surgeon. Surgery is normally done by vitrectomy surgery, laser burns to seal the retinal holes, followed by, insertion of special gas or silicone oil into the eye to prevent the retina from redetaching. Modern vitrectomy surgery can now be done without sutures. Sutureless small gauge vitrectomy surgery allows faster recovery after surgery with less post op pain. We also now use special wide-angled viewing systems with the operating microscope to have better visualization of the retina during surgery.

Retinal Surgery

Another way to treat retinal detachment is by suturing a piece of silicone called a scleral buckle to the outside of the eye and treating the retinal hole with freezing treatment called cryotherapy. This procedure is widely known as “Cryo-buckle”. The scleral buckle can also be combined with vitrectomy in more complicated retinal detachments.  This buckle presses the eyeball inwards to help close the retinal hole.

Surgery for retinal detachment is quite successful and we can reattach the retina 90% of the time with one operation. Sometimes, further surgery is required if the retina comes off again. Patients often have to posture face down after surgery to allow the gas bubble to come into direct contact with the retina. Your retinal specialist will tell you how to posture and for how often.

The gas bubble in the eye normally dissolves by itself after 1 month. You should not travel in an aeroplane if you have gas in the eye. This is because the gas bubble will expand at high altitude and cause very high pressure in the eye. If you have silicone oil injected into the eye, this oil will have to be removed after 6 months with a second operation.

In summary, if you have any symptoms of retinal detachment, you should seek expert advice from a retinal surgeon and have surgery as soon as possible if you do have such a problem. Do not delay treatment as it may result in permanent loss of vision. If retinal detachment surgery is done before the detachment involves the macula, you can normally retain your vision as before. Retinal detachment cannot be prevented by diet or supplements. People who are very myopic  (more than -6.0 dioptes of power) are at much higher risk of developing a detachment than the rest of the population.