The retina is the delicate transparent tissue covering the interior wall of the eye. Light-sensitive retinal fibers receive images projected through the lens and send them through the optic nerve to the brain which converts the information into an image. When the retina is damaged, the images sent to the brain are blurred.
Retinal tears and retinal detachments may occur through illness, injury, heredity or as the result of normal aging. Whatever the cause, there are a number of procedures available to preserve and restore your vision.
Without treatment, retinal tears and detachments will not get better. Left alone, the problem will only worsen. If you experience any of the symptoms described in this brochure, seek the advice of your eye care professional immediately.
Detached Or Torn Retina
Retinal detachment occurs in one in 10,000 Americans each year. The condition is most typically found in patients who are nearsighted, have undergone previous eye surgery, experienced eye trauma, or who are have a family history of retinal detachments. Middle-aged and older individuals are at higher risk than the younger population. The condition is also likely to recur in individuals with a previous retinal detachment.
Retinal detachment typically begins with one or more small holes or tears in the retina. These holes are caused by shrinkage of the vitreous--a clear, gel-like body which fills the center of the eye and is attached to the retina. Once a tear has occurred, watery fluid may flow through the tear from the center of the eye causing the retina to detach (fig. 2 & 3). When the retina detaches, you will experience the sensation of a veil or curtain coming across your vision. Eventually, central vision is also lost.
The sudden appearance of "floaters" -- floating black dots -- or brief flashes of light in your vision, may indicate the development of a retinal tear. Flashing lights are best seen in the dark, last a few seconds and usually occur in your peripheral (side) vision.
An untreated retinal tear can progress to a retinal detachment. As this occurs, vision is lost in the detached portion of the retina. Some individuals experience the sensation of a veil or curtain coming across their peripheral vision. If it progresses, central vision may be lost and the entire retina may become detached. If left untreated the result may be a total loss of vision in the affected eye.
Examination And Diagnosis
If you are experiencing floaters or flashes of light, blurred or wavy vision, or the sensation of a veil crossing your vision, consult your Eye Centers professional immediately. At Madison Eye Associates, Dr. Madison will examine the interior of your eye and determine whether the retina is torn or detached. This procedure will also assist the physician in determining the best course of treatment.
Treatment For Retinal Tears
Retinal tears can generally be treated in our office using painless, minimally invasive surgical procedures that require no incision.
An ophthalmic laser is used to place spots around the edge of the tear producing scars that seal the edges and in most instances prevents the development of a retinal detachment (fig. 4).
Like the laser treatment, cryopexy stimulates scar formation to seal the edges of a retinal tear (fig. 5). Vision is not usually affected by the treatment of a retinal tear, and new floaters may be seen even after treatment. Usually, they will become less noticeable after a few months.
Treatment For Retinal Detachment
Retinal detachment must be repaired surgically. Dr. Madison will refer you to a respected opthomologist that will determine which of the three commonly used methods of repair is best for you, based on the length of time the retina has been detached, the severity of the detachment and the location of the tear in the retina that caused the detachment. The procedures used are: pneumatic retinopexy, scleral buckling and vitrectomy. In some instances, a combination of these procedures is used.
This simple procedure is done in office, on an outpatient basis. It is the preferred method of repair for most retinal detachments because it is minimally invasive and usually results in quicker visual recovery than the alternative techniques. A local anesthetic is given and the retinal tear is treated with either laser or cryopexy. A gas bubble is then injected into the eye and fluid is removed. The bubble then increases in size and presses the retina back against the wall of the eye (fig. 6). The laser or cryopexy therapy holds the retina in place. The bubble usually lasts one to two weeks.
Visual recovery using this method begins within days and is often complete within two weeks. While this is the least invasive method of reattaching the retina and results in the best visual recovery, its success rate is lower than either scleral buckling or vitrectomy. The most common complication is a recurrence of the detachment. If this does occur it can usually be corrected using one or both of the following procedures.
This procedure is performed at a hospital, generally on an outpatient basis, under local anesthesia. An incision is made around the eye and fluid that has collected under the retina may be drained. An elastic band is then placed upon the outside of the eye, bringing the eye wall into contact with the retina (fig. 7). A gas bubble, similar to that used in pneumatic retinopexy, may also be used to keep the band in place.
Following this procedure vision usually begins to improve within a few weeks; it may take up to six months for full recovery. Glasses may be needed following the surgery as the operation frequently will make you more nearsighted.
This procedure is generally performed in a hospital, under local anesthesia. During this operation the gel-like material in the middle of the eye (the vitreous) is removed. Accumulated scar tissue, when present, is removed. The vitreous cavity is re-filled with a clear liquid, a gas bubble, or other vitreous substitutes. Visual recovery is slow and may take as long as six months.
Vitrectomy is reserved for rare cases which fail to respond to pneumatic retinopexy or scleral buckling and in a few other special circumstances.
What Results Can Be Expected?
Retinal detachment can be corrected in most cases, but in some patients, more than one operation is necessary. Recovery depends on many factors, including the length of time the retina was detached. Excellent vision is achieved in three to six months in about half of the cases. The remainder will recover varying degrees of reading or traveling vision.
Successful reattachment is not possible in every case. The patient's age, general health and duration of the problem must be taken into account. Retinal tears do not improve without medical help.