Retina and Vitreous Disorders

Vitreous Detachment and Retinal Tears

Between the lens and the retina a clear jelly, known as the vitreous body, maintains the shape of the eyeball. As a person ages, the vitreous gradually becomes more watery and may pull away from the retina. Although most are unaware of it, as many as half of all people experience this condition by the age of 50. A tear in the retina can occur during vitreous detachment and is characterized by light flashes in the field of vision at the onset of the condition, possibly progressing to spots and webs, which may gradually clear with a remaining  floater as a continuing annoyance.

Preventive measures are 95 percent effective; however, laser or cryosurgery may successfully treat retinal tears, which are both done on an outpatient basis. Following surgery, the majority of people can resume their normal activities with restrictions on only extreme activities.

Retinal Detachment

If you were to load film incorrectly into a camera, you would be unable to get a good photograph. In a similar way, if the retina is not properly positioned in the back of the eye, vision is lost. This problem occurs with retinal detachment, in which the retina is pulled away from the back of the eye by trauma, or more commonly, vitreous detachment. When the retina is pulled away from the choroid, the system of blood vessels covering the outer surface of the retina, it is deprived of nourishment and loss of vision results.

The warning signs of retinal detachment are the appearance of flashes of white light in the side vision of the field of vision and the onset of tiny floaters. Laser treatment or cryotherapy may be done at these initial signs to avoid the more serious effects of retinal detachment. As retinal detachment progresses, a curtain starts in the peripheral viewing field and spreads toward the center of vision. By this time, laser or cryotherapy treatment is no longer effective and major surgery must be performed.

The type of surgery employed depends upon the number, location and extent of the retinal tears:

• Scleral Buckle
• Intraocular Gas Bubble, or
• Vitrectomy

The goal of each of these, in combination with laser treatment or cryotherapy, is to close the retinal tears, which will restore the retina to its proper position.

This procedure is performed on an outpatient basis at our surgery center with minimal recovery time. Eyeglasses may need to be changed; however, this is postponed for six to eight weeks following surgery to allow the retina and vitreous body to settle in for accurate testing.

Surgery is successful for more than 90 percent of all retinal detachment cases. However, on a rare occasion a condition called “proliferative vitreoretinopathy” may call for additional surgery. Retinal detachment was once an incurable problem, but thanks to the vast improvement in surgical procedures over the past 20 years, it may be successfully treated in the majority of cases.

Macular Holes

The macula is the small central area of the retina responsible for our clear direct vision, while the remainder of the retina is used for side or peripheral vision. The vitreous body is a transparent jelly, which fills the space between the lens and the retina and maintains the shape of the eyeball. A macular hole is frequently caused when the vitreous gel separates from the retina, a condition that occurs most commonly as a person ages, although, in some cases, persistent vitreous forces upon the retina can cause a macular hole without the actual separation of the two.

Among the symptoms of a macular hole, or an impending macular hole, is distorted vision. A straight line will look bent or wavy; signs may appear to have letters missing. The center of an image may appear to be blurry while the perimeter is clear. A fully developed macular hole can result in “legal blindness.”

The presence of a macular hole may be determined during a dilated eye exam along with the use of a fluorescein angiography, a test using yellow dye so that macular holes may be revealed photographically. Once diagnosed, they may be surgically treated. Depending upon the patient’s general physical condition, medical history and the condition of the eye, the vitrectomy surgery may be performed under general or local anesthesia. For most patients, some activity is restricted for the first few days after surgery, with usually a one-week period before returning to work.