RetinalDetachment
WHAT IS RETINAL DETACHMENT
Retinal Detachment is the disease of the eye in which the Retinal layer separates from its underlying layer due to the presence of unnatural fluid in Subretinal Space. For proper functioning of retina, it needs to be attached to its underlying layer which provides blood and nutrition to Retina. Once retina is detached it needs to treated urgently as loss of nutrition results in permanent damage over time.
HOW EYE NORMALLY WORKS?
The light which enters the eye through cornea is focused over the light sensitizing tissue called the Retina. This delicate tissue converts Light energy into electrical energy which is transmitted via the Optic Nerve into Brain which interprets these signals to see the world around you.
Most of the light entering our eye is focused onto a small portion of Retina called as Macula. This is a highly sensitive portion of Retina which is responsible for detailed central vision and most of color vision. It provides the vision to read, recognize faces, drive a car etc. The rest of the retina is responsible for peripheral vision.
POSTURING
Posturing is lying or sitting in a particular position with regards to your head. Posturing method and duration will be advised by your surgeon depending upon the type of Retinal Detachment, which might last up to 2 weeks after the surgery.
If the surgeon decides that you need to posture, then there are a few things which you must plan prior to surgery. Staying face down for several days can be difficult and can be made more difficult if you have other associated problems such as arthritis. It is important to discuss with your surgeon these other conditions which might restrict your posturing.
Usually posturing is needed about 45 minutes of every 60 minutes. The time spent off posturing must be utilized for eating, toilet and instilling medicines. Trying out different posturing positions can avoid stiffness and boredom.
FLYING AFTER SURGERY
You need to tell your eye surgeon if you need to Fly after the surgery. Flying is strictly prohibited if you have a Gas bubble in your Eye. If you need to undergo any other surgery while your eye has a Gas bubble, the anesthetist needs to be informed.
HOW SUCCESSFUL IS THE TREATMENT?
Surgery is usually very successful at reattaching the retina. The extent to which your detailed central and peripheral vision will improve depends upon the extent of detachment prior to surgery, whether the macula was detached at the time of surgery or not and for how long the detachment was present before it was treated.
If your macula remained attached, then the chances are very good that you will recover a very good central vision. If your macula had detached but your treatment was carried out quickly then central vision can return but it may be distorted and wavy. Many people find that they adapt to this distortion over time.
Unfortunately for some people, the operation may be successful at reattaching the retina but it may not bring back detailed central vision or areas of peripheral vision. This can happen in any circumstance but the risk is higher the longer the retina has been detached without any treatment.
UNTREATED OR UNSUCCESSFUL TREATMENT OF RETINAL DETACHMENT
If a Retinal Detachment is left untreated then you will lose all useful vision. This can also happen if the surgery has been unsuccessful, however it is usually possible to have one or more operations to try to re attach the retina. At each stage the eye surgeon will discuss with you the likelihood of success and the need to have more treatments.
Causes & Risk
WHAT CAUSES RETINAL DETACHMENT?
Majority of Retinal Detachments occur because of a hole or tear formation on the retina. This retinal tear allows the fluid in the eye to pass through it and occupy a spaces underneath the retinal tissue causing it to detach from its underlying surface.
Tears usually occur when the Vitreous Gel which occupies middle portion of our eye undergoes separation. Although this process called as PVD is natural but in very few individuals it pulls the retinal tissue along causing it to break.
A direct blow or trauma to the eye can cause Retinal Detachment however a trauma to head without any eye injury does not lead to this.
Other Eye conditions such as Diabetic Retinopathy can form a scar tissue over the surface of retina, once this scar tissue undergoes contraction it can lead to retinal pull over that region leading to retinal break and subsequently Retinal Detachment.
Thirdly an uncommon cause of Retinal Detachment is leakage of fluid from the vessels beneath the retinal tissue without an actual presence of retinal break or tear. This is seen in cases of Eye inflammations and Tumour.
WHO IS AT RISK?
Retinal detachment itself is rare occurring in 1 in 10000 people each year. It can happen to anyone irrespective of age although is rarely seen in younger individuals and most common in individuals over 60 years of age. This is because vitreous gel changes commonly occur at an advanced age.
Risk of RETINAL DETACHMENT is more if you:
- Have Myopia
- Have had previous Cataract Surgery
- Had trauma or blow to eye
- Other eye had Retinal detachment
- Have a family history of Retinal Detachment
SYMPTOMS
WARNING SYMPTOMS OF RETINAL DETACHMENT
FLOATERS :
Floaters are caused by bits of Debris in vitreous gel which cast a shadow onto the retina. Floaters are very common and most people can expect to have a few as they get older. Individuals who are myopic or have had surgery or trauma can expect to have more floaters. These floaters can take many shapes such as rings, worms, spider webs, cob webs. They are not generally a cause of concern especially if they have been present since months or years.
However, if you notice a sudden increase in the number of these floaters in hundreds or thousands then it might indicate that some changes are happening at the back of the eye.
FLASHING of LIGHTS
Many people experience flashing of lights especially at the edges of their vision. These are caused due to retinal irritation caused by movement of vitreous gel within the eye and not by actual light entering the eye.
In most cases flashes are caused by Posterior Vitreous Detachment which is a normal process with no long term problems to vision. However, flashing lights can indicate that there is tear in the retina. You cannot tell whether flashes are being caused by retinal tear or Vitreous separation. If you suddenly experience new flashes, you must have your eyes examined by a retina specialist.
DARK SHADOWS
Once the retina detaches it can’t work properly. It appears as a black shadow or a curtain in the vision. One cannot see through or around it. As the retinal detachment progresses, more of vision is taken over by black shadows. These symptoms warrant an early examination by eye specialist.
PREVENTION
If you have a normal retina, then there is no treatment to reduce the risks of Retinal Detachment. Regular eye tests are an important way to make sure your eyes are in a good health. Most individuals should have their eyes tested every 2 years however some individuals may require a more frequent tests which will be recommended by the ophthalmologist.
One of the causes of Retinal Detachment is trauma to the eye. Individuals working with machinery must wear protective glasses. Contact sports should be taken carefully with respect to eyes. Retina Detachment does not happen with straining, bending forwards or lifting heavy weight.
If you experience flashes or floaters and the eye doctor detects a retinal hole or tear, then this should be treated in order to reduce the risk of Retinal Detachment developing.
Treatment of retinal hole or tear can be done by Laser or CryoProbe. A laser treatment causes small burns around the retinal tear which helps to “weld” the retina to the back of the eye. CryoProbe on the other hand causes freezing around the involved site which increases adherence of retina to the back of eye.
This type of procedure can be done in Out Patient using only a Local Anesthetic. Vision is usually not affected by this kind of treatment.
TREATMENT
A Retinal Detachment should be treated with surgery to reposition the retina against the back of the eye. This should be done as early as possible to attain best results. If Retinal Detachment is not treated, then the individual is likely to lose all the vision in the affected eye over a period of time. A Retinal Detachment will not get better without treatment and there is no medicine which can cure it.
Retinal Detachment surgery is complex and is individualized to each case. The type of surgery depends on the type and location of detachment and any other complicating associated factors such as other eye conditions associated with it.
After the initial assessment the surgeon will decide how quickly the surgery is required. This can be within the next 24 hours and within the next week. Usually only one operation is needed and the types of surgery described below might be combined. Most of the adults will be operated under Local Anesthesia meaning that they will be awake but will feel nothing in their eye. Children will have General Anesthesia wherein they will be unconscious for the surgery. Many people go home the same day of surgery but some may need to stay in hospital as per surgeons preference.
VITRECTOMY
Most people with Retinal Detachment will have an operation called Vitrectomy which removes Vitreous gel from the patients eye followed by filling the space with Silicone Oil or Gas depending upon the location of Detachment. The gas or Oil keeps the Retina apposed to its underlying surface.
SCLERAL BUCKLE
In some cases a Scleral Buckle might be used. This involves attaching a tiny piece of silicone material to the outside of the eye. This mechanism pushes the outside of the retina against the site of Retinal break thus sealing it and resulting in settling of Detached Retina. Cryo or Laser will be used to seal the area around the break. The buckle is generally not removed and is not visible once surgery is finished.
RECOVERY FROM RETINAL DETACHMENT SURGERY
After the surgery the eye will feel very uncomfortable which might last for a few weeks, reducing gradually. There might be some bruising and eyelids will feel sticky. Eye drops will be given to prevent infection.
If Silicone Oil is injected in the eye, then a second surgery is required to remove the oil after 1-2 months or even later. It cannot be left indefinitely in the eye.
If a Gas bubble is placed in the eye, your vision will be very blurry initially till the time the Gas remains in the eye. As the gas absorbs a wavy line will be seen in the vision which is actually the divide between the gas bubble and normal eye fluid. This will slowly move and then disappear as Gas completely absorbs from the Eye.
Even without the Gas the vision will be very blurry for a number of days or even weeks. The vision recovery is slow and gradual. Despite this you don’t have to limit how much you use your eyes, watching TV or reading will not cause any problem.
The eye surgeon will advise which activities need to be avoided after the surgery. The advice may be different depending upon the type of surgery done.
Once your eye has healed from the surgery you can continue the sports or activities you enjoy. Again, your eye surgeon is the best person to let you know if any of your regular activities should be avoided in the long term. Usually full contact sports which may involve a blow to the eye such as boxing, kick-boxing and martial arts aren’t recommended for someone who has had retinal reattachment surgery.