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Retinal Detachment

What is Retinal Detachment?
 
Retinal Detachment is where the thin layer of cells that lines the inside of the back of the eye (retina) develops a tear and starts to lose its adhesion to the underlying eye wall tissues and its blood supply.
 
The retina loses function when it is detached because nutrients cannot reach the retina.
 
A Retinal Detachment is a serious condition and may result in permanent loss of vision or even blindness unless treated promptly.
 
A Retinal Detachment Progression
 
Retinal Detachment usually starts as a progression of from Posterior Vitreous Detachment in the periphery of the retina and progresses towards the centre. 
A Retinal Tear can be lasered closed before detachment occurs.
 
Most patients observe a change in their vision. 
 
Retinal Detachment Symptoms
 
Early symptoms of Retinal Detachment are when a patient notices:
 
A dark shadow or curtain starting at the edge of the field of vision and moving centrally.
Blurred or distorted central vision if the macula becomes detached.
 
Increased sensations of flashing lights and Floaters are early symptoms caused by the vitreous gel pulling on the retina and should also be reviewed urgently
Flashes of light: bright and rapid flashes,
 
These symptoms do not always mean a Retinal Detachment is present. However, you should see your ophthalmologist as soon as possible.
 
Sometimes a Retinal Detachment is discovered during a routine Eye Examination by your ophthalmologist.
 
What causes Retinal Detachment?
 
As we get older, the Vitreous (a clear, jelly-like substance that fills the eye) develops structural changes and may pull away from its attachment at the back of the eye.  
 
This is termed a Posterior Vitreous Detachment or PVD. Usually, a vitreous detachment does not cause significant problems.
 
Sometimes the Vitreous has a strong attachment to the retina, and the vitreous may pull hard enough to tear the retina in one or more places. 
 
The fluid inside the eye can then passes through the retinal tear and lifts the retina from the back of the eye.
 
What is the Difference Between Posterior Vitreous Detachment and Retinal Detachment?
 
Posterior Vitreous Detachment describes the process of vitreous liquefaction and shrinkage that pulls away from the Retina. As vitreous is peeling away from the retina it can cause detachment and can pull so hard in areas of firm attachment that it causes Retinal Tears.
 
Who Does Retinal Detachment Affect?
 
Anyone can develop a Retinal Detachment at any time, however, some people are more at risk of the condition. Predisposing factors for Retinal Detachment include:
 
Age: Posterior Vitreous Detachment (PVD) occurs more commonly as we age
Myopia - short-sightedness increases by 10 times the risk of Retinal Detachment. This is because a myopic eye is larger than average and the retina is thinner and weaker and more prone to develop a tear during PVD. Myopia patients also develop PVD at a younger age,
A family history of Retinal Detachment,
Cataract surgery - previous intraocular surgery will slightly increase the risk,
Trauma - previous injury to the eye or face increases the risk,
Weak areas in the retina (Lattice Degeneration).
 
Patient's who have developed a Retinal Detachment in one eye are also at increased risk in their other eye. 
 
If weak areas of the retina or retinal tears are discovered in the fellow eye then preventive laser treatment may be necessary to reduce the risk to the alternate eye.
 
Retinal Detachment Diagnosis
 
Retinal Detachment is diagnosed as part of a General Eye Examination, further diagnostics tests typically include:
 
Retinal examination - The doctor may use an instrument with a bright light and a special lens (ophthalmoscope) to examine the back of your eye, including the retina. The ophthalmoscope provides a highly detailed view, allowing the doctor to see any retinal holes, tears or detachments.
 
Ocular Ultrasound Imaging - Your doctor may use Ocular Ultrasound Imaging if bleeding has occurred in the eye, making it difficult to see your retina.
 
When does retinal detachment need treating?
Patients with Retinal Detachment require surgery to re-attach and position the Retina and prevent permanent visual loss. 
 
There is a limited window of time in which to repair a retinal detachment before permanent loss of vision occurs. Acute Retinal Detachment is a medical emergency. 
 
The aim is to perform surgery before the Retinal Detachment progresses to involve the central macula. If the macula is detached at the time of surgery then the central vision may never fully recover.
 
Retinal Detachment treatment
 
There are several different ways to repair a Retinal Detachment. The decision on which type of surgery is appropriate for you depends on the characteristics of your detachment. 
 
The principal of surgical repair is to reattach the retina to the eye wall by draining the fluid from under the Retina and the sealing the tear by:
 
Retinal Photocoagulation Lasers (PRP) Surgery
Vitrectomy
Scleral Buckle
 
In complex Retinal Detachment cases, both approaches may be necessary for a successful result.
 
Untreated retinal detachment
 
Untreated Retinal Detachment usually results in: 
 
Permanent, severe vision loss or 
Blindness
 
This should be borne in mind when considering whether you should undergo Retinal Detachment surgery. In many cases, this overrides the possible risks and complications of the surgery.
 

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