Retinal Detachment Support Group

The retina is a thin disc-shaped layer of light-sensitive tissue on the back wall of the eye. Its job is to translate what we see into neural impulses and send them to the brain via the optic nerve. Occasionally, injury or trauma to the eye or head may cause a small tear in the retina, which allows fluid to seep through, and peel it away like a bubble in wallpaper.

The risk of retinal detachment in otherwise normal eyes is around 5 per 100,000 per year. Detachment is more frequent in the middle-aged or elderly population with rates of around 20 per 100,000 per year. The lifetime risk in normal eyes is about 1 in 300.

Retinal detachment is extremely common in those with severe or extreme myopia (above 5-6 diopters), as their eyes are longer and the retina is stretched thin. The lifetime risk increases to 1 in 20. Myopia is associated with 67% of retinal detachment cases. Patients suffering from a detachment related to myopia tend to be younger than non-myopic detachment patients.

Retinal detachment can occur more frequently after surgery for cataracts. The estimate of risk of retinal detachment after cataract surgery is 5 to 16 per 1000 cataract operations. The risk may be much higher in those who are highly myopic, with a frequency of 7% reported in one study. Young age at cataract removal further increased risk in this study.

Tractional retinal detachments can also occur in patients with proliferative diabetic retinopathy or those with proliferative retinopathy of sickle cell disease. In proliferative retinopathy, abnormal blood vessels (neovascularization) grow within the retina and extend into the vitreous. In advanced disease, the vessels can pull the retina away from the back wall of the eye causing a traction retinal detachment.

Although retinal detachment usually occurs in one eye, there is a 15% chance of developing it in the other eye, and this risk increases to 25-30% in patients who had cataracts extracted from both eyes.

There are several methods of treating a detached retina which all depend on finding and closing the holes (tears) which have formed in the retina.

Cryotherapy (freezing) and laser photocoagulation are treatments used to create a scar/adhesion around the retinal hole to prevent fluid from entering the hole and accumulating behind the retina and excacerbating the retinal detachment. Cryopexy and photocoagulation are generally interchangeable. However, cryopexy is generally used in instances where there is a lot of fluid behind the hole;laser retinopexy will not take.

Scleral buckle surgery is an established treatment in which the eye surgeon sews one or more silicone bands (bands , tyres) to the outside of the eyeball. The bands push the wall of the eye inward against the retinal hole, closing the hole and allowing the retina to re-attach. The bands do not usually have to be removed. The most common side effect of a scleral operation is myopic shift. The operated eye generally will be 3-5 diopters more near sighted after the scleral buckle operation.

Pneumatic retinopexy is generally performed in the doctor's office under local anesthesia. It is another method of repairing a retinal detachment in which a gas bubble ( SF6 or C3F8 gas ) is injected into the eye after laser or freezing treatment is applied to surround the retinal hole. The patient's head is then positioned so that the bubble rests against the retinal hole. Patients may have to keep their heads tilted for several days to keep the gas bubble in contact with the retinal hole. The surface tension of the air/water interface seals the hole in the retina, and allows the retinal pigment epithelium to pump the subretinal space dry and pull the retina back into place. This strict positioning requirement makes the treatment of the retinal holes and detachments that occurs in the lower part of the eyeball impractical.

Vitrectomy is an increasingly widely used treatment for retinal detachment in countries with modern healthcare systems. It involves the removal of the vitreous gel and is usually combined with filling the eye with a gas bubble ( SF6 or C3F8 gas ). Advantages of this operation is that there is no myopic shift after the operation. A disadvantage is that a vitrectomy always leads to more rapid progession of a cataract in the operated eye. Another major disadvantage of the operation is that , should a vitrectomy operation fail to work, the recurrent retinal detachment is much harder to repair. As such, except for special instances, the vitrectomy operation is not usually used as the initial operation to attempt to repair a rhegmatogenous retinal detachment.

Ignipuncture is an outdated procedure that involves cauterization of the retina with a very hot pointed instrument. It was pioneered and named by Jules Gonin in the early 1900s.

After treatment, patients gradually regain their vision over a perid of weeks, although the visual acuity may not be as good as it was prior to the detachment, particularly if the macula was involved in the area of the detachment. However, if left untreated, total blindness can occur in a matter of days.