Retinal detachment is a problem associated with eyes when the retina separates from the backside. It can be understood well with an analogy of wallpaper getting peeled off. In most of the cases, retinal detachment is an emergency that needs immediate intervention of an ophthalmologist. There are different causes of it; line of treatment is decided based on diagnosis. If not treated immediately, it may cause loss of vision (partial or full).
When we look an object, light passes through the outer layer and gets focused on the retina. Lens plays an important role in focusing the light rays properly. Retina is made of delicate tissues, and it makes the inside of the eye. It has the ability of converting optical signals into electrical signals that reach the brain through optical nerves. Brain interprets them and we can “see” the world around us. Retina gets blood supply by an intricate and delicate network of tiny blood vessels spread on the surface.
Light gets focused on an incredibly small area of the retina (called macula) that is about the size of a pinhead. It is highly précised and specialized part of the eye that gives every detail of an object when we look at it directly. This part is responsible for identifying colors. The remaining part of the retina gives us the side vision or peripheral vision. There is a clear gel-like substance filled in the eye that passes the light to the macula.
Why does retinal detachment occur?
Among various causes, the most common one is a tiny hole or tear in the retina. It causes the leakage of fluid between layers of the retina and it gets detached gradually. Normal aging process causes holes. As per experts, when vitreous gel detaches from the retina that is known as PVD or Posterior Vitreous Detachment, then it tears the retina. However, a gradual PVD may not cause retinal detachment. A direct blow t the eye may cause retinal detachment.
Diabetic retinopathy may form fibrous scar tissues from the inner side of the vitreous on the retina. There is a pressure or traction on the retina due to these tissues that may cause a detachment. Sometimes, these tissues pull it from the back side causing a displacement as well.
In very rare cases, the inside fluid behind the retina leaks between the retinal layers, there is no tear or hole though. Typically, a tumor or inflammation is the cause behind it.
The risk-prone population
Statistics reveals that it is a rare ailment; 1 out of 10000 people can have retinal detachment. It happens after the age of 16 years. Elderly people of more than 60 years have the most chances of getting affected by it because maximum changes in the vitreous fluid occur during this age.
Short sighted young people are also at a high risk of retinal detachment because their vitreous gel is not adequately firm. Hence, it has a tendency of getting detached from the backside of the eye. Particularly people with more than minus six powers or a history of trauma are under a high risk.
When there is retinal detachment occurs in one eye, there is very high probability that it will happen in the other eye as well. Experts say that around 2 to 10 percent detachments happen in both eyes.
There are some common symptoms that give an indication of the problem.
- Floaters: We all feel floaters in the form of tiny black objects floating freely. They are quite common and prominently felt as we grow old. Short-sighted people have more floaters than those who are normal sighted. They may be described as rings, cobwebs or threads. If they exist for years, then there is no need to worry. If there is a sudden increase in the number or there is a shower of dust like floaters, then it is a cause of concern.
- Flashing lights: Sometimes, people feel flashing lights around the edges of the vision. It is caused by stimulation of the retina from inside due to vitreous gel pulling on the retina. In a majority of cases, there isn’t any long-term problem. However, it indicates the tear of the retina. It is important to visit an eye specialist immediately so that exact problem can be diagnosed.
How do ophthalmologists deal with it?
- Shadows: A detached retina is not able to work properly, and there is a dark shadow that prevents vision on the edges. As it detaches further, the dark shadow approaches the center of the vision. The case has to be reported to Ophthalmologists immediately for quick diagnosis and treatment.
Surgical procedure is carried out to reposition the retina at the right place. Timing is critically important because an early diagnosis brings the best results. An untreated retina can cause permanent blindness. The surgery is a complex one, and doctors look at various parameters before going for it.
Specialist decides about it after assessing the case. Only one operation is done under the effect of local anesthesia. In some cases, general anesthesia is recommended. Doctors decide about it after checking the general health condition and discussing the same with anesthesia specialist.
- Vitrectomy: In this method, the vitreous gel is replaced with a gas bubble or clear silicon oil. They hold retina at the right place.
- Scleral buckle: in this method, a tiny piece of plastic or silicon sponge is placed on the eye in such a way that it moves the eye slightly inwards. It adjusts the detachment, and the problem is resolved. The area is sealed using Cryotherapy, and it is invisible from the front.
- Gas bubble surgery: Technically known as Pneumatic Retinopexy, the method is useful when the detachment is small and uncomplicated. A bubble of non-reactive gas is inserted into the vitreous gel. It puts pressure on the retina and keeps it in the right position. The gas gets absorbed by the fluid after some time, but the retina remains attached. There is blurry vision initially due to the bubble, but it becomes normal as the size reduces.