The retina is the delicate layer of cells at the back of the eye that captures external light, sending it to the brain, enabling sight. The retina is normally attached to the wall of the eye. Retinal detachment is a separation of the retina from the wall of the eye, akin to wallpaper peeling off a wall. This can lead to permanent loss of vision or blindness due to interruption of blood and oxygen supply.
Retinal detachment often requires urgent treatment. In particular, retinal detachment with new symptoms of peripheral visual loss that has yet to affect the central vision (often called macula-on or macula-sparing retinal detachment) may require emergency same-day surgery.
About 1 in 10,000 people per year in the general adult population will develop retinal detachment. This risk increases with age (>50 years), significant short-sightedness, prior severe trauma, eye surgery and a history of previous retinal detachment in the patient or family.
There are 3 types of retinal detachment:
1. Rhegmatogenous retinal detachment
This is the commonest type of retinal detachment. It can cause rapid loss of vision and often requires emergency surgery within 24 hours.
Rhegma in Greek means rupture or rent. A break in the retina occurs, most commonly either in the form of a retinal tear or hole. The break allows fluid that normally stays in front of the retina, to flow through the break behind the retina, leading to separation of the retina from the wall of the eye.
Causes: A retinal tear (also called a horseshoe or ‘U’ tear) develops due to posterior vitreous detachment and a focal point of vitreous pulling on the retina. Posterior vitreous detachment occurs in the majority of people by the age of 70, but can occur earlier with short-sightedness and prior surgery. A retinal hole (also called a round or atrophic hole) develops due to thinning of the retina most commonly found in short-sighted people. Significant eye injury is also a cause.
2. Tractional retinal detachment
This is due to scar tissue formation on the surface of the retina, which gradually contracts, pulling the retina off the wall of the eye in the absence of a retinal break.
Causes: Diabetes is the main cause.
3. Exudative retinal detachment.
This is due to blood vessels within the retina leaking fluid underneath the retina, and is the least common type of retinal detachment.
Causes: A range including inflammation (uveitis).
Symptoms are predominantly a sudden onset of visual floaters and/or a shadow (dark or grey curtain) in the peripheral vision. Other signs of retinal detachment include an onset of flashing lights. The peripheral shadow can increase rapidly leading to loss of central vision. Some patients may not immediately notice a loss of peripheral or central vision if it occurs in their non-dominant seeing eye.
The key is early diagnosis and treatment by a retinal surgeon when the retinal detachment is limited to the peripheral retina before central vision is affected, known as macula-on or macula-sparing retinal detachment. Once central vision is involved, there is no treatment that can return vision completely back to normal.
It is thus important to have your eye examined urgently by a retinal surgeon within 24 hours of developing any sudden change or loss of vision.
Treatment depends on both the type of retinal detachment and age of the patient.
Our team of expert retinal surgeons provide emergency same-day sight-saving surgery. If you require urgent retina care please call us on 0203 369 2020 and we will book you in to be seen immediately by our team.
Mr Chien Wong is our lead retina surgeon, highly experienced in complex retinal detachment surgery. He heads the de facto UK national centre for retinal detachment surgery in premature babies at Great Ormond Street Hospital for Children.
Our team of retinal specialists are leaders in their field, pioneering technical advances in vitreoretinal surgery. Their expertise is sought internationally by vitreoretinal surgical companies to advise on improvements of current and future technologies in order to optimise the safety and effectiveness of surgery.
You are always at the centre of everything we do. We do not offer a one size fits all approach but rather customise every single treatment to your individual visual needs, so you’ll always get the best procedure for your eyes and your vision.
The success rate depends on a number of factors, including type and duration of retinal detachment. For the commonest type of retinal detachment (rhegmatogenous), the UK national average among a large cohort of vitreoretinal surgeons in a research study of 4231 patients published in 2020 (Ferrara et al, American Journal of Ophthalmology. 2020 Sept) demonstrated a retinal reattachment success rate of 85-88%. At OCL, our equivalent success rate is >90%, with a 0% infection rate.
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