Retinal Detachment and Laser Surgery
Symptoms Of Retinal Detachment
Retinal detachment is accompanied by fairly noticeable signs and symptoms. One such symptom is the profound increase in the level of floaters - noticeable specks and streaks which pass through an individual's field of vision. Additionally, individuals can experience very brief, but very intense flashes of light in the affected eye. Typically lasting only one second, these flashes of light are known as photopsia, and can be accompanied by blurred and distorted vision.
Without treatment, symptoms can progress to include further degradation in vision, potentially leading to complete loss of vision, with some individuals comparing this to a curtain or shadow being drawn across their field of vision. Additional symptoms may also include the perception of curved surfaces, such as road or walls which are actually straight.
One of the most common causes of retinal detachment is the appearance of small holes or tears within the retina, allowing fluid to leak and accumulate underneath the retina. With a sufficient build up of this fluid, the retina may then detach. The reason for the appearance of these holes is usually associated with age, and the weakening and narrowing of the retina as a result. However, tears in the retina are commonly the result of a sudden forceful impact directly on the eye.
Retinal detachment can also occur due to the formation of scar tissue on the surface of the retina, often as a result of pre-existing eye conditions, such as diabetic retinopathy. In this case, the scar tissue can pull on the retina until it eventually detaches.
Less common causes of retinal detachment occur as a result of forms of eye cancer. Such instances involve a build up of fluid behind the retina, despite the retina itself remaining intact. As with the aforementioned example, a sufficient build up can cause the retina to detach.
Types Of Retinal Detachment
There are three different types of retinal detachment:
- The first, and most common, type is rhegmatogenous retinal detachment. This type of detachment results from a retinal tear, which allows fluid to accumulate between the retina and the retinal pigment epithelium (RPE). The RPE is a cell layer responsible for the nourishment of the visual cells of the retina.
- The second, less common type is tractional retinal detachment. With this, detachment occurs as a result of scar tissue located on the surface of the retina contracting, causing a separation of the retina from the RPE.
- The third and final type of retinal detachment is exudative/serous/secondary retinal detachment. This type of retinal detachment is characterised by an accumulation of fluid beneath the retina, due to trauma and inflammation, but without the presences of retinal tears.
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Certain individuals with a heightened risk of retinal detachment have already been discussed. These include elderly individuals in whom increased age typically results in a weakening and narrowing of the retina, thus increasing the risk of holes and fluid accumulation. Similarly, individuals who have suffered forceful impacts directly to the eye carry a risk of retinal detachment. Moreover, individuals with pre-existing eye problems, such as diabetic retinopathy and eye cancer, carry a higher risk.
Other risk factors associated with retinal detachment include individuals suffering from severe myopia (short-sightedness), individuals who have undergone surgery likely to increase the vulnerability of the retina (such as cataracts removal) and individuals with a family history of retinal detachment.
Some causes of retinal detachment, such as age and genetic vulnerability, cannot be prevented. Nevertheless, individuals can take some precautionary measures to reduce the risk of it occurring. For example, it is advisable for individuals working in environments in which trauma to the eye is a possibility (such as DIY) to wear appropriate eye protection.
An important way of identifying retinal tears is for individuals to undergo regular eye tests. Indeed it is advisable for individuals to undergo an eye examination every two years. Whilst eye tests will not prevent retinal tears and detachments, they can enable tears to be identified before they develop into a full retinal detachment. This early identification will enable the individual to undergo treatment earlier, thus reducing the risk of further complications with eyesight.
There are multiple treatment options available to individuals suffering from retinal detachment, though the course of treatment will largely depend on the severity of the condition.
One potential course of treatment is laser photocoagulation, commonly referred to as laser eye surgery. This type of treatment involves the use of lasers to cauterize blood vessels within the retina, sealing off and preventing the spread of the detachment. This can be used in isolation or, more commonly, in conjunction with other treatment methods detailed below.
An alternative to laser coagulation, though based on the same operating principle, is cryotherapy, which replace laser cauterization with freezing.
Another treatment option is sclera therapy surgery. In this treatment, a silicon band is attached to the outer coating of the eye (the sclera). The subsequent buckling of the inner eye against the detached retina repositions it, helping it to reattach. Reattachment can also be aided through the application of laser photocoagulation or cryotherapy to reduce the risk of future detachments.
An alternative, though less common, course of treatment is pneumatic retinopexy. This treatment, performed under local anaesthetic, involves the injection of a small gas bubble (typically sulphur hexafluoride or octafluoropropane) into the affected eye. Through the gas bubble maintaining contact with the retinal hole, and the use of laser photocoagulation or cryotherapy, the detached retina can be repositioned and sealed back into place.
A final treatment option is vitrectomy. In this treatment, the vitreous gel between the lens and retina is removed, and replaced with silicone oil or a gas bubble (the same as is used in pneumatic retinopexy). The effect of this is to push the detached retina back into position, wherein laser photocoagulation or cryotherapy is performed to seal it in position.