Is Retinal Detachment an emergency?

[07/09/2012]

Is Retinal Detachment an emergency?

In my line of work as a retinal surgeon, I see my fair share of retinal detachments. This is a potentially blinding condition and anyone who develops symptoms of floaters (black spots, cobwebs) or flashes of light should seek immediate attention with an eye specialist! He or she should then perform a dilated fundus examination (after instilling some eye drops to dilate the pupils) to examine the retina thoroughly.



What does it mean?



The eye behaves like a camera (albeit an old camera not like the digital cameras we have all become accustomed to) which focuses incoming light onto the film - the retina is like the film of the eye and is usually attached to the wall of the eye (sclera).





 



Why ME!?



Retinal detachment occurs largely due to an age-related degeneration of the vitreous gel within the eye which in some people can result in retinal tears and if untreated or unnoticed, can lead to a retinal detachment. Sometimes, if someone has suffered an injury to the eye, this can also lead to a retinal detachment and sometimes not immediately but it could happen weeks or in one cases, months later.



In people who are highly myopic (very shortsighted i.e. more than 600 degrees), there is also an increased risk of retinal tears and detachment as well. And finally, there are also certain inherited eye conditions which can make a person more prone to develop retinal detachment.






What do I need to do?



This is an emergency situation and the treatment is usually surgery! (I will elaborate further about the different ways to treat a retinal detachment). It is vitally important that when a person is diagnosed with a retinal detachment, he or she needs to be seen by a retinal surgeon as soon as possible to plan for surgical repair.



 



What the hell is a retinal surgeon?



That was one of my patient's reaction when she was told by her regular eye doctor that she needed to be referred to a retinal surgeon. "Why can't you do it? Isn't an eye doctor zgoing to treat my eye? Why do I need a retinal surgeon?" she asked.



It is not common knowledge at all how sub-specialized the field of medicine has become. In ophthalmology alone, there can be 10 subdivisions! Hard to imagine that an organ so small (slightly over 2 cm in diameter) can be divided into so many different sections but that is indeed how it is in the modern medicine arena.



All eye doctors are specialists (i.e. we have been trained to deal specifically with eye complaints). Some of us then choose to further subspecialize into a specific area within the eye. For me, I chose to be a retinal specialist which means further intensive training into this sub-specialty. For others it maybe glaucoma, cornea, refractive surgery, oculoplastics, orbit, neuro-ophthalmology, pediatric ophthalmology, uveitis, ophthalmic pathology. All eye doctors undergo training to do cataract surgery as that is our "bread and butter" but retinal surgery is one example where a trained subspecialist is required.






How to treat a retinal detachment



As I had mentioned, treatment is primarily surgical. There are 3 main methods and different retinal surgeons may have preferences for different methods.



1) Vitrectomy - this involves an operation whereby the vitreous gel is surgically removed, the retinal tears are sealed with laser and a gas bubble injected into the eye to support the retina until the laser takes effect and the retina "sticks" down. The procedure is dependent on a sophisticated machine as well as a surgical microscope to do the work and it is fast becoming the most popular way to treat retinal detachments as it can repair the simplest to the more complex detachments.



2) Scleral buckle - this was one of the first methods developed to treat retinal detachment but still has an important role to play in this current environment. It involves stitching a silicone band to the wall of the eye (on the outside) to oppose the wall to the detached retina and sealing the retinal holes with cryotherapy (freezing treatment). This method works very well in most cases of retinal detachment.



3) Pneumatic retinopexy - this is an office-based procedure and is not strictly surgery. It involves injecting a gas bubble into the eye to oppose the detached retina to the wall and using laser to seal the retinal holes. This method is only used for partially detached retinas and for patients who are able to maintain a specific position as the head has to be in different positions in order for the gas to support the retina.



 



So is it an emergency?



The most important part of the retina is the macula (the central portion) which is responsible for 90% of our functional vision. It is that part of the retina which is used when we read, drive, watch TV, etc. When a retinal detachment involves the macula, the outcome after surgery is often less favorable. Don't get me wrong, surgery is still required to prevent total visual loss but the final vision may not be as good as before. So when a retinal detachment has not involved the macula, it is important that surgery be done as soon as possible to prevent it from extending to involve the macula.



I leave you with a short video I put together of a vitrectomy I was doing to repair a retinal detachment.