Retinal detachment describes an emergency situation in which a thin layer of tissue (the retina) at the back of the eye pulls away from its normal position. Retinal detachment separates the retinal cells from the layer of blood vessels that provides oxygen and nourishment. The longer retinal detachment goes untreated, the greater your risk of permanent vision loss in the affected eye.
Warning signs of retinal detachment include the sudden appearance of floaters and flashes and reduced vision. Contacting an eye specialist (ophthalmologist) right away can help save your vision.
I recently had successful emergency laser surgery to prevent a retinal tear and possible retinal detachment, and I’m sharing my experience to help others recognize the symptoms that could save your vision.
Saturday night I started seeing flashes of light that looked like lightning. They popped up on the right side of my field of vision and sort of leaped at a right angle across the top of my sight. Each flash was quick, and the time between flashes varied.
I thought it might be a migraine aura, but I’ve had those in the past, and this seemed different. My auras last precisely 20 to 23 minutes and appear like a tunnel of light. These looked different and continued well beyond 20 minutes.
Because I was riding in the backseat of a car with my younger daughter driving on very dark, unfamiliar, winding rural roads in the rain, I didn’t want to say anything that might add to anyone’s stress. So I alternately closed my eyes to avoid seeing the light and searched on my phone for what could be causing the flashes.
My online searches, using reliable sites like the Mayo Clinic and Cleveland Clinic, revealed that light flashes are a symptom of a retinal tear or detachment. A retinal detachment can occur when the vitreous, a gel-like fluid inside the eye, leaks through a retinal hole or tear and collects beneath the retina at the back of the eye.
This causes the retina to pull away from the blood vessels that provide it with oxygen and nourishment, resulting in vision loss. Retinal detachment is an emergency because the longer it goes untreated, the greater your risk of vision loss.
The vitreous normally shrinks and detaches as we age and doesn’t cause problems, other than pesky floaters (specks of debris that seem to float through your vision). But, if the vitreous doesn’t detach easily and instead tugs on the retina, it can cause tears. That’s why it’s important to know what to look for to avoid retinal detachment.
Warning signs and symptoms
Most people will experience warning signs that indicate their retina is at risk of detaching before they lose their sight. These include:
- the sudden appearance of floaters – black dots, specks or streaks that float across your field of vision (usually only one eye is affected)
- a cobweb effect of lots of little floaters – others report a single large black floater that looks like a housefly
- sudden short flashes of light in the affected eye lasting no more than a second
- blurring or distortion of your vision
Without treatment, sight in the affected eye will start to deteriorate. Most people describe this as a shadow or “black curtain” spreading across their vision.
Retinal detachment usually only occurs in one eye. If your eye is affected, there is an up to one in 10 chance that retinal detachment will happen in your other eye.
Symptoms of retinal tears or detachment include:
- Light flashes
- Sudden appearance of many floaters
- A shadow or curtain over part of your visual field (usually this comes as detachment progresses; thank goodness mine didn’t go that far)
So, when we got home around 7 o’clock Saturday night, I told my family what was going on. I wasn’t certain from the websites how urgent the situation was whether I should go to the ER, call a doctor or take it easy and wait until Monday.
My two daughters quickly decided that I should call a medical professional for clarification, especially since the next day was Sunday and I wouldn’t be able to see my eye doctor until Monday at the earliest. My husband told me it wouldn’t do any good to go to the emergency room advice my eye doctor later confirmed, because the eyes need to be dilated by an ophthalmologist to be examined.
I found my ophthalmologists’ phone number online and discovered that they have an after-hours emergency number, which I dialed. I was put directly through to the on-call doctor. He listened to my symptoms and asked a few questions, such as how long I’d been seeing the flashes (2.5 hours), my age (60) and whether I was nearsighted (yes, slightly) or had diabetes (no).
The doctor asked if I could meet him at the office at 9 p.m. (seriously, 9 o’clock on a Saturday night!). I felt a little relieved and a little scared relieved that someone was available to look at my eyes at night on a weekend and scared that either something would be wrong with my vision or that it wouldn’t and this would all be a very expensive false alarm.
My husband and I and the doctor and an assistant arrived at about 8:45, and he took me in to dilate and examine my eyes. After a first look, he said he didn’t see anything obvious, but there was one area he wanted to take a closer look at. So, he applied more numbing drops and stuck a magnifying lens on my right eyeball, held in place by what he scientifically described as goop.
After closer examination, he said the vitreous fluid in my right eye was trying to detach but was not separating easily and was tugging on the back of my retina, which showed signs of compromise and weak spots on the verge of tearing.
He said I had two options: I could do nothing (a very, very bad option, he said) or I could have laser surgery to repair it immediately. Because I very much value my vision, I opted for laser surgery.
Undergoing laser surgery
He got everything ready, put a powerful lens back on my eyeball and told me to keep my forehead and chin pressed against the stabilizing bars and keep my head as still as possible. He warned me that the laser might give a sensation of heat or pressure, but no real pain.
Then he began zapping my eyeball with a laser. The laser makes tiny burns around the tears or weak spots to create scarring that “welds” the retina to the underlying tissue. I could feel both warmth and pressure from the laser, but the worst sensation for me was the feeling of bright light in my eye. I felt like I’d closed my eye to block out the light, but, in reality, the lens kept the eye open. I’m not sure how many times he zapped my retina or how long it took, but the whole procedure was relatively quick and painless.
He told me that no postsurgical care or recuperation was required because there was no cutting, no pain, no risk of infection. (Mayo Clinic says you may be advised to refrain from vigorous activities for a couple of weeks to allow the bonds to strengthen, but I was not told to take it easy.) My doctor said I might continue to see occasional flashes for a while as the vitreous fluid continued to separate (which I did), but there should be no more danger of retinal tears or detachment.
Almost exactly an hour after I entered the office on a Saturday night, I was on my way home with my vision problem corrected and my vision intact.
What I’ve learned through this is that early diagnosis is critical to preventing retinal detachment and possible permanent vision loss. It’s important to get your eyes checked annually, especially as you age or if you have other risk factors for retinal detachment. Talk to your eye care professional if you aren’t sure about your risk.
And if you notice any symptoms of a possible retinal tear or detachment, call your eye doctor immediately. The procedures to repair retinal detachment are more complex than what I had, and success is not guaranteed.
I am grateful to my job at Healthinfi for making me more aware of taking care of my health and paying attention to symptoms. I’m grateful to my daughters for encouraging me to seek immediate care. I’m grateful to my husband for taking me to the doctor’s and keeping me calm. And I’m especially grateful that the on-call ophthalmologist was willing to record the rest of the football playoffs he was watching and come in on a Saturday night to take care of my vision.
Retinal detachment itself is painless. But warning signs almost always appear before it occurs or has advanced, such as:
- The sudden appearance of many floaters — tiny specks that seem to drift through your field of vision
- Flashes of light in one or both eyes
- Blurred vision
- Gradually reduced side (peripheral) vision
- A curtain-like shadow over your visual field
When to see a doctor
Seek immediate medical attention if you are experiencing the signs or symptoms of retinal detachment. You are at greater risk of developing a retinal detachment if:
- You’re older than 50
- You or a family member has had a detached retina
- You’re extremely nearsighted
Retinal detachment is a medical emergency in which you can permanently lose your vision.
Retinal detachment can occur as a result of:
- A sagging vitreous (VIT-ree-us) the gel-like material that fills the inside of your eye
- Advanced diabetes
How retinal detachment occurs
Retinal detachment can occur when the gel-like material (vitreous) leaks through a retinal hole or tear and collects underneath the retina.
Aging or retinal disorders can cause the retina to thin. Retinal detachment due to a tear in the retina typically develops when the vitreous collapses and tugs on the retina with enough force to create a tear.
Fluid inside the vitreous then finds its way through the tear and collects under the retina, peeling it away from the underlying tissues. These tissues contain a layer of blood vessels called the choroid (KOR-oid). The areas where the retina is detached lose this blood supply and stop working, so you lose vision.
Treatment for Retinal Detachment
Surgery has proven a highly successful treatment for retinal detachment, provided the condition has been detected early enough. To ensure that treatment can be effective, anyone experiencing the symptoms above should be given medical attention within 24 hours.
Typical surgical procedures include:
- Laser surgery: Repairs tears in the retina that are the underlying cause of separation
- Cryopexy: Applies intense cold to the underlying tissue, causing a scar to develop that holds the retina in place
- Pneumatic retinoplexy: a tiny gas bubble is placed in the eye that floats the retina back into place; usually accompanied by laser surgery to ensure the retina stays in correct position permanently.
- Scleral buckle: suturing a silicone “buckle” to the eye that indents the wall of the eye into a position that allows the retina to reattach.
Aging-related retinal tears that lead to retinal detachment
As you age, your vitreous may change in consistency and shrink or become more liquid. Eventually, the vitreous may separate from the surface of the retina a common condition called posterior vitreous detachment (PVD).
As the vitreous separates or peels off the retina, it may tug on the retina with enough force to create a retinal tear. Left untreated, fluid from the vitreous cavity can pass through the tear into the space behind the retina, causing the retina to become detached.
PVD can cause visual symptoms. You may see sudden new floaters or flashes of lights (photopsia). These may be visible even in daylight. The flashes may be more noticeable when your eyes are closed or you’re in a darkened room.
The following factors increase your risk of retinal detachment:
- Aging — retinal detachment is more common in people over age 50
- Previous retinal detachment in one eye
- A family history of retinal detachment
- Extreme nearsightedness (myopia)
- Previous eye surgery, such as cataract removal
- Previous severe eye injury
- Previous other eye disease or inflammation
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