Unrepaired Retinal Holes

[gkco]

Hi, I’m 20 years old and have had fairly high myopia, standing at about -10 in both eyes.  I was diagnosed with lattice degeneration in both eyes and have had retinal holes in the superior region of my right eye only. I’ve been seeing a retinal specialist who has treated the holes in the superior region with laser retinopexy. I just had a regular eye exam done with an OD a few days ago who saw the development of another hole, in the inferior portion of the right eye and I saw the specialist again today. He told me that he would have to leave the inferior hole alone for now, since there was a higher risk of making more damage if he attempted to repaired it. However, he noticed several smaller holes reoccurring in the superior region near my old ones again and immediately repaired it. My questions are, since I didn’t have a chance to talk to him (he was so busy!):

1) What is the risk and benefits of leaving an unrepaired hole? I know many people have untreated holes, but it seems like it will be inevitable that it will lead to detachments or other concerns.

2) Are there any symptoms specific for hole development?, I know the symptoms for retinal detachment, like large shadows, flashers, showers of floaters etc., but for small holes are they the same?

3) He mentioned to take it easy for 7-10 days. Does this exclude me from activities like walking/running and carrying a heavy bag? (I’m still at school)

4) He assured me last time about lifestyle changes, where he advised against high risk activities such as sports where trauma to the eye is higher and activities which have sudden drops like bungee jumping. However, I have seen a lot of discussion on this topic and would like a second opinion. I’d like to know if I can still do things like weight lifting and martial arts (which do involve sudden drops  etc.)

Thanks for your input!

[Ray T Oyakawa, MD]

3)  I believe this is related to post laser activities.

4)  I would not recommend sports such as boxing, karate, or sports with a high likely chance of direct trauma to the eye.  Life is a balance, I have seen retinal detachment from trauma to the head,  falling off a ladder and landing on your rear end, and from other trauma not directly to eye.  These are very uncommon.

Dr. O.

[gkco]

Thank you for your input, I at least know a rough idea of the statistics out there. Still, do you have any opinions on the lifestyle questions 3 and 4?

[Ray T Oyakawa, MD]

I am a retinal specialist who does not believe in treating asymptomatic horseshoe retinal tears unless you are going to have cataract surgery.

A symptomatic retinal tears is a an acute retinal tear (horseshoe) tear which results from vitreous detachment with traction on the retina.

Only a few studies have followed untreated retinal tears and the last one was published many years ago.  An acute retinal tear has a 35% to 50% chance of retinal detachment.  Complications of treatment are about 5%.  Therefore there is an advantage of treatment.

1)  A round holes has a very low chance of retinal detachment--way less than 1%.  Therefore with treatment you have a higher chance of complications--5%.

2)  There are no symptoms related to round holes.


Treating lattice degeneration is not indicated unless you have an acute retinal tear in most cases.  Retinal tears can occur in normal areas of retina in patients with lattice degeneration.  Therefore treating the lattice will not prevent retinal tears in normal areas of retina.

Dr. O.