Retina is a photosensitive layer of tissue covering inner side of the eye globe. It consists of neurons that convey messages to brain to actualize vision. There are many different retina disorders with one of them being retinal detachment. Unfortunately, retinal detachment is not a preventable condition. However, if it is detected and repaired early, the possibility of a devastating outcome can be minimized. Therefore, in case of symptoms like lightning streaks or floating dark spots, immediate medical help should be sought from an ophthalmologist. Main treatment methods are laser, freezing treatment, and surgery such as vitrectomy.
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What is retina?
Retina is a layer consisting of a thin and transparent nerve tissue covering the inner side of the eyeball. It is sensitive to light and color, and consists of millions of cells sending the perceived light to brain via optical nerve. Retina processes the information collected by photoreceptor cells and sends these to brain via optical nerve. Retina is vital for vision; a damage in this region may result in blindness.
What does retina do?
The role of retina is to perceive light and colors, and send them to brain via neurons. Retina forms a picture of light which was focused by the eye lens, and the brain decides what this picture is. Located in the center of retina, “macula” provides a sharp, clear and central vision for reading, driving, and perceiving the images in detail. Unhealthy and non-functioning retina may affect visual ability, and may even lead to blindness over time.
Retinal detachment causes
Retinal detachment is usually associated with the gel-liquid type transparent vitreous tissue filling inside the eye globe. This tissue is firmly attached to retina on several places, and when it shrinks for some reason and tugs retina, it may cause retinal penetration or detachment.
Thus, vitreous tissue leaks through this rupture and starts to separate the retina from the eye wall. This is called retinal detachment. The position of the retina starts to change. And this results in central visual loss.
Risk factors of retinal detachment
- Eye injury
- Thinning retina with advancing age
- History of eye operations such as for cataracts or glaucoma
- High-degree short sightedness (myopia)
- Presence of other ocular signs
- Genetic predisposition
- History of retinal detachment in the other eye
While retinal detachment may occur at every age group including children, it is more common in patients who are 40 years or older. It may affect men more than women.
Symptoms of retinal detachment
- Blinking lights similar to flashes and lightning streaks
- Spiderweb-like images
- A gray curtain across the visual field
- Decreased visual ability
- Floating dark spots
Retinal detachment is an emergency medical condition because if it is not treated fast, it may result in permanent visual loss. Therefore, if any of these symptoms is experienced over and over, immediate help should be sought from an ophthalmologist.
Diagnosis of retinal detachment
When you visit the doctor office with the suspicion of retinal detachment, the examination is performed using drops which dilate the pupils. With this examination, a possible retina rupture or hole can be detected immediately.
Moreover, the doctor may use eye ultrasound to detect whether there is liquid leakage into the retina, and if there is, to detect the extent of this leakage. Thereby, a treatment is decided based on the severity of the retinal detachment.
Treatment of retinal detachment
Treatment for ruptured retina
If diagnosed early, retinal detachment can be treated using two different methods:
- Laser surgery: Laser is used to create small-sized burns around the rupture, and the retina is attached to the created scars.
- Freezing treatment (cryopexy): A wound is created around the retinal detachment area using a very cold special freezing probe, and the rupture is attached through this wound.
The patient does not feel pain in either of these procedures. They are outpatient treatment performed in the doctor’s office, and based on the condition, the patient might need to return for a follow-up visit after a few days.
Treatment for detached retina
If detachment occurs as a result of the rupture, surgical procedure is necessary to place the retina back to its proper position. The method of retinal fixation varies based on the degree of the detachment. Methods include:
A gas bubble is injected into vitreous tissue in the center of the eye, and then, laser treatment is applied to repair the rupture. Another method is to repair the detachment using freezing treatment before injecting the gas bubble. This is a simple operation causing less damage to the eye.
It can be applied under local anesthesia as an outpatient treatment in the doctor’s office. The patient might be requested to keep his/her head in a certain position for a few days. Gas bubble disappears within 15 days to 2 months. During this period, air travel is forbidden until the doctor allows it.
Scleral buckle surgery
This treatment consists of placing an elastic band (scleral buckle) onto the white part outside of the eye (sclera) to prevent the force pulling the retina out of its place. Usually, the liquid under the retina is emptied, and the retina is gently pushed back to its usual position.
This procedure is performed under local or general anesthesia in the operation room. The patient can return home after the operation.
What is vitrectomy?
This surgical procedure is the most frequently used method to treat severe retinal detachments.
How is vitrectomy performed?
It is performed under local or general anesthesia in the operation room. In this procedure, a small incision is made on the sclera (white part of the eye). Later, a small instrument is placed into the eye to remove vitreous tissue filling the middle section of the eye. To reattach the retina after the vitreous tissue removal, usually a gas bubble is injected into the eye. The injected gas bubble pushes the retina back to eye wall.
During the healing process, the eye produces new liquid that gradually replaces the gas and fills the eye. If a gas bubble is injected into the patient’s eye, the doctor may request from the patient to keep his/her head in a certain position for a while. Until the doctor says the gas bubble disappeared completely, air travel and traveling to high-altitude places is forbidden.
Because, a sudden altitude increase might be risky for eye pressure. Sometimes, oil bubbles can be used instead of gas bubbles, however, these need to be removed from the eye after a certain period of time. If oil bubble is injected, air travel is allowed. On a side note, vitrectomy can be performed together with scleral buckle treatment in certain cases.
While sometimes a second intervention might be necessary after detached retina operations, they usually produce nearly 100% success rates. If retinal detachment is treated before macular separation, better results might be obtained.
As the improvement in the visual ability cannot be predicted after the operation, it is necessary to wait for a few months to see the results.
Healing might take long, and in some cases, complete recovery might never be possible. Unfortunately, it may not be possible to treat extremely advanced retinal detachment, and day by day, the visual loss may gradually worsen and lead to blindness.
How to prevent retinal detachment?
Unfortunately, it is not possible to prevent retinal detachment. However, if routine eye exams are not neglected, early-stage retinal detachment can be diagnosed and emergency precautions can be taken. Thereby, retina separation can be avoided. Moreover, to avoid devastating outcomes in case of retinal detachment symptoms, immediate medical help must be sought from an ophthalmologist. Also check:>>>