Dr Ben Wild
Overview |
Our vision comes from light waves stimulating retinal photoreceptors and these photoreceptors transferring their signals through the several different cells along the various layers of the retina and onwards to the brain. In order for light to focus on the retina, it must pass through the clear cornea at the front of the eye, the pupil, the clear lens and the clear vitreous humor gel before stimulating the retina.
A frontal view of a healthy retina.
A retinal detachment refers to an event where the retina separates from the retinal pigment epithelium, which separates the retina from the choroidal blood supply at the back of the eye, There are 3 main types or retinal detachments; 1. rhegmatogenous, where the detachment came from fluid entering a retinal hole or tear, 2. traction, where there are pulling forces on the retina but no retinal break, and 3. exudative, where there is a leak from the blood vessels of the retina, choroid or other tissue causing the detachment.
Retinal detachments occur in 1 out of every 10,000 people, in 10% of those cases occur in both eyes at some point, and over 40% of retinal detachment patients are nearsighted where the higher the nearsightedness the higher the risk.
A frontal view of a retina with a rhegmatogenous detachment (upper left), a tractional detachment (middle), and an exudative detachment (middle right).
Signs and Symptoms |
Signs
Low eye pressure, inflammation inside the eye (uveitis), possible asymmetrical pupil reactions (RAPD), retinal break, retinal thinning, growth of fragile blood vessels, wavy moveable retina in rhegmatogenous, tent-like concave pulling on the retina in tractional, smooth convex shifting fluid in exudative,
Symptoms
Flashes of light like lightning bolts and floaters for rhegmatogenous, curtain-like blind spot for all 3 types,
Causes and Risk Factors |
Causes
Fluid entering the space between the retina and the retinal pigment epithelium.
Risk Factors
Rhegmatogenous | |
Tractional | Proliferation of blood vessels as seen in retinopathy of prematurity, diabetes, etc., penetrating trauma. |
Exudative | Intra-ocular inflammation, tumors, central serous retinopathy surgery, leaky blood vessels, unknown (idiopathic). |
Prevention and Treatment |
Prevention
Avoid health conditions that can cause retinopathy by living a healthy balanced lifestyle, treat retinal breaks before they become retinal detachments.
Treatments
· Pneumatic retinopexy where the detachment is treated with laser or cryotherapy followed by the insertion of a gas or silicone bubble to hold the retina in place.
· Scleral buckle (a silicone pad sutured to the sclera (white part of the eye), that compresses the eye), done after vitrectomy (removal of the vitreous gel).
· Manually drain the fluid.
Prognosis |
A retinal detachment, once occurred, affects vision permanently. If the macula, the area of the retina that corresponds to a patient's central vision, is still attached, the surgery for retinal detachment needs to proceed asap (within 24 hours). If the macula has detached, there is less urgency because the damage has already been done. There is a considerable amount of variability in vision after a retinal detachment has been treated. Outcomes range from 20/25 vision with a permanent blind spot to legally blind. The sooner a retinal detachment is treated, the more likely the patient is to have some visual recovery.