Retinal Detachment

Description

Retinal detachment is a sight threatening condition that affects approximately 1 in 10000 individuals worldwide. Previously thought to be a permanently blinding condition, great advancements in the field have lead to the development of surgical techniques that can repair retinal detachments. Retinal detachment occurs when the retina (the thin lining at the back of the eye) begins to pull away from the blood vessels that supply it with oxygen and nutrients. Retinal detachment can be falsely diagnosed as retinoschisis or choroidal mass. Retinal detachment is more often confused with retinoschisis. Retinoschsis can be distinguished from retinal detachment by appearance on ultrasound, uptake of light observed in retinoschisis, and absolute with retinoschisis versus relative blind spots in retinal detachment. Choroidal masses can be distinguished from retinal detachment through ultrasound imaging.

Symptoms

Individuals who are at risk of their retina detaching may notice several warning signs that occur prior to retinal detachment. It is important that these can be recognised as a potential issue. The warning signs associated with retinal attachment are outlined below.
  • Sudden appearance or floaters (dark spots that float in to your field of view
  • Sudden short flashes of light in one eye
  • Blurred vision
  • Gradual reduction in peripheral (side) vision
  • A “curtain”-like shadow over the field of view
Although retinal detachment is in itself painless, it is important to go see an eye health professional if you begin to notice any of the above symptoms.

Causes

There are three different types of retinal detachment: Rhegmatogenous Rhegmatogenous retinal detachments are the most common and are caused by a hole or tear in the retina which results in the infiltration of fluid to the sub-retinal layers. The fluid then causes the retina to pull away from the underlying tissues. The areas where the retina detaches is cut off from its blood supply therefore effectively losing its source of oxygen and nutrients, causing vision loss. The most common cause of rhegmatogenous retinal detachment is ageing. As we age the gel like substance in our eyes, known as vitreous, begins to change consistency and shrink away from the retina. In most cases this causes no harm to the retina, however, at times this can cause a slight hole, or tear. If left untreated the liquid vitreous can enter the sub-retinal layers causing retinal detachment. Tractional Tractional retinal detachment occurs most often when scar tissue grow on the retina causing the retina to pull away from the back of the eye. Tractional retinal detachment is most commonly observed in individuals who already have known eye complications or uncontrolled diabetes. Exudative Exudative retinal detachment describes the accumulation of fluid in the subretinal layers without the presence of a hole or tear. Exudative retinal detachment can be caused by eye injury, tumours, inflammatory disorders or age-related macular degeneration. Risk factors associated with retinal detachment include but are not limited to:
  • Age- retinal detachment is typically observed in people over 50 years of age
  • Previous cases of retinal detachment in one eye
  • Familial history of retinal detachment
  • Previous severe eye injury- which may cause scar tissue growth on the retina
  • Extreme nearsightedness

Diagnosis

Patients who present with symptoms of new onset of flashes or persistent new floaters should be suspected of having a retinal tear. A patient with slowly progressive visual field loss should be suspected of having a retinal detachment and treated accordingly. Doctors will perform a number of clinical tests and obtain both medical and family history in order to ensure the correct diagnosis is achieved. Basic eye health examinations will likely be performed. These include visual acuity examinations, pupil response, visual field testing, and intraocular pressure. Doctors will also use an ophthalmascope, a device similar to a magnifying glass connected to a bright light, which enables them to visualise the back of the eye and to identify the presence of holes or tears or any areas of retinal detachment. A painless imaging technique known as optical coherence tomography (OCT) may also be used to obtain a cross-sectional view of the retina and identify areas of retinal detachment.

Treatment

Before beginning treatment it is essential that the exact type of retinal detachment that has occurred is recognised. Both rhegmatogenous and tractional retinal detachment benefit from surgical intervention. For rhegmatogenous detachments, all tears or holes present in the retina should be identified, treated and closed. There are a number of treatment options for this including a scleral buckle and vitrectomy. A vitrectomy is when the surgeon removes the vitreous gel from inside the eye to prevent it from pulling further on the retina. The vitreous gel is then replaced with a mixture of gas and air. The air/gas bubble puts pressure on the edges of the macular hole encouraging it to heal. A scleral buckle is a piece of silicone, sponge, or rubber, that is sewn on to the outside of the eye to the sclera (the white part of the eye). The material “buckles” the sclera toward the middle of the. This motion reduces the “pull” or traction of the retina, allowing the tear to settle and heal against the retinal wall. Exudus retinal detachments should be treated by first treating the primary cause. If there is a mass identified this should be removed. Inflammatory diseases should be identified and treated accordingly. No matter what level of vision a person may have, it is important to look after the eyes. To find out more about what can be done to take care of the eyes on a daily basis, please visit our Tips for Good Eye Health. For further information, please contact the Research Department on 01 6789004 or email research@fightingblindness.ie.

Research

Researchers and clinicians are continually seeking more effective approaches to treat retinal detachment. Despite already having effective treatments, some clinicians are aware of the continuing retinal cell death in patients with retinal detachment following treatment and are looking to address the root of the problem. A clinical trial that is currently active is investigating the potential condition causing cytokines (immune response elements in the body) that may be present in the vitreous of the eye. This trial can be viewed in full on the clinical trials website. Information about other clinical trials that are on-going and completed can be found on the clinical trials website and can be searched by both condition and location.

Support

Receiving a diagnosis can be overwhelming for anyone, but this is not a journey that you have to make alone. There are many groups and resources available to provide support for people living with Stargardt Disease. Fighting Blindness offers a free and confidential counselling service (Insight Counselling). For further information please contact insight@fightingblindness.ie or call 01 6746496. We also offer support groups for people with a visual impairment to share their feelings and experiences with others facing the same challenges. Please consult the support groups section of our website here to access the latest timings and days for the various support groups we offer. For further information please contact insightgroups@fightingblindness.ie or call 01 6746496.

Resources

Féach provides support for parents of children living with sight loss in Ireland. ChildVision is the national education centre for children with sight loss in Ireland. Vision Ireland, formerly NCBI (National Council for the Blind in Ireland) provides support and services for people living with sight loss in Ireland. Irish Guide Dogs for the blind helps individuals and their families to achieve improved mobility and independence.