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Retinal detachment is extremely common in those with severe or extreme myopia (above 5-6 diopters), as their eyes are longer and the retina is stretched thin. The lifetime risk increases to 1 in 20. Myopia is associated with 67% of retinal detachment cases. Myopic patients are often younger than non-myopic ones.
Retinal detachment can occur more frequently after surgery for cataracts. The estimate of risk of retinal detachment after cataract surgery is 5 to 16 per 1000 cataract operations. The risk may be much higher in those who are highly myopic, with a frequency of 7% reported in one study. Young age at cataract removal further increased risk in this study.
Although retinal detachment usually occurs in one eye, there is a 15% of developing it in the other eye, and this risk increases to 25-30% in patients who had caracts extracted from both eyes.
Symptoms
People who suffer from retinal detachment feel no pain. A retinal detachment is commonly preceded by a posterior vitreous detachment which gives rise to these symptoms:
- flashes of light (photopsia) - very brief in the extreme
temporal (outside away from the nose) part of vision
- a sudden dramatic increase in the number of floaters
- a ring of floaters or hairs just to the temporal side of the
central vision
- a slight feeling of heaviness in the eye
Although most posterior vitreous detachments do not progress to retinal detachments, those that do produce the following symptoms:
- a dense shadow that starts in the peripheral vision and
slowly progresses towards the central vision
- the impression that a veil or curtain was drawn over the
field of vision
- straight lines (scale, edge of the wall, road, etc.) that
suddenly appear curved (positive Amsler Grid test)
- central visual loss
Treatment
There are several methods of treating a detached retina which all depend on finding and closing the holes which have formed in the retina. One way is to inject a gas bubble (pneumatic retinopexy) or silicone oil into the eye. The surface tension of the air/water or oil/water interface seals the hole in the retina and allows the retinal pigment epithelium to pump the subretinal space dry and pull the retina back into place. Cryotherapy or laser treatments can be used to create a scar around the hole to prvent further fluid from accumulating and the retina re-detaching. If the gas bubble is used, patients may have to keep their heads tilted for several days to keep it in contact with the retinal hole.
Vitrectomy(which involves removal of the vitreous gel using keyhole surgey combined with filling the eye with a gas bubble) is an increasingly widely used treatment for retinal detachment in countries with modern healthcare systems. Another treatment (a scleral buckle procedure) uses silicone bands (plombs, tyres) sewn to the outside of the eyeball so they push the wall of the eye against the retinal hole. This closes the hole and allows the retina to re-attach. The bands do not usually have to be removed.
After treatment, patients gradually regain their vision, although the visual acuity may not be as good as it was prior to the detachment, particularly if the macula was involved in the area of detachment. However, if left untreated, total blindness can occur in a matter of days.
Prevention
Retinal detachment can be prevented in some. The most effective way of preventing retinal detachment is educating people to seek ophthalmic medical attention if they suffer symptoms suggestive of a posterior vitreous detachment. Early examination allows detection of retinal tears which can be treated with laser or cryotherapy. This reduces the risk of retinal detachment in those who have tears from around 1:3 to 1:20.
There are some known risk factors for retinal detachment. There are also many activities which at one time or another have been forbidden to those at risk of retinal detachment, with varying degrees of evidence supporting the restrictions.
Cataract surgery is a major cause, and can result in detachment even a long time after the operation. The risk is increased if there are complications during cataract surgery, but remains even in apparently uncomplicated surgery. The increasing rates of cataract surgery, and decreasing age at cataract surgery, will inevitably lead to an increased incidence of retinal detachment.
Trauma is a less frequent cause. Activities which cause direct trauma to the eye (boxing, kick-boxing, karate and others) can cause a particular type of retinal tear called a retinal dialysis. This type of tear can be detected and treated before it develops into a retinal detachment. For this reason governing bodies in some of these sports require regular ophthalmic examination.
Individuals prone to retinal detachment due to a high level of myopia are encouraged to avoid activities where there is a risk of shock to the head or eyes, although without direct trauma to the eye the evidence base for this may not be convincing. Some doctors recommend avoiding activities that increase pressure in the eye, including diving, skydiving, lifting heavy weights, again with little supporting evidence. Activities that involve sudden acceleration or decelaration also increase eye pressure and are discouraged by some doctors. These include bungee jumping, but may also include rollercoaster rides.
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