A guide to retinal detachment

The back of your eye contains a thin lining called the retina, which sends the signals to your brain that allow you to see. However, in some instances, the retina will suddenly pull away from the blood vessels that supply it with its nutrients and oxygen. We call this, retinal detachment. It is relatively rare and mainly affects older people, typically from the age of 60 and above.

What are the warning signs of a detached retina?

Several warning signs can help you identify if you are at risk of losing your sight as a result of retinal detachment, including:

• Short, spontaneous flashes of light that last a second
• Blurry and distorted vision -Sudden streaks, specs and spots that come into your field of vision
• Large single floaters in your eye that have the appearance of a housefly
• A sudden feeling of a curtain veil obscuring your vision
• Reduced peripheral vision

Retinal detachment tends to only happen in one eye. The chance of it occurring in both eyes are one in ten. Whether it's one eye or two, if you experience any symptoms, it's best to seek medical attention and immediately go to see your doctor.

Retinal detachment causes

There are three types of retinal detachment, each of which are caused by different factors.

What causes retinal detachment?

• Rhegmatogenous-this is the most common form. A tear in your retina often causes this, allowing fluid to pass through. Fluid gathers underneath the retina as a result, and the retina detaches from the layer of tissue. A retinal tear can cause loss of vision.
• Tractional-This type of retinal detachment is common in people with diabetes and other neglected health conditions. Diabetic retinopathy is an eye disease that can cause blood vessels to form and if left untreated can result in scar tissue which can then contract and result in a tractional detachment. In this case, the retina detaches from the eye as a result of scar tissue growing on its surface.
• Exudative or secondary retinal detachment-This occurs when fluid is collected beneath the retina without there being a hole or tear in the retina. AMD can cause this, as can inflammatory problems, eye injuries and tumours.

Lattice degeneration can also lead to retinal detachment as it weakens the retina and as a result can cause tears and holes which can develop into a retinal detachment.

Injury of the eye is a less common cause of retinal detachment. Boxers often succumb to detachments when given harsh blows to the eye. Previous eye surgery, such as cataract removal, may also make the retina more vulnerable to damage.

What is the most common cause of retinal detachment?

The most common cause of retinal detachment is ageing. The retina becomes thinner and more brittle over time and may detach from the blood vessels beneath. The nerves send signals to the brain, which allow you to see. If a substantial amount of blood deprives the nerves, the nerve cells die, which can result in loss of sight.

How to prevent retinal detachment

You cannot prevent retinal detachment; however, you can take precautions to lower the risk of retinal detachment caused by an injury. Precautions include protecting your eyes with the appropriate eyewear when playing sports or carrying out other activities that could pose a threat to your eyes.

Can a retinal detachment heal on its own?

Retinal detachments cannot heal on their own. You should treat them immediately.

How serious is a detached retina?

A detached retina can lead to permanent vision loss if left untreated. It is, therefore, a serious matter.

Diagnosis

If your GP suspects you have a retinal detachment, they will refer you to an ophthalmologist who will examine your eyes for signs of retinal detachment. They may use an ophthalmoscope or may go one step further with an ultrasound scan if needed.

Retinal detachment Treatment

Surgery is often required to reattach loose retinas, and most treatments are successful. Surgery can be done under general and local anaesthetic depending on the doctors and the patient's personal preference.

Retinal detachment surgery

Depending on the individual and scale of the problem, there are several different surgeries available, including:

Laser surgery - a laser can weld the retina back to the tissue by creating a scar. It does this by burning around the retinal tear.

Cryotherapy - extreme cold destroys abnormal tissue and forms a retinal scar around the tear. The scar attaches the retina to the wall of the eye.

Scleral buckling - this involves attaching silicone or sponge onto the sclera (the white of the eye) at the spot of the retinal tear. Doing this holds the retina against the sclera until a scar heals the damage.

Vitrectomy - the vitreous humor gel is taken from the eye to allow easy access to the retina. Silicone oil acts as a substitute to keep the retina in place. Stitches repair the hole or tear, and the silicon oil gets removed months after.

Pneumatic retinopexy - This happens in less complicated cases. Cyropexy is first used to freeze the torn area, and the vitreous cavity gets injected with a bubble. The bubble prevents additional fluid from gathering under the retina and puts pressure on the retina, causing it to reattach.

Recovery ranges from a few weeks to many months, during which time you are likely to experience reduced vision initially, which should improve as you heal. Some people may experience reduced peripheral or central vision, even if the retina is attached again.

Leaking fluid, and feelings of stickiness and itchiness around the eye are normal after surgery.

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