Last weekend, our clinical director, Rachel, called me describing the appearance of a curtain or shade that had come down over her right eye’s superior part of her vision. I drove to our Knoxville office and met her there to see if she had what sounded like a detached retina. A detached retina happens when the retina peels away or detaches from its underlying layer of support tissue at the back of the eye. The retina is a thin layer of light-sensitive nerve cells at the back of the eye.
She had arrived before me and had done an Optomap photo of her retina and was having an OCT image done of her central vision. Both showed an inferior detached retina resulting in a superior (upper) field vision loss or curtain-like blurring.
Examination, OCT, and Optomap images confirmed the worst-case scenario, a retinal detachment. A retinal detachment is considered an ocular emergency. We phoned the retinal specialist on call at Southeastern Retina Associates in Knoxville. They gave Rachel instructions to be at the surgery center first thing Monday morning.What Symptoms are common with Retinal Detachments?
A person with a detached retina may experience several symptoms.
Photopsia, or sudden, brief flashes of light outside the central part of their vision, or peripheral vision. The flashes are more likely to occur when the eye moves.
A significant increase in the number of floaters (the bits of tissue in the eye that make us see things floating in front of us, usually like little strings of transparent bubbles that follow our field of vision as our eyes turn).
An additional symptom can be a heavy feeling in the eye.
A shadow that starts to appear in the peripheral vision and gradually spreads towards the center of the field of vision.
A sensation that a transparent curtain is coming down over the field of vision.
Straight lines can start to appear curved.
There is not usually any pain.
At first, detachment might only affect a small part of the retina, but without treatment, the whole retina may peel off, and vision will be lost from that eye.
We instructed Rachel to be careful, take it easy, and sleep upright in a chair so as not to let any more retinal tissue pull away. Rachel’s parents came and picked up her son, Palmer, so that she could rest and be ready for her retinal repair and so her husband, Justin, could help her as much as possible.
What might have caused Rachel’s retinal detachment?
People with severe myopia, those with diabetes, patients who have had complicated cataract surgery, and anybody who has received a blow to the eye are all more susceptible to a detached retina. Many can’t narrow down any root cause. We believe Rachel’s detachment was caused by her high myopic prescription.
There are three types of detached retinas:
Rhegmatogenous retinal detachment is a break, tear, or hole in the retina. This hole allows liquid to pass from the vitreous space into the subretinal space between the sensory retina and the retinal pigment epithelium. The pigment epithelium is the pigmented cell layer just outside the neurosensory retina.
Secondary retinal detachment is also known as exudative retinal detachment or serous retinal detachment. It happens when inflammation, vascular abnormalities, or injury cause fluid to build up under the retina. There is no hole, break, or tear.
Tractional retinal detachment is when an injury, inflammation, or neovascularization causes the fibrovascular tissue to pull the sensory retina from the retinal pigment epithelium.
Rachel was heading for surgery, but we did not yet know exactly which route the surgeon would take. Depending on how severe the detachment is, there are many ways to repair a retinal detachment. Surgery is necessary to find all the retinal breaks and seal them and to relieve present and future vitreoretinal traction or pulling. Without surgery, there is a high risk of total vision loss.
Options for surgery include:
Laser surgery, or photocoagulation: A laser beam is directed through a contact lens or ophthalmoscope. The laser burns around the retinal tear, resulting in scarring tissue that then fuses the tissue back together. Cryotherapy: Cryosurgery, or freezing, involves applying extreme cold to destroy abnormal or diseased tissue. The procedure produces a delicate scar that helps connect the retina to the wall of the eye.
Scleral buckling: In the area where the retina has detached, very thin bands of silicone rubber or sponge are sewn onto the sclera, the outside white of the eye. The tissue around the area may be frozen or lasers may be used to scar the tissue.
Vitrectomy: The vitreous gel is removed from the eye and a gas bubble or silicon oil bubble is used to hold the retina in place. The wound is stitched. Silicon oil needs to be removed 2 to 8 months after the procedure.
Pneumatic retinopexy: This can be used if the detachment is uncomplicated. The surgeon freezes the tear area, using cryopexy, before injecting a bubble into the vitreous cavity of the eye. This pushes the retina back against the tear and the detached area, preventing further flow of fluid behind the retina. After some days, the pressure eventually makes the retina reattach itself to the wall of the back of the eye. A person who has a gas bubble placed in the eye is advised to hold the head in a direction for some time.
Rachel’s detachment was so severe that they did a combination of these procedures.Her retinal surgeon believes the surgery went well, but Rachel has a long road to healing.She needs to head posture (face straight down) and take it easy for the next week to three weeks in hopes that the retina reattaches.
The National Eye Institute estimate that around 90 percent of treatments for retinal detachment are successful, although some people will need further treatment. Sometimes, it is not possible to reattach the retina, and the person’s vision will continue to deteriorate. The patient’s vision should return a few weeks after treatment. If the macula is involved in the detachment, the person’s sight may never be as clear as it was before. (The macula is the part of the eye that enables us to see what is straight in front of us.)
There is some risk of complications from the surgery. These include allergies to medications, infection, pain, swelling, bleeding in the eye, double vision, cataracts, glaucoma, and eye infection.
So far, Rachel and family are getting good reports and seem to be healing well.We ask for everyone’s prayers and well wishes for a speedy and full recovery. Rachel has been with our practice for many years and is a close friend and critical member of our work family. We miss her and can’t wait until things get somewhat back to normal for her and her family.
If you are experiencing any of these symptoms or want to know if you are at risk for a retinal detachment, schedule an appointment right away.The success rate on repairing retinal detachments is much higher the sooner it is found and acted upon.Rachel knew this, and we hope that her actions will bode well for her healing and outcome. For those who are high risk we recommend that you continue getting annual eye examinations.
Torrey Carlson, O.D.
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