The retina is a thin layer of nerve tissue at the back of the eye and is responsible for sending visual signals to the brain. Due to various processes in the eye or trauma, this nerve layer could tear or detach from the back of the eye and cause detrimental vision loss. Luckily, it is not always irreversible. If caught early, there are treatments that can help to bring working vision back. The article below expands on the various treatment options available for retinal detachments.
Retinal detachment refers to when the sensory retina has separated from the underlying tissue that lines the back of the eye. This prevents signals from visual stimuli to be sent to the brain. There are two types of retinal detachments: rhegmatogenous retinal detachments and non-rhegmatogenous retinal detachments.
Rhegmatogenous retinal detachments (RRDs) refer to when the retina breaks, either from dying tissue (i.e. atrophic holes) or due to tugging forces from the vitreous (gel-like substance responsible for maintaining the eye shape) right in front of it. Patients will often notice flashes of light with floaters or a curtain over their vision, but in some cases patients may be asymptomatic.
Non-rhegmatogenous retinal detachments are due to any other reason not listed above. This includes exudative retinal detachments, referring to separation that is due to fluid seeping underneath the sensory retina. This could be due to conditions such as diabetic retinopathy, vascular conditions or age-related macular degeneration (ARMD).
The other type of non-rhegmatogenous RD is tractional retinal detachment. This type of RD is most often associated with proliferative diabetic retinopathy, a manifestation of diabetes at the back of the eye that causes the blood vessels to grow out of control and break easily.
These blood vessels are easily stuck onto the overlying vitreous and can cause the retina to be pulled and torn. Other causes include sickle cell retinopathy and retinopathy of prematurity. It is common for patients who have these retinal detachments to be asymptomatic or to experience decreased vision with flashes and floaters.
If identified by our optometrist, they may also note if the retinal detachment was a “mac-off” or “mac-on”, referring to whether or not the macula has come off with the rest of the retina. The macula is the spot at the back of the eye that is responsible for your central vision, important for being able to see details and focus clearly on an object.
In cases of “mac-off”, the macula has come off with the retina and the patient’s vision will be permanently reduced. These cases will need to be treated within 48-96 hours. In cases of “mac-on”, the retina has not yet come off at the macula but has the potential to. For this reason, the patient needs to be seen immediately (within 24 hours) and central vision could potentially be unaffected if proper treatment is completed in a timely manner.
In some special cases, if the retinal tear or detachment is asymptomatic and has been there for a long time to stabilize, treatment may not be necessary. In all other cases, treatment will be needed to ensure the best visual outcomes.
Pneumatic retinopexy is when a gas bubble is injected into the eye to temporarily push on the retina and encourage reattachment to the back of the eye. This also prevents fluid from entering the retinal tear. Laser treatment or cryotherapy (freezing of the eye) is then used to permanently seal the break that has occurred.
A scleral buckle is a silicone strap that is permanently stitched onto the sclera, the white part of the eye. This is done to allow the eye to be squished inwards and relieve some of the pulling force from the vitreous. Laser treatment or cryotherapy is also used at the location of the break.
The disadvantages of this procedure are that it can increase nearsightedness in the patient and cause pain, infection and double vision.
Vitrectomy refers to a procedure where the vitreous is removed, thus relieving the tension building up between the vitreous and the retina. Gas or silicone oil is injected instead and laser treatment or cryotherapy is used to seal the retinal break.
If appropriate, treating the underlying condition that caused the detachment is very important. If the detachment occurred due to proliferation of blood vessels at the back of the eye, anti-VEGF injections will need to be used. Blood sugars or the status of one’s ARMD will also need to be monitored.