Frequently Asked Questions about Retinal Detachment

What is retinal detachment?

The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. Retinal detachment is a serious condition that can lead to severe visual impairment or even total blindness in the affected eye. If any part of the retina is lifted or pulled from its normal position, it is considered detached, and will cause some vision loss.  The detachment will almost always progress, and vision loss will increase until it is treated. Therefore, retinal detachment is always considered an emergency. If not promptly treated, retinal detachment can cause permanent vision loss.

In some cases, there may be small areas of the retina that are torn. These areas, called retinal tears or retinal breaks, can lead to retinal detachment.

What are the different types of retinal detachment?

There are three different types of retinal detachment:

Rhegmatogenous—A tear or break in the retina allows fluid to get under the retina and separate it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina. These types of retinal detachments are the most common.

Tractional—In this type of detachment, scar tissue on the retina’s surface contracts and causes the retina to separate from the RPE. This type of detachment is less common.

Exudative—Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.

What causes retinal detachment?

Retinal detachment is caused by a combination of factors including retinal holes, retinal breaks, or retinal tears, and liquefaction of the vitreous humour. Any tiny tears or holes in the retina can allow vitreous fluid to seep under the retina, separating it from the back wall of the eye (like wallpaper). Retinal tears may also result from a hard blow or injury to the eye, though this is rather rare.

 How common is retinal detachment?

Not very common. Only 6-8 people out of 10,000 experience retinal detachment. Retinal detachment can occur at any age, but it is more common in midlife and later. It affects more men than women, and Caucasians more than Blacks.

Who is at risk for retinal detachment?

A retinal detachment can occur at any age, but it is more common in people over age 40. It affects men more than women, and Whites more than African Americans.

A retinal detachment is also more likely to occur in people who:

• Are extremely near-sighted
• Have had a retinal detachment in the other eye
• Have a family history of retinal detachment
• Have had cataract surgery
• Have other eye diseases or disorders, such as retinoschisis, uveitis, degenerative myopia, or lattice degeneration
• Have had an eye injury

What precautions can I take to avoid a retinal detachment?

Knowing the symptoms of a retinal detachment is your best defence. Also seek immediate eye care if you experience any symptoms as listed above have regular dilated eye exams if you are very near-sighted or if you have a family history of retinal problems be sure to have your eye doctor examine your eye after any serious eye injury always wear safety eyewear during sports and other hazardous activities

Is a retinal detachment after eye surgery related to surgeon’s mistake?

No. Retinal holes, breaks, or tears can occur after uncomplicated eye surgery performed at the highest level of excellence.

What kind of trauma can lead to retinal detachment?

Direct trauma to the eye can lead to retinal breaks, holes, or tears that occur days, weeks, months, or even years after the incident.

What injuries typically cause retinal detachments?

Bottle rockets, BB guns, racquetball, tennis, golf, soccer, boxing, and diving injuries can lead to retinal detachment.

What else other than retinal breaks, tears, or holes can cause retinal detachment?

Retinal detachment can also occur as a complication of diabetic retinopathy, retinopathy of prematurity, inflammatory disorders, or trauma.

Can retinal detachment cause total blindness?

Yes, even a slight blockage of the vision caused by partial retinal detachment can result in blindness if not treated right away.

If one eye develops retinal detachment will the other develop it as well?

Detachment is more likely to occur if the other eye has the condition (such as lattice degeneration) associated with retinal detachment in the first eye. If only one eye suffers a serious injury or requires eye surgery then, of course, the chance of detachment in the other eye is not increased by the event

What are the symptoms of retinal detachment?

Symptoms include a sudden or gradual increase in either the number of floaters, which are little “cobwebs” or specks that float about in your field of vision, and/or light flashes in the eye. Another symptom is the appearance of a curtain over the field of vision. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.

Can retinal detachment be treated?

Yes. Early diagnosis and proper treatment is recommended to restore your vision. A small tear in the retina can be treated by laser or gas (Pneumatic Retinopexy). These procedures are in-office procedures. For larger detachment, a scleral buckle procedure is recommended. This procedure is done in a surgical centre.

 Is there a medication or eye drop for the treatment of retinal detachment?

No. There is no medicine, eye drop, vitamin, herb, or diet that is beneficial to patients with retinal detachment.

 Do retinal detachments ever disappear without surgery?

Only if the detachment is due to a successfully treated medical condition such as toxaemia of pregnancy or rare forms of eye inflammation.

How is retinal detachment treated?

Small holes and tears are treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor’s office. During laser surgery tiny burns are made around the hole to “weld” the retina back into place. Cryopexy freezes the area around the hole and helps reattach the retina.

Retinal detachments are treated with surgery that may require the patient to stay in the hospital. In some cases, a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. If necessary, a vitrectomy may also be performed. During a vitrectomy, the doctor makes a tiny incision in the sclera (white of the eye). Next, a small instrument is placed into the eye to remove the vitreous, a gel-like substance that fills the centre of the eye and helps the eye maintain a round shape. Gas is often injected to into the eye to replace the vitreous and reattach the retina; the gas pushes the retina back against the wall of the eye. During the healing process, the eye makes fluid that gradually replaces the gas and fills the eye. With all of these procedures, either laser or cryopexy is used to “weld” the retina back in place.

With modern therapy, over 90 percent of those with a retinal detachment can be successfully treated, although sometimes a second treatment is needed. However, the visual outcome is not always predictable. The final visual result may not be known for up to several months following surgery. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails and vision may eventually be lost. Visual results are best if the retinal detachment is repaired before the macula (the centre region of the retina responsible for fine, detailed vision) detaches. That is why it is important to contact an eye care professional immediately if you see a sudden or gradual increase in the number of floaters and/or light flashes, or a dark curtain over the field of vision.

What research is being done?

The NEI supported The Silicone Study, a nationwide clinical trial that compared the use of silicone oil with long-acting intraocular gas for repairing a retinal detachment caused by proliferative vitreoretinopathy (PVR). With PVR, cells grow on the surface of the retina causing it to detach. This is a serious complication that sometimes follows retinal detachment surgery and is difficult to treat. The results indicate that both treatments are effective and give the surgeons more options for treating these difficult cases.