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A patient came in complaining of floaters and flashes, and their vision ended up having a retinal detachment. So what happens with a retinal detachment?
The retina is the lining inside the back of the eye, like the film of a camera; that’s what you see with. The back of the eye, in front of the retina, is filled with a substance called the vitreous humor or vitreous body; this is a Jello-O-like substance that is attached to the retina more strongly out to the peripheral part to the side, and also attached to the posterior part.
Over time, the vitreous humor tends to liquefy and start to move around. A retinal tear can also happen from an injury, because a force hitting the eye can cause the vitreous humor to move around.
What happens is that the vitreous starts to move, shrink, and pull loose from the retina. When it pulls loose, that’s when you see these floaters that can be like cobwebs, veils, curtains, bugs, gnats—things floating in your vision.
As this tugging and pulling occur, or as you move your eye, the vitreous bounces and hits your retina, then you get flashes. Usually, the flashing is not very bright, so you may not see it that much in the daytime, but you see it at night. That’s what goes on with a vitreous detachment; the vitreous pulls loose, and 90+% of the time, you get floaters and flashes, and that’s all that happens.
But on a rare occasion when this pulls loose, it tears a hole in the retina. Because there’s a hole there, now the fluid inside your eye can seep underneath through that hole, underneath that retina, and then the fluid pushes the retina off of its attachment to the choroid, the next layer down, and that is a retinal detachment.
In people who get retinal detachment, the detachment spreads and can detach the whole retina, after which vision becomes extremely bad. In the beginning, if it’s only detached in an area, you may notice a dark area to the side.
We consider two types of retinal detachments as far as how the outcome is going to be after repairing the retinal detachment. When the detachment is localized and does not involve the macula, then almost always, that person, once the retina is fixed, is going to maintain good vision because the macula has stayed in its proper location. That type of retinal detachment needs to be repaired immediately because you want to keep that macula from detaching.
The other type is where the macula has been detached. So now the macula has been detached from the underlying choroid and nutritional blood supply to some extent, and so even though the retina can be fixed, that macula may have been damaged; it may not be as healthy as we would like, and so therefore the vision return after having a retinal detachment with the macula that has been detached is not as good.
It’s important that if someone has flashes and floaters, they get the retina looked at to make sure they don’t have a tear. If they do, they’ll want to fix that tear before the retina detaches; that way, they can maintain their vision. If you do get a retinal detachment, you want to catch it early so your macula stays in place.
There are different ways to fix a retinal detachment. One method is: if the tear is above, the top half of the eye, and is not too large, apply a freezing application around the tear from the external part of the eye so it seals it back up. Then a gas bubble is inserted into the eye, and that bubble then pushes the retina back up to its proper location and seals everything back down. That can even be done in the office.
If the tear is too large, there are too many, or it is located below, then you have to actually go into surgery and have the retina fixed. Many times, that would include putting a band, like a rubber band that goes around the eye, to squeeze this in so it releases the traction inside the eye. That area where the tears are is frozen as well, and sometimes a vitrectomy is done, in which all the vitreous is removed to relieve any further traction on the retina. This has to be done in a surgery center or hospital, as far as the procedure goes.
Those are the two basic ways in which a retinal detachment can be fixed. In summary, if you have flashes and floaters, you need to go see your eye doctor right away to make sure that your retina is okay. If you do have a retinal detachment, the good news is that, with today’s technology, most of the time it can be fixed. It’s important to do this as soon as possible if your macula is still intact, because it will preserve the quality of your vision.
If you have more questions about retinal detachment or other vision problems, contact the Cataract & Refractive Institute of Florida today. If not, may God grant you healthy eyes and great vision!
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