You can think of the retina as the translator of light. Light enters your eye through the pupils and is focused by the lens. The focused image then goes to the retina, a thin layer of light-sensitive tissue that lines the back of your eye. The retina processes that light through photoreceptor cells that detect color and light-intensity and translates it into neural signals. The signals travel up the optic nerve to the brain, which decodes and interprets what you are looking at.
The retina’s role in vision is critical and damage to it can cause permanent blindness. Retinal detachment is just what it sounds like: the retina detaches from its normal position, preventing it from processing light and sending it on to the brain.
There are 3 types of retinal detachment:
- Rhegmatogenous retinal detachment, the most common type, is the result of a small tear in your retina. If this happens, some of the vitreous humor, a gel-like fluid in your eyeball, may leak behind the retina and cause it to detach. The most common cause of this type of retinal detachment is aging. As you get older, the vitreous humor in your eye changes in texture and may shrink and start to pull on the retina, causing a tear.
- Tractional retinal detachment is caused by scar tissue on the retina pulling it away from the back of your eye. The most common cause of tractional retinal detachment is diabetes. Diabetic retinopathy damages tiny blood vessels in the retina, which can cause scarring. As the scars get bigger, they can pull on your retina and detach it from the back of the eye.
- Exudative retinal detachment is a rare form of retinal detachment that happens when fluid builds up behind the retina, even though the retina doesn’t have any tears or breaks. The accumulation of fluid can cause the retina to detach. The most common reason for the fluid accumulation is leaky blood vessels or swelling in the back of the eye. This type of retinal detachment may be caused by injury or trauma, eye tumors, age-related macular degeneration, or diseases that cause inflammation inside the eye.
Symptoms of Retinal Detachment
Retinal detachment itself is painless but there’s no missing the symptoms – warning signs you should never ignore.
- Floaters: These appear as small dark spots or squiggles floating across your field of vision – a few floaters is normal, but if you suddenly notice many of them, you could have a detached retina.
- Flashes of light in one or both eyes that may resemble "seeing stars" after getting hit in the eye or head.
- A dark, curtain-like shadow in your side vision that gradually grows and extends toward the center.
- Blurred vision: A sudden decline in visual clarity that makes it hard to focus on what you are looking at.
Any type of retinal detachment is a medical emergency that requires an immediate trip to the eye doctor, or the Emergency Department if your eye doctor can’t see you right away. When the retina detaches, it separates from the layer of blood vessels that provides oxygen and nourishment to the eye. Deprived of blood and oxygen, retinal cells start to die. The longer retinal detachment goes untreated, the greater the risk of permanent vision loss. The speed at which vision loss occurs depends on environmental factors, where the retina has started to detach, and whether your activities are making the detachment worse.
Treating Retinal Detachment
See your ophthalmologist immediately if you have any symptom of retinal detachment. They will start by checking your eyes with a dilated eye exam to look at your retina. The exam is usually painless. If further information is needed, you may get an ultrasound or an optical coherence tomography (OCT) scan of your eye to help the doctor see the exact position of your retina.
Treatment for retinal detachment is ultimately successful for roughly nine out of ten people. The earlier the detachment is diagnosed, the better the chances of a successful repair. The ophthalmologist will choose an approach based on the type and extent of the retinal detachment. They may use more than one treatment at the same time to fix retinal tears and reattach the retina. Freeze treatment (cryopexy) or laser surgery can be performed in the doctor’s office to seal small holes or tears in the retina. If a larger part of your retina is detached, you may need to have reattachment surgery in the hospital.
Who is at risk for retinal detachment?
Retinal detachment can happen to anyone, but some people are at higher risk. Risk factors include:
- Nearsightedness
- Having had surgery for cataract, glaucoma, or other eye issue
- Being on certain glaucoma medications such as pilocarpine
- Having had a serious eye injury
- History of a retinal tear or detachment
- Family members who have had retinal detachment
- Weak areas in your retina as seen by an eye doctor during an eye exam
- Having diabetic retinopathy
- Posterior vitreous detachment
- Certain other eye diseases
- Playing sports that put you at risk for an eye injury, such as squash, baseball, basketball, soccer, or motocross
This article appeared in the May 2024 edition of the HealthPerks newsletter.
