Never lose sight of sight

Retinal detachment occurs when the retina, the light-sensitive layer at the back of the eye, lifts away from its supporting layers. The detachment induces a marked and abrupt deficiency of oxygen and nutrients to the retinal cells, leading to sudden and various symptoms in one eye. These include seeing bright flashes of light, floaters that look like thin threads or spots “floating” in the eye, a darkening of the vision or a shadow over one part of the field of vision. Importantly, these warning symptoms do not cause any pain and may not lead to an initial loss in visual acuity. However, if you suffer any of these symptoms, you should seek the immediate opinion of an ophthalmologist.

Most of the time, retinal detachment results from the shrinkage of the gel-like substance (vitreous humor) that fills the eye. This induces a tear or hole within the retina called a retinal tear, which allows fluid from the vitreous humor to leak underneath the retina. As we age, retinal tears tend to occur due to changes in the vitreous humor characteristics or due to various retinal disorders. 

Nearsighted individuals are more prone to retinal detachment – and the higher the myopia, the higher the risk – as are those with a family history of retinal detachment or who have had cataract surgery or Argon laser therapy. Detachment may also be caused by violent trauma, either immediately after the injury or even several years later. Rare cases of retinal detachment are brought on by advanced diabetes and tumours of the eye.

Treatment must be performed by an ophthalmologist who specialises in retinal diseases. Retinal tears, which often occur before detachment, can easily be treated without hospitalisation. Both Argon laser and cryopexy (freeze method) are done at the doctor’s clinic to seal the hole or tear. The small laser burns around the lesions “welds” the retina layer in its right location. This treatment is effective in preventing retinal detachment. 

When the retina has already detached, a surgical procedure under local or general anaesthesia must be promptly performed to reposition the retina at its right location and restore a normal blood supply. Different approaches are prescribed based on the severity of the detachment and on the eye condition. They are: injection of gas bubble into the eye (pneumatic retinopexy) combined with laser to close the retinal holes; a surgical procedure called scleral buckle, which uses a synthetic band attached to the outside of the eyeball to “intend the wall of the eye” against the detached retina; and a vitrectomy surgery, which consists of draining and replacing the vitreous humor in the eye with air, gas or liquids to reattach the retina. 

When treated on time and in specialised centres, retinal detachment surgery is successful in the large majority of cases. 

But prevention is of course the best approach and regular eye check-ups are the only effective method. Eye screening allows for implementing preventive laser treatment on minor retinal fragility sites before more advanced tears occur. Regular eye check-ups are highly recommended for any individual over 40 years of age at least every two years, on an annual basis from age 60 and even more frequently for predisposed individuals. 

 

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].