the retina it is located in the back of the eye, which receives the light and images we see and sends them to the brain so that it can interpret them. That is, it allows us to relate to the environment in a visual way. Sometimes, one can occur tear and its detachment. If this happens, immediate medical attention should be sought as an early diagnosis prevents a major problem, such as a possible blindness. the doctor Marta S. Figueroa, director of the retina department of Clínica Baviera and head of the Retina Unit of the Ramón i Cajal University Hospital tells us what this eye problem is, what the consequences are, if it can cause blindness and what treatments are given to reverse this medical emergency.
What is retinal detachment?
The retina is a tissue that covers the inside of the back of the eye and in which the first neuron of the visual pathway is located. This tissue sits on a vascular layer, from which it feeds, which is called a choroid.
There are 3 types of retinal detachments:
- Rheumatoid arthritis. It is the most common type of retinal detachment (affects 1 / 10,000 inhabitants). It occurs when a hole or tear forms in the retina through which fluid passes and separates the retina from the outermost layers.
- Tractional. Something pulls on the retina and separates it from the outermost layers.
- Exudative. Fluid builds up under the retina that comes from the vascular layer below.
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Are the causes known?
Retinal detachment rheumatoid arthritis happens mostly in patient with degenerative lesions of the retina which evolve into holes or tears. An example is patients with myopia.
Another common cause is vitreous detachment. Vitreous is a gel that occupies the back of the eyeball and is attached to the retina. With age, the vitreous comes off the retina and at times it tears. in the myopic this vitreous detachment occurs at earlier ages.
Eye trauma can also cause retinal ruptures and retinal detachments.
The most common cause of detachment traction of the retina is the diabetic retinopathy. In advanced stages of poorly controlled diabetes, abnormal vessels form that grow on the surface of the retina and if left untreated in time, can cause traction on the retina and come off.
Retinal detachment exudative it has different causes: age-related macular degeneration, diabetes, tumors, choroid inflammations etc.
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What are the symptoms of retinal detachment?
The alarming symptoms of retinal detachment are myodesopsias (see black particles moving as the eye moves) and photopsies (flashes of light that are seen with eyes open in the dark). Indeed, these are the symptoms of vitreous detachment which is one of the most common predisposing lesions of retinal detachment. Once the retina has been detached, the patient perceives it as one stain or as a curtain which covers a part of the visual field.
Sometimes, we diagnose retinal detachments that do not cause symptoms, such as accidental finding on a routine scan.
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How is it diagnosed?
The diagnosis is made by a complete ophthalmologic examination which includes dilation of the pupil. Pupil dilation is essential to be able to identify if the patient has tears that need laser treatment, and thus prevent the appearance of a retinal detachment, or if there is already a retinal detachment that needs surgery.
Can it cause blindness?
Today it is uncommon for a retinal detachment to cause blindness if treated early. However, there are cases where several surgeries are needed and this obscures the visual prognosis.
It’s a lot important to operate the detachments of the retina when the macula has not yet been affected, that is, when the central area of the retina has not yet been affected, because the visual results after surgery are better.
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What is the treatment? Has there been any progress?
The treatment is surgical and there are different types of surgery that can be performed with the aim of putting the retina back in place and fixing it with a laser so that it does not come off again.
The most frequently used technique is vitrectomy in which, through three small incisions, instruments are inserted into the eye to manipulate the retina, apply it and seal it.
Advances in retinal surgery have been a constant in recent years. Some of the most notable are the progressive reduction of the size of the instrument, the need for suturing in many cases, intraoperative imaging tests, which allow us greater accuracy of maneuvers, and the 3D surgery in which both the surgeon and the rest of the team can see the surgery in three dimensions.