12 Nov Understanding Retinal Detachment: Symptoms, Causes, And Risk Factors
Retinal detachment occurs when the retina pulls away from its normal position. It can lead to sudden vision loss. There are different types, including rhegmatogenous, exudative and tractional. Symptoms include flashes, floaters, or a shadow over vision.
Types Of Retinal Detachment
- Rhegmatogenous Retinal Detachment (Most Common)
This is the most common type of retinal detachment. It occurs when a tear or hole develops in the retina, allowing fluid from the vitreous (the gel-like substance that fills the eye) to seep underneath the retina. This fluid accumulation causes the retina to detach from the underlying tissue.
Causes and risk factors:
- Aging (usually over 50 years old)
- Myopia (nearsightedness)
- Trauma or eye injury
- Previous eye surgeries (e.g., cataract surgery)
- Inherited retinal conditions
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- Tractional Retinal Detachment
This type occurs when scar tissue on the retina contracts, pulling the retina away from the underlying tissue. It is often caused by complications from other conditions such as diabetic retinopathy, retinal vein occlusion, or sickle cell disease, where abnormal blood vessels or scar tissue grow on the retina.
Causes and risk factors:
- Diabetic retinopathy
- Retinal vein occlusion
- Eye trauma or injury
- Premature birth (in cases of retinopathy of prematurity)
3. Exudative (Serous) Retinal Detachment
In exudative retinal detachment, fluid accumulates under the retina due to leakage from blood vessels without any tears or holes. This type does not involve any retinal breaks. It can be caused by a variety of conditions that lead to abnormal fluid production or leakage, such as inflammation, tumours, or vascular issues.
Causes and risk factors:
- Age-related macular degeneration (AMD)
- Retinal vein occlusion
- Inflammatory diseases (e.g., uveitis)
- Tumours or other growths behind the eye (e.g., choroidal melanoma)
Who Is At Risk?
Retinal detachment is more likely to happen to people between the ages of 40 and 70. As we get older, the vitreous gel in our eyes shrinks and changes texture. This natural process increases the risk of the gel tearing away from the retina.
If you’re nearsighted, your risk is higher as well. Nearsightedness — particularly if it’s bad enough — can alter the shape of the eye, putting strain on the retina.
Other eye procedures, such as cataract surgery, also increase risk. If you’ve had any type of eye procedure, your eyes may be even more sensitive. Eye injuries can damage the retina over time.
Your family history has an outsized influence. If someone in your family has experienced retinal detachment, it’s smart to watch for symptoms yourself. The risk is even higher if a close relative has had it. If you’ve had a retinal detachment in one eye, it’s more likely to happen in the other.
Symptoms And Early Signs
Do you ever see those little floaters in your vision? They’re little dots or squiggly lines that float around your vision. A sudden increase in these floaters is a huge red flag. It’s something you want to keep an eye on, especially if you start seeing flashes of light. These flashes may occur in one or both eyes and can indicate something is wrong. If you see a dark shadow or a “curtain” in your field of vision, make an appointment with your optometrist. This is a very clear signal that you must pay attention to.
Initially, the changes in your vision may be mild. If the detachment increases in size, those changes will be much more evident. That’s why prompt recognition is so important. The sooner you catch these symptoms, the better the chances are of getting effective treatment.
Diagnosis Methods
They’re extremely important for detecting retinal detachment. The eye doctor uses a slit lamp to get a close look at your retina. It’s like looking into your eye with a microscope to try to find tears or detachment. The slit lamp throws a beam of light into your eye, so the doctor can see tiny details.
2. Direct And Indirect Ophthalmoscopy
Your eye doctor uses tools to view your retina. Direct ophthalmoscopy is when they look straight into your eye, and indirect is when they use a lens. Both ways help them check the retina’s condition, and it’s super thorough.
Before any eye exam, you’ll receive some dilating eye drops. These drops make your pupils bigger, like a portal, and make it easier for your eye doctor to see all the tiny details of your eyes.
3. Diagnostic Imaging Tools
Optos or Optomap — is an instrument that takes an ultra-wide field image of 200 degree of the retina. You sit in front of the instrument and in just a few minutes, your optometrist gets a detailed view of your retina. This image helps the optometrist be able to pick off any small breaks and tears found in the retina so further treatment can be done immediately.
If there’s any opacity or if the view is cloudy, ocular ultrasound comes in handy. If something’s blocking the view, it helps to visualize the retina past this opacity. In cases where there’s been trauma, CT scans can be used. These scans provide another way to look at the eye when things appear slightly off.
During your visit, your optometrist may ask questions to learn more about symptoms or history. If they don’t find a retinal tear, they may ask you to return in several weeks. Keeping an eye on things is key because catching a retinal detachment early can prevent vision loss. The success rate for diagnosing retinal detachment is approximately 90 percent. Sometimes, one procedure isn’t enough, and more might be needed to fix things. You may be advised to skip jarring activities to help your eyes heal properly post-surgery.
Treatment Options For Retinal Detachment
The treatment for retinal detachment depends on the type of detachment (rhegmatogenous, tractional, or exudative), the extent of the detachment, and the specific circumstances of the individual patient. Here are the main treatment options for retinal detachment:
1. Laser Therapy (Laser Retinopexy)
Laser treatment is used primarily to treat retinal tears or holes that have not yet progressed to a full detachment. It works by creating small burns around the retinal tear or hole, which helps to seal the retina to the underlying tissue, preventing further detachment.
2. Cryotherapy (Freezing Treatment)
Cryotherapy uses extreme cold to create a scar around a retinal tear or hole. Like laser therapy, it helps seal the tear and prevent fluid from getting underneath the retina, causing further detachment.
3. Pneumatic Retinopexy
Pneumatic retinopexy is a less invasive procedure that involves injecting a small gas bubble into the vitreous cavity of the eye. The gas bubble pushes the retina back into place, and the retina adheres to the underlying tissue as the gas bubble gradually dissipates.
4. Scleral Buckling Surgery
Scleral buckling is a surgical procedure used for more extensive retinal detachments. It involves placing a silicone band (buckle) around the outside of the eye to gently push the sclera (the white part of the eye) toward the retina. This helps to close the tear or hole and allow the retina to reattach.
5. Vitrectomy
Vitrectomy is a more invasive surgical procedure where the vitreous gel (the clear, jelly-like substance filling the eye) is removed. The surgeon then repositions the retina and may use a gas or silicone oil bubble to hold the retina in place during the healing process.
6. Silicone Oil or Gas Injection
In cases of more severe retinal detachment or complex cases, a gas bubble or silicone oil may be injected into the eye after vitrectomy or scleral buckling. The gas bubble temporarily holds the retina in place as it heals, while silicone oil may be used if the retina does not reattach after the initial surgery.
7. Observation (for Exudative Retinal Detachment)
Exudative retinal detachments, which do not involve a tear or hole but instead are caused by fluid accumulation underneath the retina (due to conditions like age-related macular degeneration, retinal vein occlusion, or inflammatory diseases), may not require immediate surgical intervention. Treatment focuses on addressing the underlying cause.
How To Prevent Retinal Detachment?
To reduce the risk of retinal detachment, take the following steps:
- Get Regular Eye Exams– Visit an eye doctor regularly for comprehensive exams, especially if you’re over 40 or have risk factors like diabetes or a family history of eye issues.
- Protect Your Eyes from Injury– Wear protective eyewear during activities that could cause eye trauma, such as sports or work with machinery.
- Manage Health Conditions- Control conditions like diabetes and hypertension, which can increase retinal risk. Regular eye checks are crucial for those with these conditions.
- Know the Warning Signs- Seek immediate medical help if you notice flashes of light, floaters, or a shadow over your vision, as these could signal retinal problems.
- Wear Sunglasses- Protect your eyes from UV rays, which can contribute to eye damage over time.
- Monitor Age-Related Changes– Be aware of natural aging effects on the retina and report any vision changes promptly to your eye doctor.
If you’re experiencing symptoms such as flashes of light, floaters, or a sudden decrease in vision, don’t wait—consult an optometrist. Book an appointment with Dr. D’Orio Eyecare today to get the care you need. Visit drdorioeyecare.com/book-appointment or call us at 416-656-2020 for our Toronto location, or 416-661-5555 for our North York location. Your vision deserves the best!
