Retinal detachment

Retinal detachment doesn't cause any pain. Even in its early stages it is noticeable because of the visual problems it causes, including:

• Flashes of light that are sometimes visible even when you close your eyes
• Bright streaks, rings or black dots which move when you look around (“floaters”)
• Dark patches that flow across your field of vision
• Little falling black dots (“black rain”)
• Shadows that cover the field of vision like curtains being drawn from the outside to the inside lasting several hours or days

Things like exactly where the retina is detaching will determine which of these symptoms develop. If the middle of the retina ( macula) is affected, your vision can become blurry or distorted.

The most common cause of retinal detachment is a torn retina.

The retina is loosely attached to a layer below it, which supplies the retina with nutrients. The gel-like liquid in the middle of the eye (vitreous body) can get under the retina through a tear or a hole in the retina. That pushes the retina away from the layer beneath, meaning that the sensory cells in the retina no longer get enough nutrients. That leads to the typical symptoms of retinal detachment and causes permanent damage to the retina.

Not all detached retinas are caused by tears. They can sometimes be caused by scars on the retina or a build-up of fluids resulting from other medical conditions, but both cases are much less common.

There is an increased risk of detached retina caused by tears in people who have:

• moderately to severe nearsightedness,
• close relatives with detached retina (genetic predisposition),
• already had eye surgery, e.g. for cataracts or far or nearsightedness,
• have injured their eye in the past, perhaps when doing martial arts or ball sports.

In the years following retinal detachment in one eye, the retina of the other eye also detaches in up to 20 out of 100 people.

Some people have retinal damage as a result of diabetes (diabetic retinopathy). Retinal detachment is more common in those people.

Experts estimate that retinal detachment affects about 10 to 25 out of 100,000 people in central Europe per year.

It becomes increasingly common in older age: About 3% of all people experience retinal detachment by the age of 85. It is more common in men than in women. But children and people under the age of 30 years are less commonly affected.

If the retina has detached, a swift diagnosis and surgery are key to saving or restoring vision. It is possible that the affected eye will go blind without surgery.

The retina can usually be re-attached. Sometimes, several procedures are needed. How good your eyesight will be afterwards depends on things such as where exactly the retina detached from and how severe the damage already was.

Your eye specialist will first ask you about your symptoms and any other conditions or injuries you might have. Your eye will then be closely examined. A vision test is sometimes done first to check your eyesight. The doctor will look into your eyes using a special microscope called a slit lamp.

This is followed by an examination of the back of the eye to take a closer look at the retina there. You will be given eye drops beforehand to dilate (widen) the pupils. The doctor will shine a special device called an ophthalmoscope directly into your eye to make the retina visible. They can then see if there are any tears or detachments. Your eyes will be more sensitive to light and your vision will be a little blurry for a while after the examination.

Other examinations such as ultrasound scans might also be done afterwards.

Age-related retinal detachment often can’t be avoided with preventive measures. But it’s important to see an eye specialist quickly if you notice changes in your eyesight. Permanent loss of vision can often be prevented if detached retina is detected and treated early on.

Regular check-ups are important if you have an increased risk of retinal detachment, for example due to nearsightedness. Pre-stages of retinal detachment such as tears can be treated at your doctor’s office to prevent full detachment.

There are two options: laser treatment (thermal laser coagulation) or cold therapy (cryocoagulation). Heat or cold is then used to attach the retina back onto the lower layer around the tear or hole. The tears are then still there, but can’t get any bigger.

The risk of eye injuries and related retinal detachment can be reduced by wearing safety goggles when doing certain activities, like work that involves sawing, drilling or hammering, but also contact and ball sports such as hockey and squash.

Retinal detachment usually calls for fast surgery in hospital. The two most common types of operation in Germany are:

• Scleral buckling: A silicone seal or a silicone ring is used to indent the eyeball from the outside so that the retina is in contact with the layer below again.
• Surgery to remove the vitreous body (vitrectomy): The gel-like vitreous body is replaced by gas or silicone oil. The two layers are then pressed together again. The gas is then replaced by the body’s natural fluid over time. But another procedure is needed to remove the silicone oil.

The choice of procedure depends on things such as where and how severely the retina is damaged, but also whether the eye has already been operated on before. It is best to talk to your doctor about which procedure makes the most sense in your individual situation.

They can also give you valuable tips about what you have to be aware of before and after the operation. For example, it’s important to avoid quick head and eye movements to prevent the retina from detaching more quickly.

It is usually possible to surgically reattach the detached retina. That often also improves eyesight in that area. But if the middle of the retina ( macula) is affected, vision usually remains permanently impaired, with blurred vision and less contrast.

Being told you have retinal tears by an eye specialist can be worrying. Even if you don’t have any vision problems yet, knowing that you have an increased risk of retinal detachment can be unsettling and distressing.

People with sudden, severe vision problems due to retinal detachment are often scared of the possible serious consequences. Above all, they are often very worried about going blind. But that can usually be prevented if it is treated early enough.

No longer being able to see very well due to retinal detachment can affect your everyday life. Certain strategies and adjustments can then help you to cope better, such as:

• Rearranging things at home: Contrasts, color accentuations and good lighting can make it easy to find your way around at home. For instance, you can put brighter colors on corners or light switches.
• Using aids at work and in your free time: There are lots of useful aids, such as magnifying glasses and voice-controlled household devices. Smartphone and tablet apps can also come in handy, e.g. for reading out text or identifying objects. You can get information at your doctor’s office or from your health insurer about useful aids and which costs might be covered. Company doctors are responsible for such topics at the workplace.
• Talking to other people who have had retinal detachment: Many people with vision problems find it helpful to talk to other people with the same condition, like at a support group. Real-life stories can give you an idea of how other people cope with the disease and its effects.
• Support from family and friends: People with vision problems are more reliant on help from others. They can help you to stay as active as possible. It can be a relief to put your trust in them and talk to them about your fears and concerns.

Eye doctors are usually the first point of contact for eye conditions. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your visit to the doctor.

In Germany there are various places people with eye conditions can turn to for help, including support groups and information centers. Our list might help you to find the support you’re looking for.