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Retinal Detachment

  • When the thin layer of tissue at the back of the eye (the retina) pulls away, causing blurry vision
  • Symptoms include floaters, flashers, shadows, visual field defects, and sudden decrease in vision
  • Treatments include laser therapy, cryotherapy, and in some cases outpatient surgery
  • Involves retina & vitreous , ophthalmology

Overview

A torn retina is a common problem that many people experience, usually without any lasting damage. If you suspect you have a torn retina, it's smart to seek evaluation. That's because sometimes a torn retina progresses to a detached retina, which can bring lasting loss of visual function or even blindness. 

Ophthalmologists and researchers at Yale Medicine are focused on developing new, more effective treatments for retinal conditions.

How does a retina tear and detach?

If you think of the eye as a camera, the lens is in the front, while the retina acts as the film.

The eyeball is filled with vitreous gel, a clear substance that is attached to the retina. Sometimes inflammation or age-related nearsightedness can cause this gel to pull away. If it takes a piece of the retina with it, you have a retinal tear.

Once a retinal tear occurs, that vitreous gel-like fluid may seep through and lift the retina off the back wall of the eye, causing the retina to detach or pull away. (Think of it as the film detaching from the camera.) Sometimes the vitreous pulls hard enough to tear the retina in one or more places. Fluid may pass through a retinal tear, lifting the retina off the back of the eye—much like wallpaper can peel off a wall. This is called retinal detachment.

“Retinal detachment is like a curtain that comes from one side, and it slowly expands,” says Ron Adelman, MD, director of Yale Medicine's Retina & Vitreous Program. If the problem is located at the center of the retina (called the macula) the central field of vision will seem to be blurry.

What are the types of retinal detachment?

There are three main types of retinal detachment:

  • Rhegmatogenous retinal detachment (RRD) is the most common type of retinal detachment. This occurs when a tear or break in the retina allows fluid to get under it, separating it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina.
  • Tractional retinal detachment (TRD) is the second-most-common type of retinal detachment. This occurs when scar tissue on the retina’s surface contracts, causing the retina to separate from the RPE.
  • Exudative retinal detachment (ERD) is a rare complication caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.

What are the risk factors for retinal detachment?

Patients who have poorly managed diabetes might be at a higher risk of retinal detachment. Also predisposed to retinal detachment are people with a family history of retinal detachment and those who have already had a detachment or a tear in the other eye.

Additional risk factors include nearsightedness, previous cataract, glaucoma or other eye surgery or a severe eye injury, such as a trauma or accident.

What are the symptoms of retinal detachment?

A retinal detachment or retinal tear may have the following symptoms.

  • Floaters: A sudden increase in size and number of floating specks in your eye may indicate that a retinal tear is occurring.
  • Flashers: A sudden appearance of light flashes is often the first stage of a retinal tear or detachment.
  • Shadows: A shadow appearing in the periphery of your vision may be a sign of retinal tear or detachment.
  • Visual field defects: A gray curtain moving across your field of vision is a sign of retinal detachment.
  • A sudden decrease in vision: Seeing a flash or a floater as mentioned above doesn’t necessarily mean that you have a
    retinal tear or detachment, but if the symptoms become more severe or your vision gets worse, you should see an ophthalmologist right away.

How is retinal detachment diagnosed?

An ophthalmologist will perform an eye examination to look for and diagnose a retinal tear or retinal detachment. The examination requires dilation of the pupils. An ultrasound of the eye may also be performed to get additional detail of the retina. Treatment depends on whether you are found to have a tear or full retinal detachment. 

How is retinal detachment treated?

The process for retinal surgery begins with a clinical evaluation and consultation. The ophthalmologist may suggest a laser treatment, which is very effective for retinal tears.

“It fixes the tear so it prevents further retinal detachment happening,” explains Dr. Adelman. An ophthalmologist may also suggest cryotherapy, which freezes the retina around the retinal tear and creates a scar that helps to hold the retina in place on the eye wall.

A detached retina will require surgery. Retinal detachment surgery options include:

  • Scleral buckle, in which a flexible band is placed around the eye to counteract the force pulling the retina out of place.
  • Vitrectomy, in which the vitreous gel is removed and replaced with a gas bubble or oil bubble to hold the retina in place.
  • Pneumatic retinopexy, when a gas bubble is injected into the vitreous space inside the eye, pushing the retinal tear into place against the back wall of the eye via cryotherapy or laser surgery.

“The physician needs to make sure that there is a good reason to do the surgery,” Dr. Adelman says. “Some testing is done to evaluate the level of the condition.”

Retinal surgery is usually done in an outpatient basis. Patients come in the morning, get the surgery done in the Yale Eye Center surgery center or a hospital, and then leave the hospital or the surgery center by noon.

What makes Yale Medicine’s approach to retinal attachment unique?

“Retinal surgery is commonly done at Yale Eye Center and Yale Medicine, and the success rate is quite high,” says Dr. Adelman. “For conditions such as retinal detachment, the success rate is around 90 percent.” Yale Medicine’s researchers have developed new approaches to retinal conditions, which will be introduced to clinical medicine.