Retinal detachment 

Retinal and vitreous detachments are different. A posterior vitreous detachment is very common (floaters and flashes), but is only sight-threatening  if it results in a retinal tear and retinal detachment. A retinal detachment is a serious and rapidly blinding condition that requires timely vitreoretinal surgery to present total loss of vision.

Retinal detachment 

A posterior vitreous detachment (PVD) occurs with symptoms of floaters and flashes. Such symptoms should lead to early retinal examination within a week. Although 95% of people will not develop any problems, the few patients who do develop a retinal tear as a result of the PVD will need retinopexy (retinal adhesion with laser or cryo) to prevent the tear progressing to blinding retinal detachment.

A retinal detachment is when a tear in the retina allows fluid from inside the eye to leak underneath the retina, stripping it off the inside of the eye. This is similar to wallpaper peeling off a wall. 

The retina is no longer able to function properly because the photoreceptors (light sensitive cells) lose their nutrition and die, and thus are unable to transmit their message to the brain. 

Retinal detachment symptoms

A retinal detachment will most likely begin at the periphery of the retina. This means that, while floaters or flashes of light might occur, there may not be any noticeable symptoms.

Often, the next sign of a detached retina is a dark shadow to the side of their vision, which then slowly moves closer to the centre. The build-up of fluid under the retina causes the growing shadow. In some people, this can happen very quickly (over a few hours) and must be attended to urgently.

Treatment for a detached retina

Surgery is the most likely treatment for retinal detachment. There are two types of surgery:

• Vitrectomy. This involves intraocular microsurgery with surgical removal of the vitreous gel. Your surgeon may remove scar tissue and create a support for reattaching the retina. A dense liquid is injected into the eye to smooth the retina into place. Then, the ophthalmic surgeon will bond the retina back against the wall of the eye, injecting a gas or silicone oil to secure it in place as it heals.
• Cryo-buckle surgery. Performed under an anaesthetic, this involves pushing the retinal pigment epithelium (RPE) on the inside of the wall of the eye towards the detached retina within. Cryo (freezing) treatment then creates a scar that sticks the retina to the RPE around each tear.

Your ophthalmologist will explain why they have chosen one surgical option over the other.

Prognosis after retinal detachment surgery

First and foremost, the aim of surgery is to stop progression of the loss of vision. The retinal reattachment rates depend on the extent of the retinal detachment (RD), the duration of RD, the number of retina tears, the size of the retinal tears and the experience of the surgeon. The repair of retinal detachments has improved greatly over the past few decades, with surgery also offering restoring useful vision to many patients.