Retinal Detachment

The retina is a thin layer of nerve tissue that lines the inside of the eye. It contains more than a million neurons and specialized  “vision cells” called photoreceptors. Much like the film in a camera, the retina is essential in capturing visual images.

A retinal detachment is a separation of the retinal from the underlying wall of the eye. If left untreated, this separation can result in total, permanent vision loss.  There are three types of retinal detachments: rhegmatogenous (due to a tear of hole in the retina), tractional (due to fibrotic bands of scar tissue) and exudative (due to a collection of fluid beneath the retina). Rhegmatogenous detachments are the most common form of retinal detachments and are often spontaneous and unpredictable in origin.  When the retina has a small tear or hold, fluid form the vitreous jelly that fills the eye can seep through the hole and behind the retinal. Much like fluid behind wallpaper, fluid behind the retina causes the remaining retina to detach from the underlying eye wall. Risk factors for rhegmatogenous retinal detachments include extreme myopia (near-sightedness), posterior vitreous detachments (PVD’s), lattice degeneration (irregularly thinned areas of retina), and a history of previous eye trauma and/or surgery.

Patients with rhegmatogenous retinal detachments often experience an acute onset of flashing lights and/or the sudden onset of floaters (black dots or web-like debris in the vision). Patients can experience a black curtain progressing from the periphery of one’s vision towards the central vision, which corresponds the to the progressive detachment of the retina.

Depending on the timing and extent of the retinal detachment, there are several different treatments that can be employed. If the retinal tear is noted before significant detachment occurs, the tear can be lasered or frozen to seal off the opening and prevent future detachment. If a full retinal detachment has already occurred, retinal surgery is often needed to oppose the retinal back to the eye wall and to seal off all retinal tears and holes.  The visual outcome following a retinal detachment repair varies greatly and depends largely on the duration in which the retina is detached and whether or not the macula (the highly specialized area of the the central retina that is responsible for fine-focus acuity) is involved in the detachment.