Detached retina

What is a detached retina?

Your retina is a thin layer of light‑sensitive tissue that lines the back of your eye. When light passes through your pupil, your retina converts it into electrical signals. These signals are then transmitted to your brain which turns them into the images you see. 
 
In certain situations, the retina gets pulled away from its normal position. When this happens, it gets cut off from its blood supply so it stops working. 
 
According to the charity Healthify, there are about 400 cases of retinal detachment per year in New Zealand.

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Types of detached retina

There are three types of retinal detachment, and you can have more than one type at a time. They have different causes, but the symptoms are the same. All three types of retinal detachment are medical emergencies.

1. A hole or tear in the retina

The most common cause of retinal detachment. Fluid can leak through the tear and lift the retina away from the back of the eye, cutting off its blood supply. This is called rhegmatogenous retinal detachment.

2. Retinal scarring

A few different health conditions can damage the retina, causing scars to form. Over time, these scars can bunch up, pulling the retina up and away from the back of the eye. The medical name for this is tractional retinal detachment (TRD).

3. Fluid leaks from behind the eye

Rarely, leaking blood vessels can push the retina away from the eye wall. This is called exudative retinal detachment.

Detached retina diagnosis

If you have symptoms and signs of a detached retina, it's really important to get medical treatment as soon as you can. The faster it's diagnosed, the better your chances of protecting your sight. Head to the ED to get your eyes checked immediately if you have any warning signs of retinal detachment (such as a sudden increase in floaters, flashes or a shadow in your vision). The ED staff will know how to test for detached retina.

Detached retina treatment

If you have retinal detachment you will need to have urgent eye surgery. There are a few different methods that the surgeon will use, depending on the type of retinal detachment, which part of the retina has become detached and the underlying cause. 

You'll normally be awake when you have the surgery. You'll be given a local anaesthetic so you won't feel any pain (though you may be aware of some pressure). You'll be able to speak with the surgeon if needed.

Detached retina recovery and outlook

Retinal detachment surgery is often very effective. Many people go back to having a similar level of sight to what they had before. But, like any surgery, it comes with risks ‑ and your vision may not be quite as good as it was before. 

The success of retinal detachment surgery depends on how much of the retina had pulled away, for how long, and if the macula (the central part of your retina) was affected. Your post‑surgery recovery can also have a big impact ‑ especially if you need to do posturing (see below). Sometimes, people need to have detached retina surgery multiple times to fully treat the problem.

Vitrectomy

This is the most commonly used treatment for retinal detachment in New Zealand. The surgeon will take out some of the fluid from inside your eye and replace it with a small bubble of gas (or sometimes a type of oil). The gas presses gently against the retina, helping it move back into place against the inside wall of the eye so it can reattach. 

After a few weeks, the gas will be absorbed by your body, and you will produce new vitreous fluid to replace what the surgeon took out. 

After surgery, you may need to do something called 'posturing' for a couple of weeks. This involves keeping your head in specific positions ‑ like lying on your side, face down or sitting upright. The aim is to make sure the gas bubble stays in the right spot. Posturing can be fairly uncomfortable and inconvenient. But remember that it won't last too long, and it plays a key role in helping your eye recover. 

If you’ve had a vitrectomy, you must avoid changes in air pressure, since this can cause the gas bubble to expand or shift, which can be dangerous. This means you should not fly or do things like scuba diving until your doctor says it's OK.

Pneumatic retinopexy

This is a less common kind of retinal detachment surgery. As with a vitrectomy, a small amount of gas is put into your eye. But no vitreous fluid gets removed The bubble then presses the retina back in place, and cryotherapy or laser is applied around the hole or tear. The gas is reabsorbed over time and is replaced by fluid as the eye heals. 

Again, if you've had gas put in your eyes, you must not fly or scuba dive until your doctor says it's OK to do so.

Scleral buckle

The sclera is the white outer part of your eye. In scleral buckle surgery, a tiny band (usually made of silicone) is placed around your eyeball. This squeezes it gently, so the inside of your eye is pressed inwards. That in turn helps the retina reattach. The buckle will be left in place permanently, but it won't be visible.

Cryotherapy or laser surgery

If you have a hole or tear in your retina, the surgeon might use a laser or cryotherapy (a freezing technique) to seal up the edges of the tear or hole. This stops more vitreous fluid from seeping out.

Detached retina prevention

Retinal detachment is usually caused by things that are out of your control (such as getting older), so you might not be able to prevent it. 
 
That being said, you can reduce the chances of it happening with some simple precautions. Regular eye tests can detect early signs of a detached retina. Eye tests are especially important if you're very sshort sighted or recently had an eye injury. 
 
Wearing protective eyewear when doing sports or DIY can help. If you have diabetes, managing this can also reduce the risks of diabetic retinopathy.

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