If you’re old enough to remember when you had to put film in a camera to get a picture, then you should be able to understand the important role of your retina.
The retina is the thin layer of tissue lining the back surface of the eye. Like the film in a 20th century camera, it captures visual images and sends them to the brain. Without a healthy retina, your vision is severely hampered, if not lost altogether. That’s why you should know how to protect your vision by recognizing the signs of retinal malfunction.
The most serious problem is a detached retina. When the retina pulls away from the layer of blood vessels that nourish it, you may experience something like a grey curtain or veil suddenly moving across your field of vision. This is a medical emergency that requires immediate attention.
Retinal detachment requires surgery that is not always successful. If the retina cannot be reattached soon enough, vision will continue to decline and eventually result in blindness in that eye.
The process of retinal detachment is painless, but there are warning signs along the way that, if heeded, can keep you from an emergency situation.
Retinal Tears and Holes: Far more common than retinal detachment are retinal tears and holes.
As a natural consequence of aging, the retina thins, making it vulnerable. At the same time, the vitreous gel that fills the middle of the eye begins to shrink. As it does so, it tends to tug on the retina and may loosen it and cause it to peel away. If tears or holes develop in the weakened retina, the gel is able to get behind the retina and speed the process of peeling.
Flashes May Signal Trouble
Again, there is no pain, but the tugging causes the retina to give out visual symptoms–flashes of sparkling light when your eyes are closed or you are in a dark room. As little pieces of debris collect in the vitreous gel, floaters may become increasingly noticeable in your field of vision. These are little shapes or specks, usually transparent, that float across your vision and may be visible only when you look at the sky or a white background.
In many cases, the gel eventually pulls away from the retina and causes no further problems. Flashes may stop, and floaters become less noticeable or remain stable.
Most individuals have at least some floaters. They develop gradually and are usually no cause for concern. But when you notice new floaters, a greater number of floaters or different kinds of floaters, it could be a signal that your retina is damaged or beginning to peel away.
The major signs that you should look for are:
• flashes of light, typically from the outside corner of your eye;
• new or different floaters;
• reduction of vision and
• a grey curtain or veil that moves across your field of vision.
When detected early enough, retinal holes and tears can be treated, usually with a laser procedure or cryotherapy (freezing) in the ophthalmologist’s office. The goal is to create scars that seal the retina to the tissue underneath.
Once the situation advances to retinal detachment, it is much more grim and requires immediate action. Without the blood cells underneath that nourish and support it, the retina will become weak and start to die.
The macular cells in the center of vision are critical to good vision, and when they become detached, permanent damage is imminent. The person’s sight begins to decline significantly, sometimes leading to blindness in that eye.
The main risk factors for retinal detachment include:
• shrinkage or contraction of the gel-like material inside the eye, a fairly normal occurrence with aging;
• previous retinal detachment in the other eye;
• a family history of retinal problems;
• extreme nearsightedness;
• injury to the eye;
• cataract surgery;
• advanced diabetes or
• an inflammatory eye disorder.
As cataract removal has become easier to perform and more prevalent, several studies have pointed to a higher risk of retinal tears and detachment following this type of surgery. The risk seems particularly high in males younger than 60 who are very nearsighted.
One study found a four-fold increased risk after cataract surgery with the highest risk in the first six months but remaining elevated for as long as 10 years. The actual number of detachments, though, was only 465 out of 202,226 cataract surgeries.
As the phacoemulsification technique has been perfected over the last three decades, the number of retinal complications has steadily declined.
The most serious problems occur when the macular part of the retina becomes detached. Even when this occurs, though, it’s usually possible to repair some of the damage and prevent total blindness. Three basic treatments are used.
Pneumatic retinopexy involves injection of a gas bubble into the eye, pushing the retina back against the wall of the eye. Laser surgery or crysurgery can be used to close the tear and secure the retina to the eye wall.
The patient is asked to hold a certain head position for several days. Eventually, the gas bubble will disappear.
Scleral buckling involves suturing a piece of silicone rubber or sponge to the white of the eye to indent the affected area and relieve some of the stress being exerted on the retina. The surgeon might also create a permanent buckle that circles the eye like a belt.
Vitrectomy involves draining the vitreous fluid inside the eye plus any tissue that is tugging on the retina. Air, gas or liquid is then injected into the space in order to re-attach the retina and hold it in place. Eventually, this fluid is absorbed as the space within the eye fills with body fluid.
Depending on the size, location and complexity, two or more of these options are combined in the same procedure. And, in some cases, the procedures can be performed in the physician’s office or an outpatient center.
Most retinal tears and holes and even 85 to 90 percent of retinal detachments can be repaired. When the macula is left detached for more than four or five days, though, major vision loss can be expected.
The key is to be aware of the symptoms, particularly any reduction of vision or a great veil or curtain starting to appear. The earlier a retinal problem is detected, the better the chance of maintaining vision.
EDITED AND APPROVED BY John F. Kludt, O.D. Optometry FROM WEST RIVER EYE CENTER
REFERENCES:
Laurie Barclay, “Floaters and/or flashes may warn of retinal tear and detachment,” Medscape Medical News, December 9, 2009.
Kierstan Boyd, “Retinal detachment: what is a torn or detached retina?” EyeSmart, American Academy of Ophthalmology, reviewed by Dr. Raj Maturi, September 1, 2013.
Stephanie Brunner, “What is a detached retina? What causes a detached retina?” Medical News Today, last updated September 15, 2014.
“Eye health and retinal detachment,” WebMD Medical Reference, reviewed by Alan Kozarsky, M.D., September 28, 2014.
Laird Harrison, “Fluoroquinolones linked to retinal detachments,” Medscape Gastroenterology, April 3, 2012.
Jim Kling, “Phacoemnulsification complications declining,” Medscape Medical News, July 16, 2012.
Norra MacReady, “Certain therapies may increase risk for retinal detachment,” Medscape Medical News, April 4, 2011.
Mayo Clinic Staff, “Retinal detachment,” MayoClinic.com, July 8, 2014.
Damian McNamara, “Cataract surgery may up retinal detachment risk 4-fold,” Medscape Medical News, September 13, 2013.
National Eye Institute, “Facts about retinal detachment, last reviewed October, 2009.
National Institutes of Health, “Retinal detachment,” MedlinePlus, updated by Franklin W. Lusby, M.D., August 24, 2013.
The Patient Education Institute, Inc., “Retinal tear and detachment,” X-Plain Patient Education, last reviewed December 20, 2013.
University of Michigan Kellogg Eye Center, “Detached retina,” reviewed by Grant M. Comer, M.D., 2014.
Peter Walter, “Retinal detachment surgery,” Expert Reviews in Ophthalmology, 2012;7(5):441-4
01/21/2015
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