Ep. 011: Everything You Wanted to Know About Retinal Detachments with Sugat Patel, MD

Dr. Sugat Patel, a retina specialist, joins Dr. Suh to discuss retinal detachments (RD), a potentially sight-threatening condition. Around 5 in 100,000 people per year will develop a retinal detachment.

A posterior vitreous detachment, separation of the liquefied vitreous gel from the retina, will occur eventually in most people. It is a major cause of flashes of light or floaters in the vision. Sometimes this may also lead to a retinal tear.

If the normal inner eye fluid (aqueous) gets under the retina through the tear, then the retina will lift off of the eye wall. This is a rhegmatogenous retinal detachment. When the retina detaches, most people will notice a scotoma, or a dark/blind spot, in their side (peripheral) vision. This scotoma may get bigger quickly and infringe on the central vision. This is an emergency and the patient needs to be evaluated by an eye care specialist immediately. Trauma and myopia (nearsightedness) are risk factors for this type of RD.

Exudative detachments occur when fluid leaks from the choroid, the nutrient layer underneath the retina. This can happen from uveitis (inflammation), bleeding, or an ocular tumor.

Tractional detachments occur when something inside the eye is pulling on the retina such as scar tissue from advanced diabetic retinopathy and retinopathy of prematurity.

Retinal tears can be treated with an in-office laser or with cryopexy (extreme cold therapy). Laser retinopexy is the more common way to treat this condition because it seals the tissue down quicker and with less inflammation.

For patients with small, asymptomatic RDs, laser retinopexy can be performed instead of surgery in the operating room. Even larger, asymptomatic RDs with tears in the upper part of the retina can be treated in the office with pneumatic retinopexy where a gas bubble is injected into the vitreous cavity to push the retina back into place. Laser or cryopexy is then used to seal down the area around the tear.

If a RD needs to be fixed in the operating room, various techniques can be used alone or together to fix the retina.  A scleral buckle is a band that encircles the eye to help bring the eye wall closer to the retina. A vitrectomy is surgical removal of the vitreous gel which is what usually tugs on the retina in the first place. Laser is then used to seal the area around any retinal tears. Sometimes a gas bubble or silicone oil may be used to keep the retina in place.

All RDs need attention quickly, but macula-on detachments should be fixed more urgently because the macula is still functioning and has not separated yet. The center of the macula (fovea) is the most important area of the retina that enables one to see to read and to see details far away.  

Post-operatively, patients may have some discomfort. With scleral buckles, there may be some double vision, which is usually temporary, because the buckle goes underneath the eye muscles. If a gas bubble is placed, the vision may be very fuzzy for several days. The patient may need to be in a certain head position for two to ten days to let the gas bubble push against the area where the main part of the detachment was located. 

The success rate for primary RD repair is around 90-95%. Some risk factors for re-detachment include younger age, trauma, and underlying inflammation. 

To find out more about Dr. Patel and his practice, go to Midwest Retina’s website.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.