Retinal Detachment
Vitreous fluid flows through a tear and seeps behind the retina, eventually causing the retina to detach from the choroids. If the detachment is in the periphery, vision usually improves with treatment. But if the macula is detached, central vision may remain affected even after treatment.

UNDERSTANDING VISION CHANGES
When your eyes work normally, it's easy to take the view out the window for granted. But when a swarm of black spots (floaters), frequent flashes of light, or other vision changes suddenly interfere with your sight, vision becomes a serious concern. If your ophthalmologist, an eye physician and surgeon, finds that your symptoms are due to a retinal detachment, treatment is needed to avoid permanent vision loss. With prompt treatment, however, your outlook for the future is usually very good.

When the Eye Is Normal
The eye takes in light, changes it into signals, and sends the signals to the brain. The brain turns these signals into images--- what we call vision. When you're young, vision is usually sharp and clear. Overtime, however, your eyes and your vision can change.

The Eye's Normal Aging
The vitreous is a gel-like material. When you're young, the vitreous is firmly attached to the retina all around the eye. As you age, the vitreous breaks down into pockets of fluid separated by strands of thin tissue.

When the Retina Is Damaged
If the shrinking vitreous pulls on a weak spot in the retina, a hole or tear may develop and possibly progress to retinal detachment. The impact on your vision depends on how much of the retina is affected and whether the macula is involved. Your risk of developing a problem increases with age and is greater if you're nearsighted or if you have a history of retinal thinning.

Atrophic Retinal Hole
A tiny piece of the retina is pulled off the choroid as the vitreous shrinks (atrophies). Atrophic holes typically occur on the periphery of the retina and rarely threaten vision. Treatment usually isn't necessary.

Flap Tear
A flap of retinal tissue is pulled off the choroid as the vitreous shrinks. If the flap stays connected to the vitreous, the retina may keep pulling. With treatment, the damage usually can be repaired. Left untreated, a tear may lead to retinal detachment.

YOUR EYE EVALUATION
To learn if your symptoms are caused by a retinal tear or detachment, your ophthalmologist will ask you questions and examine your eyes. After your evaluation, your doctor will discuss treatment options with you. For the best long term results, your doctor may recommended combining several treatments.

YOUR HISTORY
During your office visit, your ophthalmologist will ask about any recent changes in your sight, such as flashes or floaters. You'll also be asked if you've had any previous retinal problems. Be sure to mention any general health problems you may have, such as a heart condition, that might requires special precautions.

YOUR EXAM
After hearing about your symptoms, your ophthalmologist uses special instruments to examine the retina. You'll be given drops to widen (dilate) your pupils making it easier for your doctor to see inside your eyes.

Indirect Ophthalmoscope
For a three- dimensional view of the entire retina, your doctor uses the indirect ophthalmoscope. By gently pressing a small probe against your eyelid (scleral indention), your doctor can bring peripheral tears into view.

Slit Lamp
A special microscope, called a slit lamp, let your ophthalmologist see the individual parts of your eye. your doctor may use a magnifying contact lens along with the slit lamp to help confirm a suspected retinal tear or detachment.

TREATING RETINAL TEARS AND DETACHMENT
If you have a tear or detachment in the periphery of the retina, you may be treated in your doctor's office or in an outpatient surgery center or hospital. Treatment may immediately follow or your exam. No matter which procedure you have, the goal is to rejoin the retina and choroid so vitreous fluid can't further separate these layers of tissue.

Sealing a Tear
Your doctor may use heat cold to seal a tear. These treatments create tiny scars, which join the retina and choroid. You will be given anesthesia to keep you free of pain during treatment.
LASER THERAPY
The laser's light beam passes through the pupil. When the beam touches the retina, the light changes into heat and "spot welds" the retina to the choroid.

Cryotherapy
A freezing probe touches the eye directly above the tear. The cold freezes the tissue around the break, causing the retina and choroid to stick together.
Pneumatic Retinopexy
To push a torn or detached retina back into place, your ophthalmologist may inject a gas bubble into the vitreous. This procedure is called pneumatic retinopexy. As the bubble rises, it presses the detached retina against the choroid. Your doctor may then use laser or cryotherapy to seal the retina in place. The bubble is usually absorbed by the body within one to three weeks. Until then you, may notice the bubble during eye movement.

TREATING DETACHMENT
To repair a more severe detachment, your ophthalmologist likely to combine two or more of the procedures discussed in this booklet. You may be treated at an outpatient surgery center or hospital within several days- or even hours-of your exam. You'I I be given an anesthetic to help you stay pain free during treatment.

Scleral Buckling
To press the choroid into contact with a detached retina, a silicone band may be wrapped around the eye. When the band is threaded under the eye muscles and tightened, the sclera of the eye buckles slightly. This minor indentation helps during the choroid and retina together. The retina is then sealed to the choroid using the band remains around and it cannot be seen.

Vitrectomy
To release fibrous tissue that is pulling on or growing over the retina, the vitreous may be removed. This procedure is called vitrectomy. Using an operating microscope, your ophthalmologist cuts the fibers tugging on the retina. Then, these fibers and any areas of clouded vitreous are removed from the eye and replaced with a saline solution. In many cases, scleral buckling is performed along with vitrectomy.

Risks and Complications
Treatment of a retinal tear or detachment involves some risks. They include:
• Infection
• Abnormal scar tissue forming on the retina, possibly requiring surgery.
• Damage to nearby structures in the eye, such as the lens
• Bleeding severe enough to interfere with vision.

AFTER YOUR TREATMENT
The retina is a delicate tissue that needs time to heal fully. Although a repaired retina may knit into place within days, you may notice short-term changes in sight, such as double or blurred vision. For the best vision possible after recovery, you may need new prescription lenses.

The First Few Days
After a tear is sealed, your eye may be slightly inflamed. If you were treated for detachment, the eye may be sore, red, and swollen. You'll be given medication to control pain and prevent infection. Depending on your condition, you may be told to avoid strenuous physical activities, especially contact sports.

Back to Normal activities
You can expect to return to work and many other normal activities within two weeks. If you treatment included pneumatic retinopexy, avoid increases in altitude-plane rides, especially-until your doctor gives the okay.

Follow Up With Your Doctor
To monitor your recovery, your ophthalmologist may examine your eye the day after treatment. If everything is fine, you'I I probably be scheduled for several follow-up visits over the next two or three months.
Call your Doctor If
• The pain doesn't lessen with time.
• The eye gets more tender, swollen, or red
• The eye has an increasing amount of discharge
• Your vision suddenly worsens

LOOKING AHEAD
Any threat to your vision can be frightening, and a retinal tear or detachment is no exception. But with early diagnosis and proper treatment, your ophthalmologist can usually prevent your vision from getting worse. To ensure your best vision in the future, see your doctor as soon as possible if new vision changes occur.