What is Retinal Detachment?
Retinal detachment is a type of eye health disorder caused by a thin layer in the eye / retina that comes off and can cause permanent vision loss. [1,3,4,5,7].
The retina itself is a very vital part of the eye because without it, the incoming light and the eye cannot be processed.
Normally, after the eye catches light, it converts the light into an electrical signal and then this is transmitted to the brain.
This signal processing also occurs in the brain and is issued in the form of images.
You can imagine how severe a person’s visual impairment will be if the retina is separated from its normal position.
How large the detachment of the retina is is a factor that determines whether the visual impairment is partial or complete.
Overview
Retinal detachment is a condition where the retina detaches from its normal position which has the potential to cause blindness in the sufferer.
Facts About Retinal Detachment
Rhegmatogenous retinal detachment is more prone to occur in men than women with a ratio of 1: 10,000 and 6.3-17.9 per 100,000. [1].
Types and Causes of Retinal Detachment
Retinal detachment is classified into three types of conditions, which include: [1,3,4,7]:
Exudative retinal detachment
This retinal detachment type is characterized by a buildup of fluid just under the retina.
It’s just that in this condition, there is no tear or hole in the retina.
The most frequent causes of exudative retinal detachment are inflammation of the eye, tumors, eye injury, or even macular degeneration making it more susceptible to occur in the elderly.
Rhegmatogenous retinal detachment
This retinal detachment type is the most frequent where the main cause is a tear or hole in the retina.
Because there is a hole or tear in the retina, this is an opportunity for fluid to cross through and eventually collect under the retina.
As a result, the retina detaches from its tissue.
Blindness has the most potential to occur in this retinal detachment type because in the area of the detached retina, the blood supply stops so that the retinal area can no longer function properly.
Increasing age is a major factor that increases the risk of rhegmatogenous retinal detachment.
This is because as we age, the gel-like fluid inside the eye (vitreous) changes in consistency, becomes much more fluid, and can shrink.
Tractional retinal detachment
This retinal detachment type is characterized by detachment of the retina from the eye back as the scar tissue on the surface of the retina continues to grow.
For diabetes sufferers, those who have difficulty controlling blood sugar levels or other degenerative disease conditions have a higher risk of experiencing tractional retinal detachment.
Overview
There are three types of retinal detachment conditions to watch out for, namely exudative retinal detachment, rhegmatogenous retinal detachment (the most frequent), and tractional retinal detachment.
Retinal Detachment Risk Factors
The following factors need to be recognized and watched out for as an increased risk of retinal detachment in many people: [5,6,7]:
- Have had a retinal detachment on one side of the eye.
- Factors increasing age, because people over the age of 50 years are much more likely to experience retinal detachment.
- Have a history of uveitis, peripheral retina, or retinoschisis.
- Have had a serious eye injury.
- Have had cataract surgery so retinal detachment can occur as a side effect of this eye surgery.
- Myopia or nearsightedness, which is already at an extreme stage.
- Family medical history where there is a family member with a history of retinal detachment (especially a parent).
Symptoms of Retinal Detachment
Retinal detachment is generally painless, so it is quite difficult to detect it at first.
In fact, in many cases, blindness often occurs suddenly because there are no symptoms of pain felt by the sufferer.
It’s just that, some of the following symptoms need to be watched out for immediately to an eye specialist: [3,4,6,7].
- Narrowing of the field of view (range of vision).
- In the patient’s vision, a floating black spot is seen which is known as floaters.
- Photopsia or the appearance of flashes of light in the patient’s vision.
- Vision becomes blurry.
- Shadows appear resembling curtains in the patient’s vision.
When should you see a doctor?
Even though there is no pain as a symptom, if one or more of the symptoms mentioned above start to occur, don’t hesitate to see an ophthalmologist.
There is nothing wrong with getting your eyes checked as soon as possible to detect the cause of your symptoms and determine whether these symptoms are related to retinal detachment.
The early examination and treatment can minimize the risk of blindness due to retinal detachment.
Retinal Detachment Examination
To ensure that the symptoms experienced are leading to retinal detachment, doctors need to perform several diagnostic methods as below.
Ophthalmoscopy is an examination method that doctors usually use to examine a patient’s retina [1,3,4].
Not only the retina, through ophthalmoscopy, doctors can detect abnormalities or disorders of the blood vessels, the inside and back of the eye, and the optic disc.
The level of accuracy of this examination method is known to be very high as a detection of serious eye diseases from the initial symptoms occurs.
In general, ultrasound is a scanning test method that doctors will apply if bleeding occurs in the patient’s eye [1,7].
As bleeding occurs, it is usually more hard to examine directly using an ophthalmoscope because the retina is not clearly visible.
Even if the symptoms are only experienced in one eye, the doctor will still examine the condition of both eyes.
Doctors also ask the patient to come back for a re-examination in a few weeks when a hole or tear in the retina is not identified on the first examination.
However, if within a few days after the first examination new symptoms occur, do not hesitate to immediately see a doctor and consult him.
Overview
The tests commonly used to detect retinal detachment are ophthalmoscopy and eye ultrasound. From the results of these two examination methods, only the doctor can determine the best treatment for the patient.
Retinal detachment treatment
Retinal detachment is generally treated in different ways, because the doctor will determine the treatment method based on the patient’s overall health condition.
The ophthalmologist will first check and consider in terms of whether the perforated or torn retina has been removed or not.
In the case of a retina that has not been completely detached, the following medical procedures are usually applied so that the retina does not become detached and helps the patient’s vision to improve.
This treatment is also called the laser therapy method where the main goal is to burn the tissue in the area around the retinal tear and prevent the retina from detaching [3,4].
Cryopexy is a method of treating retinal detachment which is also quite common, which is done by making the retinal tear freeze so that it does not become detached and remains attached. [1,3,4,7].
In more serious cases or when the retina has detached, doctors always recommend surgery as the best treatment step.
In this procedure, the doctor uses silicone to be placed from the sclera (outer side of the white part of the eye) where the purpose of using silicone here is as an adhesive between the eyeball wall and the retina. [1,3,4,5].
Scleral Buckling can make the retina return to its original position.
In patients with retinal detachment with retinal detachment that is too severe, the installation of silicone by doctors is different, namely around the eye and made permanent without obstructing vision.
Vitrectomy is another method that is also often used to treat retinal detachment [1,3,4,5].
Vitrectomy is performed with the aim of removing the vitreous and retinal tissue more easily.
Next, the procedure is followed by injecting silicone into the eye, so that the retina remains firmly in position.
In the future, the silicone will not need to be replaced or removed, because body fluids will naturally replace it.
This retinal detachment treatment procedure is applied by giving a direct injection containing gas bubbles into the patient’s eye [1,4,5].
The purpose of this injection is to put pressure on the retina and return it to its previous position.
Pneumatic retinopexy action is the type of treatment that doctors are likely to take for patients with slightly detached retinas.
Conditions and Treatment After Retinal Surgery
For retinal detachment patients who have to undergo retinal surgery procedures, after that there are several treatment steps that need to be known [5].
- Patients usually still have to stay in the hospital after undergoing surgery for at least one night, or even longer.
- Medical staff will put eye protection in the eyes of patients who have just been operated on.
- Patients were asked not to touch, press, and rub their eyes.
- After a few weeks and still recovering, the patient may still need to wear eye protection, especially every night before going to bed to speed healing.
- Within a few weeks after surgery, patients will feel discomfort in the operated eye, especially for those who are undergoing the procedure scleral buckling.
- Eyes will water more easily after surgery, and often vision will feel blurry for a few weeks to several months (this is normal during recovery).
- Follow the rules for using medicines that have been prescribed by a doctor, such as the rules for using eye drops.
- Follow the doctor’s advice regarding the position of the head when lying down, or in any activity performed.
- Avoid doing activities that are too strenuous for a few weeks after retinal surgery and wait until the eyes are really good and healthy.
- There is a possibility of pain arising in the eye and if this is very bothersome, immediately see a doctor and consult him.
Retinal detachment is a medical condition that on average can be cured with just one operation, although in some cases patients have to undergo several surgeries.
The severity of the retinal detachment and the retinal surgical procedure determine whether the patient’s vision can be repaired or not.
In patients with fully detached macula, permanent blindness is an unavoidable risk of complications.
Even the surgical steps are not able to help overcome the condition of the macula that has been detached.
Overview
The treatment of detachment is adjusted according to the severity of the retinal detachment. In general, cryopexy and photocoagulation are the treatments for cases of slightly detached retina. For more severe cases, treatment is done with scleral buckling, vitrectomy, or pneumatic retinopexy.
Complications of Retinal Detachment
The risk of complications is much greater even after retinal detachment treatment.
Depending on what medical procedure the patient underwent to treat retinal detachment, the following are possible complications to watch out for: [1,3,5]:
- Bleeding into the vitreous cavity.
- Infection in the eye that has just been operated on.
- Glaucoma or a condition where pressure builds up in the eye.
- Cataracts or the lens of the eye that becomes very cloudy.
- Uveitis or inflammation of the middle layer of the eye.
- Loss of vision/blindness.
Retinal Detachment Prevention
Some efforts to prevent retinal detachment can be done, namely by doing the things below: [7].
- Wear eye protection when doing activities that have a high potential for injury to the eye, including during sports.
- Checking blood sugar levels regularly, including blood pressure levels where this is also a way to maintain the health of retinal blood vessels.
- Have an eye exam 1-2 times per year.
- In people with diabetes, eye conditions should be checked more often every year.
- If flashes of light and floaters begin to appear, then the range of vision also changes, immediately see an ophthalmologist to have it checked.
Overview
- The best prevention of retinal detachment is the use of eye protection when engaging in activities with a high risk of eye injury.
- Routine health checks (eye exams, blood pressure and blood sugar) are also an important effort to minimize the risk of retinal detachment.
- Kyle Blair & Craig N. Czyz. 2020. National Center for Biotechnology Information. Retinal Detachment.
- Anonymous. 2018. The Ministry of Health of the Republic of Indonesia Directorate General of Health Services. Overview of Uncorrected Refractive Disorders in the Screening Program by the Community Ophthalmology Unit of the National Eye Center of the Cicendo Eye Hospital in the Bandung Regency Region in 2017.
- Subhadra Jalali, MS. 2003. Community Eye Health Journal. Retinal Detachment.
- Scott Fraser & David Steel. 2010. Clinical Evidence. retinal detachment.
- Anonymous. Better Health Channel. retinal detachment.
- Anonymous. 2019. National Eye Institute. At a glance: Vitreous Detachment.
- Anonymous. 2019. National Eye Institute. At a glance: Retinal Detachment.
- Image: Pixabay
- Video: Craig Blackwell
