FYI: Retinal Detachments 101

[berrywoo]

I’ve decided to compile a list of sorts to inform people about RDs, its treatments, and effects.

Retinal detachments: who’s at risk
Those w/ a family history of RDs, high myopia, previous eye surgery, previous eye trauma/injury, weak spots in the peripheral retina, having an RD in the fellow eye, as well as those w/ certain conditions such as Diabetes, Marfan’s, ROP, etc. are at greater risk for developing an RD

Retinal detachments: symptoms
flashes of light, which may look like camera flashes, or lightning bolts, visible during the day, but more likely to be seen at night or dim lighting
floaters, these come in many shapes and sizes, if you notice an INCREASE or sudden onset of these than take warning
black curtain or veil, if you notice any sign of visual loss go see an eye doctor immediately

Retinal detachments: treatments
laser or cryotherapy, both seal holes by creating scar tissue, may be done in office or in the OR combined w/ other treatments
scleral buckle, is done under anesthesia in an OR, a silicone band is sewn around the eye
PPV, in a pars plana vitrectomy the vitreous gel inside the eye is removed to help alleviate traction on the retina or to clear debris from the eye; often done in conjunctions w/ pneumatic retinopexy
Pneumatic retinopexy, is the insertion of a gas bubble to push the retina against the back of the eye, there are two types of gas SF6 which gets absorbed very quickly or C3F8 which takes 6-8 weeks to get absorbed by the body. may be done in the doctors office or in the OR
A variation of pneumatic retinopexy uses silicone oil instead of gas, in this case a PPV must be done prior to insertion of oil

*Note: PPV, scleral buckling, laser, cryotherapy, and pneumatic retinopexy can be done in various combinations to help ensure a stable attached retina

Retinal detachments: effects
*If not treated the result is blindness in the affected eye
*Depending on the extent of the detachment and whether or not the macula was off will determine final visual outcome
Laser: if this method was used to seal breaks in the retina along the periphery you may notice some peripheral vision loss; also, you may notice a temporary loss of vision which should only last a few minutes after treatment if done in office
Scleral buckle: pain and swelling may occur which can be treated w/ OTC meds. possible side effects include double vision, strabismus, ptosis, infection. Will cause a myopic shift in vision so if you’re already myopic you’ll be even more myopic afterwards
PPV and pneumatic retinopexy: head positioning may be necessary, vision will be terrible w/gas or silicone oil inside the eye. travel to high altitudes will be restricted if you have a gas tamponding agent, risks include increase in intraocular pressure, vitreous hemorrhage, cataract formation

**Please note that this is a simplified info sheet I’ve compiled. Talk w/ your doctor about any concerns you have and know the risks involved w/ any procedure before you sign that consent form!!!**

Retinal detachments: post-op
               After any surgery, your eye will be patched. You may experience some discomfort and the eye may be red. This will subside w/ time.
After surgery, you will be given drops: a steroid, to help w/ inflammation; a antibiotic for obvious reasons, and maybe a cycloplegic agent to keep the eye dilated and comfortable while the eye gets used to a scleral buckle
Floaters and flashes of light may still be present after surgery.
Flashes of light should stop w/time, if they persist see your doctor asap. Keep in mind that flashes of light are not localized, which means if you see flashes of light in the center of your vision it does not necessarily indicate that the macula is in danger, just that there is a problem w/ the retina.
Floaters may NOT be removed completely w/ vitrectomy. Eventually they may settle to the bottom of the eye or your brain will learn to ignore them.
Vision will be horrible if you have a gas bubble or silicone oil inside the eye.

Retinal detachments: complications post-op
Know the signs of rapidly increasing IOP: headache, usually located above the brow of the operated eye; naseousness, dizziness, and loss or worsening of vision
Sometimes the initial treatment may fail and additional procedures may need to be done. So be on the watch for returning symptoms of a RD. Generally, the riskiest time for re-detachment is in the first few days to weeks after surgery. If the retina remains attached for 3-6 months the chances of a recurrent detachment reduces significantly.
The success rate for retinal detachment surgery is high. Anatomically speaking, most retinas remain attached, some just take multiple attempts. Visually speaking, the success rates, especially for complex detachments, are less then ideal.

Retinal detachments: resources
Look through this forum and its archives. The doctors and other members of this forum have provided thorough answers to many RD related questions.
Talk w/ your doctor. He/She is in the best position to guide you and keep you informed.
If financial assistance is needed contact the hospital or doctor’s office they may have aid programs available. Or locate a Lion’s Club or Knights Templar office near you they have programs to help those who can not afford the costs of surgery.
Take advantage of support groups on the web or contact your local Services for the Blind, they have wonderful programs to help you.

Retinal detachments: final thoughts
Remember vision may take a while to return. Final visual acuity may not be known for up to a year after surgery. Be Patient.
Take care of your vision, especially the non-RD eye as it has now at increased risk for developing an RD.
I can’t stress this enough: Don’t be afraid to talk w/ your doctor. If you feel uncomfortable around your doctor seek another one. It never hurts to have a second opinion.


***Am I missing anything? If you’ve gone through an RD and feel that there is something missing please feel free to add to this, as I was just trying to be as brief as possible.***

This will probably be my last post for a few weeks as I go back to the OR on Tues. for yet another RD surgery. Bringing my total to 10 surgeries (5 left eye, and now 5 right eye)

Good luck to everyone. Take Care

[AppleBr]

Btw, my vision left eye now is better WITHOUT glasses  - no one know the reason why.
Quite bad one, but get worse wearing glasses

[AppleBr]

Still on the road,dear?
One more year was gone and the damn RD keeps doing her victims...
Well, well... thats the way things are

For all you new folks my simpathy  and good wishes

[trebor45]

I have yellow orbs passing from side to side occasionoly, no flashes

[berrywoo]

@barter: technically speaking, I believe all flashes are phosphenes, since, phosphenes are characterized as the perception of light without actually seeing light. A flash is caused by stimulating the retina (through traction via vitreous gel, scar tissue, etc) without the actual presence of light.
Don't worry about the flashes you're currently seeing, worry when they increase or you notice floaters or a shadow/veil in your vision.

@trebor45 & @momofrm96: I'm very glad that the info I've provided has been useful. I hope that everything goes well for the both of you. :)

[momofrm96]

I wish I had this back in march 2011!!! I am on my third surgery in a year. hope everything goes well and I will keep you in my prayers!!!!

[trebor45]

Thanks for some great info, esp about the terrible vision while silicone oil is in the eye. I was panicking

[trebor45]

Sounds like the same thing I am going thru, i get my oil out in March, then a new lens 3 months afterwards, They took out the lens during the 2nd operation, good luck!

[barter]

I spoke with my retinal specialist after he did a comprehensive check and said that the Flashes are what he called Phosphenes, I tried to research on the net and still am not 100% sold does anyone have any more info on Phosphenes related to RD and use of oil in eye

[hanibee]

when i look side to side with my eyes closed i get a ring of light in both eyes. and when i stare at something with only one eye and dont blink i get a shadow like curtain come over my eye but when i blink it goes away. is this a retinal detachment?

[barter]

I recently had my second DR left eye in 6 years, this time because I was overseas on business I chose to have oil so I could fly home - it's about 5 weeks now post op and for the last 2 weeks I have been having flashes in my eye about 10+ per day. I started recording dates times and location to show the doctor but I have seen 3 different doctors in the past 2 weeks and they have all said the retina is attached but none of them could explain the flashes.

I am so stressed each time it happens and keep thinking its coming off again.

Can anyone tell me is this normal post op with oil as the first time I had gas and don't remember having flashes post op.

[AppleBr]

No contact lens pos RD, just got the IOL ones on June 2010,in the same surgery ( had the one for cataracts and oil removal at the same time)

[LarryG333]

Thank you for the informative post on the basics of RD surgery.

/Larry

[kathryn241]

Did any of you get an aphakic contact lens post RD and lensectomy surgery?

[berrywoo]

Having low IOP does not mean you'll have low blood pressure.
IOP and overall bp are related and studies have shown that a 10mmHG increase in bp leads to a slight rise in IOP and that a decrease in bp leads to a decrease in IOP. However, IOP does not effect systemic bp.
Overall bp is also related to eye health. Having high blood pressure increases your chances of damaging the eye since the blood vessels in the eye are extremely sensitive. So increased overall blood pressure puts your more at risk for things like retinal vein occlusions, hemorrhages, etc. Chronically low blood pressure could adversely effect the eye as well, since you'll be at a greater risk of not having proper blood circulation in the retina. Having your bp taken at the dr.'s is important b/c it alerts the doctor to possible problems that can occur due to either high or low pressure, not to mention gives clues to overall health.

[kathryn241]

Does blood pressure have any relation/correlation to IOP?  Can LOW blood pressure cause low IOP and vice versa?

[garysharr]

Well the doctor decided not to do the laser today.  He said that he couldn't get a good enough look at the lattice as it is on the peripheral part of the retina.  Instead he wants to have a look under general anesthetic next week.  He also mentioned that the peripheral was pale as well.  i know my son was diagnosed with congenital stationary night blindness 8 yrs ago but not sure if this is the reason for the paleness.  Hope this all sounds normal.

[berrywoo]

Hello. I'm sorry to hear about your son's complicated RD. I'm more than glad to help in any way. Just send me a note or PM (private message).
Take care.

[garysharr]

My son 15 lost the sight in his left eye last Tuesday from Rd.  He is myopic .7 in his good eye and .9 in his bad.  His first op lasted 21 days, his 2nd 10 weeks but this brought down the macular as well. He now has laser tomorrow for some lattice degeneration in his eye and we are obviously very worried.  I've been reading your posts and hope you don't mind if i ask a few questions as I am trying to find out as much info as I can.  The doc has been great but talking to others who have been through this situation also helps me see the many inspirational stories as well.

[berrywoo]

There is really no known way to increase IOP. Sometimes steriods can increase IOP, but it's not commonly used (for the sole purpose of increasing IOP). If you've had surgery recently and pressure is low due to surgery, than IOP may gradually return to a normal range. And then there are persistent cases of hypotony. In any given situation, it's best to discussion things with your doctor and see what course of action, if any, can be taken.
There was a member of these forums a few years back, AnnaE, who was dealing with persistent hypotony due to RD repair complications. You might try and contact her.
I was lucky and my IOP, in the left eye, rebounded from around 2-3 mmHg to about 8-10 mmHg, although it took a few months post silicone oil removal.

[kathryn241]

My retina is in place but my eye pressure is too low and I now have no vision in my right eye.  How can you get the pressure UP?  

[suzie521]

tank you very much for your help and information,  i will look for some kind of help for him.

[berrywoo]

Yes, FEVR can cause retinal detachments as can cataract surgery. If your son's doctor has diagnosed him with FEVR than this is much more likely to cause a retinal detachment than cataract removal.
Even if your son has 20/20 vision in his "good" eye, it never hurts to be informed about the help that is available should the worst happen. I do not think he needs a low vision evaluation at this time, but be prepared for it and know in advance what organizations you can contact, and what sorts of aides/adaptive skills can be helpful in the future. Since FEVR is bilateral and one eye has been severely affected the other eye is at greater risk. I do not know of any support groups solely for those with FEVR (I suppose you could try visiting this site: www.fevr.net), but there are support groups for those with retinal problems that may help. The other eye may be stable and remain so for years, but there is no guarantee that it will stay the way it is and often the prognosis is guarded. So, it is important for him to always wear protective eyewear and avoid activities that could cause eye injuries (like boxing) as well as maintaining regular exams with his ophthalmologist.

[kathryn241]

berrywoo is very up to date with her info, knows a lot about all of this.  

[suzie521]

oh and i forgot to mention he also had surgery for cataract when he was 6yr they had to place and implant, so i thought that,.. maybe that was the reason for the RD but the dr. said no that he had FEVR.becuse he said that he saw it on the other eye, do you know if this would be a reason to get a RD? im just worried and dont want my son to go blind on the other eye. thak you