What is retinal detachment?

A Retinal Detachment is a serious and potentially sight-threatening visual event that affects the back of your eye and needs immediate medical attention and treatment by an eye doctor, either with laser or surgery.

It is a serious condition because it can take away the central vision if not treated early.

With a detached retina, the retina (a light-sensitive layer of tissue in the back of your eye) is pulled away from its normal position at the back of your eye and fluid seeps under the retina through a hole or tear, which causes the retina to lift off the underlying structures.

Retinal detachment is one of the most common eye emergencies in the UK, with an annual incidence of about 10–15 per 100,000 people. It can occur spontaneously or as a consequence of eye trauma. Eye doctors are trained to recognise and treat the early signs of retinal detachment.

What are the symptoms of retinal detachment?

If only a small part of your retina at the back of the eye has detached, you may not have any symptoms. Preceding a retinal detachment, you may have a posterior vitreous detachment, where the transparent jelly filling the centre of the eye pulls onto the retina, stimulating flashing lights and causing a small hole or tear. At this stage, you may experience floaters or flashing lights. These indicate the retina being pulled by the vitreous, which risks subsequent retina detachment.

As more of your retina is detached with fluid seeping under the retina, you may not be able to see as clearly as usual, and you may notice other sudden symptoms, including:

• A lot of new floaters or sudden shower of floaters (small dark spots or squiggly lines that float across your vision)
• Flashes of light in one eye or both eyes
• A dark shadow or “curtain” on the sides or in the middle of your field of vision, which can come up into your lower field of vision or down like a blind.

Retinal detachment is a medical emergency, so if you have symptoms of a detached retina, flashing lights, floaters or decreasing vision, it’s important to go to an ophthalmologist.

The symptoms of retinal detachment often come on quickly. If the retinal detachment isn’t treated right away, more of the retina can detach — which increases the risk of permanent vision loss or blindness.

What causes retinal detachment?

There are many causes of retinal detachment, but the most common causes are aging, high myopia or an eye injury.

There are three types of retinal detachment, all of which are medical emergencies. Each type happens because of a different problem that causes your retina to move away from the back of your eye.

There are three types of retinal detachment:

• Rhegmatogenous (“reg-ma-TAH-juh-nus”) – usually with age, myopia or trauma. This is the most common type.
• Tractional – usually with longstanding detachment or advanced diabetic eye disease
• Exudative – usually in advanced diabetic eye disease

Rhegmatogenous retinal detachment

Rhegmatogenous retinal detachment is the most common type of retinal detachment. It can happen if you have a small tear or break in your retina.

When your retina has a tear or break, the gel-like fluid in the centre of your eye (called vitreous) can get behind your retina. The vitreous then pushes your retina away from the back of your eye, causing it to detach.

What causes rhegmatogenous retinal detachment?

Aging is the most common cause of rhegmatogenous retinal detachment. As you get older, the vitreous in your eye may change in texture and may shrink. Sometimes, as it shrinks, the vitreous can pull on your retina and tear it.

Other things that can increase your risk of rhegmatogenous retinal detachment are eye injuries, eye surgery, and near-sightedness (myopia).

Tractional retinal detachment

Tractional retinal detachment happens if the scar tissue on your retina pulls your retina away from the back of your eye.

What causes tractional retinal detachment?

The most common cause of tractional retinal detachment is diabetic retinopathy — an eye condition in people with diabetes. Diabetic retinopathy damages blood vessels in the retina and can scar your retina. As the scars get bigger, they can pull on your retina and detach it from the back of your eye.

If you have diabetes, getting a comprehensive dilated eye exam at least once a year is important. Managing your diabetes — by staying physically active, eating healthy foods, and taking your medicine — can also help you prevent or delay vision loss.

Other causes of tractional retinal detachment include eye diseases, eye infections, and swelling in the eye.

Exudative retinal detachment

Exudative retinal detachment happens when fluid builds up behind your retina, but there aren’t any tears or breaks in your retina. If enough fluid gets trapped behind your retina, it can push your retina away from the back of your eye and cause it to detach.

What causes exudative retinal detachment?

The most common causes of exudative retinal detachment are leaking blood vessels or swelling in the back of the eye.

Several things can cause leaking blood vessels or swelling in your eye:

• Injury or trauma to your eye
• Advanced Diabetic Eye Disease
• Age-related macular degeneration (AMD)
• Tumours in your eye
• Diseases that cause inflammation inside the eye
• Coats disease, a rare eye disorder

How can I prevent retinal detachment?

Since retinal detachment is often caused by aging, there’s often no way to prevent it. But you can lower your risk of retinal detachment from an eye injury by wearing safety goggles or other protective eye gear when doing risky activities, like playing sports.

Be aware that any new symptoms of flashing lights, floaters or losing part of your visual field can indicate a retinal tear, incipient retinal detachment or actual detachment.

The earlier you go to an Ophthalmologist with symptoms, the better the likelihood of a good outcome with laser treatment or surgery.

If you experience any symptoms of retinal detachment, go to an ophthalmologist immediately. Early treatment can help prevent permanent vision loss.

It’s also important to get comprehensive dilated eye exams regularly. A dilated eye exam can help your eye doctor find a small retinal tear or detachment early before it affects your vision.

What’s the treatment for retinal detachment?

Depending on how much of your retina is detached and what type of retinal detachment you have, your eye doctor may recommend laser surgery, freezing treatment (cryotherapy), or other types of surgery to fix any tears or breaks in your retina and reattach your retina to the back of your eye. Sometimes, your ophthalmologist will use more than one of these treatments at the same time.

Freeze treatment (cryopexy or cryotherapy) and laser surgery: If you have a small hole or tear in your retina, your ophthalmologist can use a freezing probe or a medical laser to seal any tears or breaks in your retina.

Surgery: If a larger part of your retina is detached from the back of your eye, you may need surgery to move your retina back into place. This is specialised vitreo-retinal surgery done by Clinica London´s Vitreo-Retinal Surgeons, Miss Evgenia Anikina and Mr Julian Robins.

Treatment for retinal detachment works well, especially if the detachment is caught early. In some cases, you may need a second treatment or surgery if your retina detaches again — but treatment is ultimately successful for about 9 out of 10 people.

How will my ophthalmologist check for retinal detachment?

If you see any warning signs of a retinal detachment, your ophthalmologist can check your eyes with a dilated eye exam. They will give you some eye drops to dilate (widen) your pupil and then look at your retina at the back of your eye.

This eye examination is usually painless. The ophthalmologist may press on your eyelids to check for retinal tears, which may be uncomfortable for some people. They will use a bright light to examine the whole retina, which can leave a brief afterimage for a few minutes, as it is bright.

What is a dilated eye exam?

A dilated eye exam to look at the back of your eye is the best thing you can do for your eye health! It’s the only way to check for eye diseases early on, when they’re easier to treat — and before they cause vision loss.

The exam is simple and painless. Your ophthalmologist will check for vision problems that make it hard to see clearly, like being near-sighted or farsighted. Then they will give you some eye drops to dilate (widen) your pupil and check for eye diseases.

Since many eye diseases have no symptoms or warning signs, you could have a problem and not know it. Even if you think your eyes are healthy, getting a dilated eye exam is the only way to know for sure.

If your ophthalmologist still needs more information after a dilated eye exam, you may get an ultrasound or an optical coherence tomography (OCT) scan of your eye. Both of these tests are painless and can help your ophthalmologist see the exact position of your retina.

What happens during a dilated eye examination?

The exam includes:

• A visual acuity test (before dilating) to check how clearly you see. Your ophthalmologist will ask you to read letters that are up close and far away.
• A visual field test (before dilating) to check your peripheral (side) vision. The doctor will test how well you can see objects off the sides of your vision without moving your eyes.
• An eye muscle function test to check for problems with the muscles around your eyeballs. Your ophthalmologist will move an object around and ask you to follow it with your eyes.
• A pupil response test to check how light enters your eyes. Your ophthalmologist will shine a small flashlight into your eyes and check how your pupils react to the light.
• A tonometry test to measure the pressure in your eyes. Your ophthalmologist will use a machine to blow a quick puff of air onto your eye or gently touch your eye with a special tool. Don’t worry — it doesn’t hurt!
• Dilation with eye drops to widen the pupils and enable a good back of the eye check.
• Eye Diagnostics with Ocular Coherence Tomopgraphy (OCT), Scanning Laser Ophthalmoscopy (SLO) and B scan Ultrasound. These are to visualise the exact position and extent of the detached retina. These tests are done by the specialist Ophthalmic Technician and the Consultant Ophthalmologist.

How does dilation work?

Dilating your pupil lets more light into your eye — just like opening a door lets light into a dark room. Dilation helps your ophthalmologist check for common eye problems, including diabetic retinopathy, glaucoma, and age-related macular degeneration (AMD).

How often do I need to get a dilated eye exam?

How often you need a dilated eye exam depends on your risk for eye disease. Talk to your ophthalmologist about what’s right for you.

Get a dilated eye exam every 1 to 2 years if you:

• Are over age 60
• Have a family history of glaucoma
• High Myopia (short-sighted)
• Diabetes and diabetic eye disease – once-a-year checks are better in this case!
• Age related Macular Degeneration

If you have diabetes or high blood pressure, ask your ophthalmologist how often you need an exam. Most people with diabetes or high blood pressure need a dilated eye exam at least once a year.

What happens after a dilated eye exam?

For a few hours after a dilated eye exam, your vision may be blurry and you may be sensitive to light. Ask a friend or family member to drive you home from your appointment since you must not drive home yourself.

If your eye doctor finds refractive errors in your vision, you may get a prescription for eyeglasses or contact lenses to help you see more clearly.

Bring your sunglasses!

Your eyes may be sensitive to light for a few hours after your dilated eye exam. Sunglasses can help, so bring them if you have them! Your ophthalmologist may also have disposable sunglasses they can give you.

If your ophthalmologist finds signs of eye disease, you can talk about treatment options and decide what’s right for you.

If you’re seeing clearly and there are no signs of eye disease, you’re all set until your next exam. Make an appointment for your next dilated eye exam before you leave the clinic — that way, you won’t forget!

Clinica London Retinal Care

At Clinica London, we have four retinal care surgeons, all of whom can diagnose and treat retinal holes and tears with laser and cryopexy, and stabilise early retinal detachments.

If your retinal detachment requires more specialised vireo-retinal surgery, this is done within one to three days of diagnosis if acute or a week if chronic, by one of the two vitreo-retinal surgical specialists, Ms Evgenia Anikina and Mr Julian Robins. The expert will advise each patient on the best treatment for their detached retina. Book an appointment!