The Risk of Ignoring Signs of Retinal Damage

It may begin as a few dark specks or wavy lines floating across the field of vision, or lightning-like flashes in the corner of the eye. Although painless and often no cause for alarm, such symptoms can signal a tear in the retina, the layer of tissue at the back of the eye that processes light and sends images to the brain. In most cases, unless treated promptly, a tear can progress to permanent vision loss. Fortunately, treatments to fix retinal tears have advanced in recent years, and surgical procedures to repair retinal detachments have relatively high success rates. In addition, researchers are exploring how lifestyle and nutritional factors may influence the health of the retina.

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Simply getting older is a major risk factor in many eye diseases, including macular degeneration and cataracts. As part of aging, the gel that fills the eyeball starts to shrink and pull away from the retina, a condition known as a posterior vitreous detachment, or PVD. The pulling releases small particles of connective-tissue fibers that float through the field of vision, and the tugging on the retina can cause what look like flashes of light. Most PVDs don’t require treatment, although it can be disconcerting to know you have the condition. About 15% go on to become a tear, and there is no sure way to predict if or when that will happen. Retina specialists warn patients to be vigilant about new symptoms, such as an increase in the volume of floaters, more frequent flashes, blurry vision or the appearance of a dark curtain over the field of vision. These could be signs that the retina is peeling away from the underlying supportive tissue, much like wallpaper peeling off a wall.

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To treat tears, retina surgeons use a laser or a freezing procedure under topical or local anesthesia, spot-welding around the edges of the tear to prevent it from progressing. Although the prognosis is usually good if the tear is diagnosed early, there is still a risk of additional tears so it is important to keep monitoring patients.

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Surgery to repair a detached retina involves reattaching the retina to the back of the eye and sealing the tears or holes. Dr. Ferrone says surgery succeeds 9 out of 10 times with one operation, although more than one procedure might be required. Techniques include a scleral buckle, which places a silicon band outside the eye to push the wall of the eye toward the retinal tear, using a freezing treatment to induce scarring, thereby permanently sealing it.

In another procedure, called a pneumatic retinopexy, the doctor injects a gas bubble into the eye to push the retina back in place then follows up with a freezing treatment or a laser surgery. Surgeons may also perform a vitrectomy, which involves making incisions in the eye, removing the vitreous gel, draining the fluid under the retina, injecting a gas bubble, replacing the gel with a clear fluid like silicone oil that is removed surgically when the retina is stable. Recovery can be arduous, requiring the head to remain face down as much as possible for up to several weeks to keep the gas bubble in the right place. Patients must avoid air travel or high altitudes while the gas bubble is in the eye.

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https://www.wsj.com/articles/retinal-damage-eyes-11649451327 (subscription)