The retina is the nerve layer at the back of your eye. The retina is responsible for sensing light that enters the eye and for transmitting these signals via the optic nerve to the brain. The brain is then able to generate an image.
What is Retinal Detachment? A retinal detachment occurs when the retina is separated from the underlying tissue by fluid; and it stops functioning. This causes complete loss of central and peripheral vision; and a shutter like effect that can lead to total blindness. A retinal detachment is a very serious problem that almost always causes blindness; unless it is assessed and treated promptly.
For INSURED patients this is mostly covered by private hospital health insurance and for all UNINSURED patients (including pensioners) the cost is about $4500 + Medicare rebates per operation which covers the facility bed fee, the operating theatre costs, the anaesthetist, the surgeon and the assistant surgeon.
The vitreous is a clear jelly-like substance that fills the middle of the eye. As we get older the vitreous may pull away from it’s attachment to the retina at the back of the eye. Usually the vitreous separates from the retina without causing problems. But sometimes the vitreous pulls hard enough to tear the retina in one or more places. Fluid may pass through the retinal tear, lifting the retina off the back of the eye, much like wallpaper can peel from a wall.
The following conditions can increase the chance of having a retinal detachment:
- Nearsightedness (Myopia)
- Previous cataract surgery
- Previous retinal detachment of your other eye
- Family history of retinal detachment
- Weak areas in your retina that can be seen by your ophthalmologist
These early symptoms may indicate a retinal detachment:
- Flashing lights
- New floaters
- A shadow in your peripheral vision
- A gray curtain or veil moving across your field of vision
These symptoms do not always mean a retinal detachment is present, however you should see your ophthalmologist as soon as possible. Your ophthalmologist can diagnose a retinal detachment during a dilated eye examination. Only after careful examination can your ophthalmologist detect if a retinal tear or early retinal detachment is present. Sometimes a retinal detachment can occur even though the eye has been carefully examined. The risk is greater in the first 6 weeks following symptoms.
Most retinal tears need to be treated with laser surgery or cryotherapy (freezing), which seals the retina to the back of the eye. These treatments cause little or no discomfort and may be performed in the ophthalmologist’s rooms. Treatment of retinal tears usually prevents a retinal detachment.
Almost all patients with retinal detachments require surgery to return the retina to its normal position. Urgent treatment may be necessary depending on the degree and position of the retinal detachment. Your ophthalmologist will advise whether surgery is urgent or if it can be scheduled for a more convenient time for you.
Retinal detachment surgery is major eye surgery. Surgery is sometimes urgent to prevent macula damage or before further vision is lost. Some cases are less urgent and can be delayed a few days or even longer.
Scleral buckle and vitrectomy are the two procedures mostly preferred to treat a retinal detachment. Scleral buckle surgery may be used in combination with vitrectomy surgery.
Small sutures are used to sew a silicone band or “buckle” to the outside of your eye at the point of the detachment. The buckle gently makes an indent in your eye and pushes the eye wall back into contact with the retina. The buckle is placed behind the muscles that move your eye and is not visible to other people. The buckle is usually permanent.
This procedure is used to remove the vitreous that is pulling on the retina and sometimes to clear blood that prevents a view of the retinal detachment. Through tiny incisions, small instruments are placed inside the eye to remove some or all of the vitreous. This can help relieve traction on the retina.
An air or gas bubble may then be injected into the vitreous to push the retina back into place. The retina is held in place by the pressure of the gas bubble. The body’s own fluid will slowly replace the gas bubble. In some cases silicone oil may be used instead of gas. After the retina has healed the silicone oil can be left in the eye or removed during another procedure. If scar tissue has formed on the surface of the retina, it can be peeled away during the vitrectomy surgery.
Additional procedures to help treat retinal detachment
- Drainage of sub-retinal fluid: The fluid trapped between the retina and underlying tissue may be reabsorbed naturally or may be drained during the re-attachment procedure. Subretinal drainage has additional risks.
- Laser treatment (photocoagulation): A retinal tear may be sealed with laser during surgery. Laser also helps to seal any leaking retinal blood vessels.
- Cryotherapy: This is used to seal retinal tears. A probe cooled with nitrous oxide is applied to the tear which freezes the retina around the tear. As the area heals it forms a seal around the tear and helps the retina reattach to its normal position.
All surgical procedures have risks. An untreated retinal detachment usually results in permanent severe visual loss or blindness. Some of the surgical risks include:
- Endophthalmitis – infection inside the eye which can cause permanent vision impairment.
- Choroidal Haemorrhage – bleeding in the retina causing permanent visual blurring.
- Post-operative Glaucoma – increased pressure inside the eye with regular visits to the specialist required to assess.
- Cataract development – clouding of the natural lens causing gradual reduction in vision and high sensitivity to light.
Most retinal detachment surgery is successful, although a second operation is sometimes needed. If the retina cannot be reattached, the eye will continue to lose sight and ultimately become blind.
Details regarding risks and complications will be provided by your treating ophthalmologist when discussing surgery and proceeding with consent. At this time, your Brisbane Eye Clinic Ophthalmologist will be pleased to answer any queries you may have.
Vision may take many months to improve and in some cases may never return fully. Unfortunately some patients do not recover any vision. The more severe the detachment, and the longer it has been present; the less vision may be expected to return. For this reason it is very important to see your ophthalmologist at the first sign of any trouble.
The strength of the spectacle lens will change following retinal detachment surgery, especially if a scleral buckle is applied. Even with the correct lens in place the vision may still not improve