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Retinal detachment | |
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Ultrasound of a retinal detachment in a patient presenting with complete vision loss and light perception only. | |
Specialty | Ophthalmology ![]() |
Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. [1] Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness. It is a surgical emergency. [2]
The retina is a thin layer of light-sensitive tissue on the back wall of the eye. The optical system of the eye focuses light on the retina much like light is focused on the film in a camera. The retina translates that focused image into neural impulses and sends them to the brain via the optic nerve. Occasionally, posterior vitreous detachment, injury or trauma to the eye or head may cause a small tear in the retina. The tear allows vitreous fluid to seep through it under the retina, and peel it away like a bubble in wallpaper.
As the retina is responsible for vision, persons experiencing a retinal detachment have vision loss. This can be painful or painless.[ citation needed ] Symptoms of retinal detachment may include: [1]
Ultrasound, MRI, and CT scan are commonly used to diagnose retinal detachment.[ citation needed ]
There are 4 main types of retinal detachment: [3]
A small number of retinal detachments result from trauma, including blunt blows to the orbit, penetrating trauma, and concussions to the head. A retrospective Indian study of more than 500 cases of rhegmatogenous detachments found that 11% were due to trauma, and that gradual onset was the norm, with over 50% presenting more than one month after the inciting injury. [5]
The risk of retinal detachment in otherwise normal eyes is around 5 in 100,000 per year. [6] Detachment is more frequent in the middle-aged or elderly population with rates of around 20 in 100,000 per year. [7] The lifetime risk in normal eyes is about 1 in 300. [8]
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 have had cataracts extracted from both eyes. [9]
A retinal detachment is commonly but not always preceded by a posterior vitreous detachment which gives rise to these symptoms:
Sometimes a detachment may be due to atrophic retinal holes in which case it may not be preceded by photopsia or floaters.
Although most posterior vitreous detachments do not progress to retinal detachments, those that do produce the following symptoms:
There are several methods of treating a detached retina which all depend on finding and closing the breaks which have formed in the retina.
85 percent of cases will be successfully treated with one operation with the remaining 15 percent requiring 2 or more operations. After treatment patients gradually regain their vision over a period of a few 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 will occur in a matter of weeks.[ citation needed ]
Retinal detachment can sometimes be prevented. The most effective means is by educating people to seek ophthalmic medical attention if they have symptoms suggestive of a posterior vitreous detachment. [15] Early examination allows detection of retinal tears which can be treated with laser or cryotherapy. This reduces the risk of retinal detachment in those who have tears from around 1:3 to 1:20.[ citation needed ]
There are some known risk factors for retinal detachment. There are also many activities which at one time or another have been forbidden to those at risk of retinal detachment, with varying degrees of evidence supporting the restrictions.[ citation needed ]
Cataract surgery is a major cause, and can result in detachment even a long time after the operation. The risk is increased if there are complications during cataract surgery, but remains even in apparently uncomplicated surgery. The increasing rates of cataract surgery, and decreasing age at cataract surgery, inevitably lead to an increased incidence of retinal detachment.[ citation needed ]
Trauma is a less frequent cause. Activities which can cause direct trauma to the eye (boxing, kickboxing, karate, etc.) may cause a particular type of retinal tear called a retinal dialysis. This type of tear can be detected and treated before it develops into a retinal detachment. For this reason governing bodies in some of these sports require regular eye examination.[ citation needed ]
Individuals prone to retinal detachment due to a high level of myopia are encouraged to avoid activities where there is a risk of shock to the head or eyes, although without direct trauma to the eye the evidence base for this may be unconvincing. [9] Some doctors recommend avoiding activities that suddenly accelerate or decelerate the eye, including bungee jumping and skydiving but with little supporting evidence. Retinal detachment does not occur as a result of eye strain, bending, or heavy lifting. [ attribution needed ]
Diabetic retinopathy, is a medical condition in which damage occurs to the retina due to diabetes. It is a leading cause of blindness in developed countries.
A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision of the eye. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colours, blurry or double vision, halos around light, trouble with bright lights, and difficulty seeing at night. This may result in trouble driving, reading, or recognizing faces. Poor vision caused by cataracts may also result in an increased risk of falling and depression. Cataracts cause 51% of all cases of blindness and 33% of visual impairment worldwide.
Floaters or eye floaters are sometimes visible deposits within the eye's vitreous humour, which is normally transparent, or between the vitreous and retina. They can become particularly noticeable when looking at a blank surface or an open monochromatic space, such as blue sky. Each floater can be measured by its size, shape, consistency, refractive index, and motility. They are also called muscae volitantes, or mouches volantes. The vitreous usually starts out transparent, but imperfections may gradually develop as one ages. The common type of floater, present in most people's eyes, is due to these degenerative changes of the vitreous. The perception of floaters, which may be annoying or problematic to some people, is known as myodesopsia, or, less commonly, as myodaeopsia, myiodeopsia, or myiodesopsia. It is not often treated, except in severe cases, where vitrectomy (surgery), laser vitreolysis, and medication may be effective.
Vitrectomy is a surgery to remove some or all of the vitreous humor from the eye.
Retinoschisis is an eye disease characterized by the abnormal splitting of the retina's neurosensory layers, usually in the outer plexiform layer. Retinoschisis can be divided into degenerative forms which are very common and almost exclusively involve the peripheral retina and hereditary forms which are rare and involve the central retina and sometimes the peripheral retina. The degenerative forms are asymptomatic and involve the peripheral retina only and do not affect the visual acuity. Some rarer forms result in a loss of vision in the corresponding visual field.
Retinopathy of prematurity (ROP), also called retrolental fibroplasia (RLF) and Terry syndrome, is a disease of the eye affecting prematurely born babies generally having received neonatal intensive care, in which oxygen therapy is used because of the premature development of their lungs. It is thought to be caused by disorganized growth of retinal blood vessels and may result in scarring and retinal detachment. ROP can be mild and may resolve spontaneously, but it may lead to blindness in serious cases. Thus, all preterm babies are at risk for ROP, and very low birth-weight is an additional risk factor. Both oxygen toxicity and relative hypoxia can contribute to the development of ROP.
Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.
This is a partial list of human eye diseases and disorders.
A posterior vitreous detachment (PVD) is a condition of the eye in which the vitreous membrane separates from the retina. It refers to the separation of the posterior hyaloid membrane from the retina anywhere posterior to the vitreous base.
A scleral buckle is one of several ophthalmologic procedures that can be used to repair a retinal detachment. Retinal detachments are usually caused by retinal tears, and a scleral buckle can be used to close the retinal break, both for acute and chronic retinal detachments.
Epiretinal membrane or macular pucker is a disease of the eye in response to changes in the vitreous humor or more rarely, diabetes. Sometimes, as a result of immune system response to protect the retina, cells converge in the macular area as the vitreous ages and pulls away in posterior vitreous detachment (PVD).
A macular hole is a small break in the macula, located in the center of the eye's light-sensitive tissue called the retina.
Intraocular hemorrhage is bleeding inside the eye. Bleeding can occur from any structure of the eye where there is vasculature or blood flow, including the anterior chamber, vitreous cavity, retina, choroid, suprachoroidal space, or optic disc.
Proliferative vitreoretinopathy (PVR) is a disease that develops as a complication of rhegmatogenous retinal detachment. PVR occurs in about 8–10% of patients undergoing primary retinal detachment surgery and prevents the successful surgical repair of rhegmatogenous retinal detachment. PVR can be treated with surgery to reattach the detached retina but the visual outcome of the surgery is very poor. A number of studies have explored various possible adjunctive agents for the prevention and treatment of PVR, such as methotrexate, although none have yet been licensed for clinical use.
Scleral reinforcement is a surgical procedure used to reduce or stop further macular damage caused by high myopia, which can be degenerative.
Vitreomacular adhesion (VMA) is a human medical condition where the vitreous gel of the human eye adheres to the retina in an abnormally strong manner. As the eye ages, it is common for the vitreous to separate from the retina. But if this separation is not complete, i.e. there is still an adhesion, this can create pulling forces on the retina that may result in subsequent loss or distortion of vision. The adhesion in of itself is not dangerous, but the resulting pathological vitreomacular traction (VMT) can cause severe ocular damage.
Yog Raj Sharma is an Indian ophthalmologist and ex-chief of Dr. Rajendra Prasad Centre for Ophthalmic Sciences of the All India Institute of Medical Sciences (AIIMS), New Delhi, the apex body of the National Programme for the Control of Blindness, a Government of India initiative to reduce the prevalence of blindness in India. He is the Chairman of the Task Force on Prevention and Control of Diabetic Retinopathy Group and the Co-Chairman of the National Task Force on Prevention of Blindness from Retinopathy of Prematurity under the Ministry of Health and Family Welfare of the Government of India. An advisor to the Ministry of Health and Family Welfare, India. Sharma was honored by the Government of India in 2015 with Padma Shri, the fourth highest Indian civilian award. In 2005, Yog Raj Sharma's published article on "Pars plana vitrectomy vs scleral buckling in rhegmatogenous retinal detachment" in Acta Ophthalmologica Scandinavica and in November 2021, American society of retina specialists cited it as top 100 publications on retinal detachment management in the last ~121 years. Of these top hundred publications, only nineteen countries contributed, three of the contributing countries were Asian and from India this study was the sole contribution. Dr Sharma called it 'the singular biggest achievement of his career" in an article published in Daily Excelsior, Jammu in December 2021.
Paul Anton Cibis was a clinical ophthalmologist, surgeon and pioneer of modern vitreoretinal surgery. As part of Operation Paperclip Cibis came to the United States and performed research for the U.S. Air Force and studied the effects of atomic weapons testing on the eye. He was an internationally recognized expert in retinal detachment surgery and pioneered the use of liquid silicon for this procedure.
Sickle cell retinopathy can be defined as retinal changes due to blood vessel damage in the eye of a person with a background of sickle cell disease. It can likely progress to loss of vision in late stages due to vitreous hemorrhage or retinal detachment. Sickle cell disease is a structural red blood cell disorder leading to consequences in multiple systems. It is characterized by chronic red blood cell destruction, vascular injury, and tissue ischemia causing damage to the brain, eyes, heart, lungs, kidneys, spleen, and musculoskeletal system.
Schwartz–Matsuo syndrome is a human eye disease characterised by rhegmatogenous retinal detachment, elevated intraocular pressure (IOP) and open angle of anterior chamber.
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