Have you ever looked up at the clear blue sky on a sunny day and noticed strange objects that look like something you would see under a microscope? Or, have you ever thought you were seeing a bug out of the corner of your eye and tried swatting at something that wasn’t really there?
Flashes and Floaters What you are seeing are floaters. Floaters are usually translucent and come in many shapes and sizes. The eye is filled with a clear, jelly-like substance called the vitreous. It is not unusual for small bits of protein to become trapped in the vitreous during the eyes formation, prior to birth, and remain trapped there indefinitely. Since floaters are in the eye, they move as the eye moves. Floaters will seem to dart away whenever you try to look at them directly. Floaters are normal and will gradually increase in number as you age. However, if you ever notice a sudden increase in the number of floaters you are seeing, and/or they are accompanied by flashes of light, you should schedule an eye examination as soon as possible. These changes can be an indication of a retinal break or detachment.
Symptoms of a Retinal Detachment A retinal detachment is considered a sight threatening emergency and must be treated as such. The retina is the inner lining of the eye and is responsible for converting the image that falls on it into an electrical signal to be transmitted back to the brain. If the retina is not able to get the nutrients and oxygen it needs from the tissue it normally rests against, it can begin to atrophy and die within a few days. At this time the technology does not exist to restore the vision lost when retinal tissue dies. It is vital to reattach the retina as quickly as possible, in order to prevent permanent vision loss. Unfortunately, there is no pain associated with a retinal detachment. You must rely on recognizing the symptoms of this sight robbing emergency. These symptoms include not only flashes and floaters, but also include a sudden decrease in vision, a veil or curtain obstructing your vision, and wavy or watery vision.
Who is More Likely to Develop a Retinal Detachment?
It has been estimated that one in approximately 10,000 to 15,000 people will experience a retinal detachment, or roughly 6% of the population. You are more prone to developing a detached retina if you are highly nearsighted or myopic. Other risk factors for retinal detachment include: a family history of retinal detachment, previous retinal detachment in a fellow eye, a history of trauma to the eye, cataract surgery, lattice degeneration, a posterior vitreal detachment, or a history of uveitis. Systemic diseases can also predispose you to developing certain types of detachments. Some of these conditions include diabetes, sickle cell disease, leukemia, eclampsia, and tumors from breast cancer or malignant melanoma.
How are Detachments Diagnosed? Retinal detachments are generally diagnosed by your eye doctor after careful examination of your retina. This can be done with a binocular indirect ophthalmoscope. This instrument gives your doctor a stereoscopic (3-D) view of your retina. Magnifying lenses may also be used with a Slit Lamp, or Biomicroscope, to get an alternate view of your retina. A retinal camera, such as the Optomap, may be used as well. If it is not possible to get a clear view of the retina by normal means, due to the presence of cataracts or hemorrhaging, ultrasound may be used to determine whether the retina is in its proper place or not.
Tests of your peripheral vision can also be very diagnostic. Wherever the retina is detached, there will be a corresponding loss of peripheral vision. Loss of peripheral vision is not diagnostic for detachments found in the outer edges of the retina, since most peripheral vision tests only check the central thirty degrees or so of vision and not the entire field of vision.
Treatment If you do find yourself with a retinal detachment, the good news is that there are several techniques available to repair the damaged tissue. The type of treatment chosen depends upon the location, severity, and type of the detachment found.
Pneumatic retinopexy may be used to reattach the retina in cases where there is only a small break in the retinal tissue or just a few small breaks located close together. With this technique a gas bubble injected into the eye is used to push the retina back into place. The surgeon will often ask the patient involved to keep his or her head in a specific position in order to manipulate the bubble into the desired position. Because gas rises, this treatment works best for detachments in the upper portion of the retina. The gas bubble will be slowly reabsorbed over a one to two week period of time.
After the once errant tissue is in position, an additional procedure will be preformed during which the retina will be “tacked down.” This is done either with a laser procedure or by cryotherapy. During cryotherapy a cold probe is touched to the outside of the eye. The extreme cold is then transmitted through the thin wall of the eye, opposite the area needing to be treated. This in turn creates scar tissue at the site causing the retina to be “tacked down.” Laser treatment works much the same way. A laser is sited through the patient’s pupil and is then used to zap around the edges of the torn retina, “spot welding” the retina in place. Some detachments are best treated with a surgical procedure called a scleral buckle. During this procedure a retinal surgeon will attach a tiny sponge or silicone band to the outside of the eye so that it is pressed inward. Pressing the eye inward helps hold the retina in place so that the surgeon will be able to “tack” the retina in place with either cryotherapy or laser surgery after he has removed the vitreous gel from the eye. The buckle is not visible and remains permanently attached to the eye. Sometimes this technique can elongate the eye, causing nearsightedness or increasing it greatly.
When other techniques have been unsuccessful, in some cases it may be necessary to use silicone oil to reattach the retina. First the vitreous gel is removed and then it is replaced with silicone oil. The oil is then used to press the retina into place. Vision is very poor as long as the oil remains in the eye. Once the retina has resealed itself against the back of the eye, a second procedure may be preformed to remove it.
Annual eye examinations allow your eye doctor to monitor the health of your retinas on a regular basis. If you are in one of the high risk groups for retinal problems, make sure you monitor your vision on a daily basis. It is a good idea to compare the vision between your eyes. One way to do this is to pick out an object and look at it with one eye and then with the other and make sure that it looks equally clear and that you notice no distortion. The object should look pretty much the same to both eyes. Also make sure to be aware of the symptoms of a retinal detachment. If you ever notice a sudden increase in floaters, flashes of light, a curtain or veil over your vision, blurred or distorted vision, or wavy or watery vision make sure you contact your eye doctor immediately!
