Retinal Tear

Description

Retinal detachment is a sight threatening condition that if left untreated could lead to retinal detachment and possible severe sight loss. Retinal tears occur when the vitreous, the gel like substance inside the eye, begins to change composition or shrink. This causes traction on the retina and can result in tears or holes.

Symptoms

Retinal tears are painless and symptoms may be difficult to distinguish straight away. The most common symptoms noted by individuals who are experiencing a retinal tear include:
  • Sudden appearance or floaters (dark spots that float in to your field of view
  • Sudden short flashes of light in one eye
If left untreated, these symptoms can progress to blurred vision and periods of visual loss indicating the tear may be progressing to retinal detachment. It is important to go see an eye health professional if you begin to notice any of the above symptoms.

Causes

Although retinal tears can be the result of injury, most retinal tears are a result of posterior vitreous detachment (PVD). The vitreous is a gel like substance that fills the back of the eye. As we age the vitreous begins to loose it’s gel like consistency and become watery. It may also begin to shrink detaching from the retina. In most cases the vitreous comes away easily as we age and there is no damage causes. However, certain people have a more “sticky” vitreous and as it begins to shrink away from the retina the traction pulls creating a retinal tear. People who are at higher risk of retinal tears may have a high degree of myopia (nearsightedness), familial history of retinal tears, associated lattice degeneration (thinning spots of the retina), and uncontrolled diabetes or other ocular conditions.

Diagnosis

Patients who present with symptoms of new onset of flashes or persistent new floaters should be suspected of having a retinal tear. 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.. 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 tears.

Treatment

Before beginning treatment it is essential that the degree of retinal tear that has occurred is recognised. 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. 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

There are currently no active clinical trials investigating alternative treatment options for retinal tears or holes. Completed trials have investigated novel surgical techniques such as Internal limiting Membrane (ILM) technique which is used to promote faster and more effective healing of retinal tears. 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.