Padmashree Dr. S. Natarajan, Aditya Jyot Eye Hospital, On Tackling The Problem Of Retinal Detachment
What is a human eye?
The human eye is a specialised sense organ capable of receiving visual images which are then carried to the brain. The retina is a light-sensitive layer.
https://www.youtube.com/watch?v=s0B_CiOEXSI
Vision is one of the most important senses. The eye’s main function is to detect light patterns and partner with the brain to translate light into images that we see and perceive. The eye is a complex operative system similar to the camera. Much like a camera lens, the lens in the eye focusses on the retina at the back of the eye.
The retina functions as a film in the eye’s camera – capturing incoming light rays from objects and sending them to the brain to be developed as an image.
Let’s explore the eye’s lens and film and get a closer look at the structures in between that allow us to see.
The process of vision begins when light rays bounce off the object and enter the cornea – the clear dome-shaped window on the eye similar to the lens of the camera. The cornea is a powerful refractor surface responsible for about 75% of the eye’s power. It is the cornea that enables us to see clearly. After travelling through the cornea, the light rays reach the iris and the pupil. The iris is that distinctively coloured part that you see in the mirror. The pupil is the small opening at the centre of the iris that acts like a camera’s aperture. As muscles in the iris relax and constrict, the pupils change their size too.
In the eye, everything has to be transparent; I wish our politicians learnt that. The cornea, the aqueous humour, the lens and then it falls on the retina. An optic nerve is like the electrical connection for the mains, where all the images are processed to the brain. So, when somebody has an accident at the back of head, it can cause loss of vision called cortical blindness.
This is an instrument to check the retina and the course of light. Retinal detachment is one of the layers. It is an eye problem that happens when your retina is pulled away from its normal position at the back of your eye. The retina gets torn and looks like this diagram.
There is a separation of the neurosensory layers from the retinal pigment’s epithelial layer. There is an instrument called OCT to detect that. So, that is why it becomes expensive for investigation and surgery. Thanks to Dr. Prasanna who came as a visiting fellow. He wanted to be an engineer but he is a third-generation ophthalmologist. He has made this animation.
There are three types of major detachment – Rhegmatogenous, the most common type, is a retinal tear that leads to separation of the retinal from epithelium. Traction, fibrosis proliferation leads to scar tissue that pulls off the retina and Serous, the accumulation of subretinal fluid due to inflammation at the back of the eye that leads to retinal detachment.
These are various high-risk groups, mainly ageing and high myopia. Retinal detachment can happen to anyone. Any person above 50 or due to myopia or injury. So, they see floaters happening and it happens to 1 out of 10,000 approximately. [showing procedure on PPT] For a giant retinal tear, earlier, we had to put the patient upside down and me and Dr. Badrinath used to operate in 1984 like that. Now, with the technology, we can do it under a local anaesthesia and the retina can be attached. [more steps on ppt] Retinal detachment is mainly because of diabetes and is caused by chronic traction from inflammatory or vascular fibrous membranes on the surface of the retina which tether to the vitreous. The other is Exudative retinal detachment, where due to the production of serous fluid under the retina, there is no break in the retina. Inflammation is the major cause of the exudative RD. Symptoms are that you suddenly see black spots and flashes of light, you get blurred vision and one side the vision starts coming down and that is where the retinal tear is.
Indirect ophthalmoscope helps in diagnosing RD and to identify the location of the tear or hole. Anybody with myopia, that is wearing glassed with a minus number, has a certain weak point. They need preventive treatment. [Shows surgical management video https://www.youtube.com/watch?v=GPAQIB__ojM
Prognosis – Ultimate outcome depends upon the time the retina is detached, the underlying mechanism of the RD, and whether the macula, that is the central part of the retina, is involved. Related inversely to the degree of macular involvement and the length of time the retina has been off.
How can I prevent retinal detachment?
No person can prevent themselves. Since retinal detachment is often caused by aging, there’s often no way to prevent it. But you can lower your risk of retinal detachment from an eye injury by wearing safety goggles or other protective eye gear when doing risky activities, like playing sports.
If you experience any symptoms of retinal detachment, go to your eye doctor or the emergency room right away. Early treatment can help prevent permanent vision loss.
It’s also important to get comprehensive dilated eye exams regularly. A dilated eye exam can help your eye doctor find a small retinal tear or detachment early, before it starts to affect your vision.
Coping and support
Educating the patient and the family is the most important. It is important to counsel them as well.
[from PPT] Retinal detachment may cause you to lose vision. Depending on your degree of vision loss, your lifestyle might change significantly.
- You may find the following ideas useful as you learn to live with impaired vision:
- Get glasses. Optimise the vision you have with glasses that are specifically tailored for your eyes. Request safety lenses to protect your better-seeing eye.
- Brighten your home. Have proper light in your home for reading and other activities.
- Make your home safer. Eliminate throw rugs and place colored tape on the edges of steps. Consider installing motion-activated lights.
- Enlist the help of others. Tell friends and family members about your vision problems so they can help you.
- Get help from technology. Digital talking books and computer screen readers can help with reading, and other new technology continues to advance
- Check into transportation. Investigate vans and shuttles, volunteer driving networks, or ride shares available in your area for people with impaired vision.
- Talk to others with impaired vision. Take advantage of online networks, support groups and resources for people with impaired vision
Some myths and facts.
According to one school of thought, it was considered advisable to restrict myopic patients from bending down, reading in excess, seeing television and carrying heavy weights to prevent retinal detachment and this is a myth. When I came from Madras to Bombay it was a shock to me. So, I wrote this article – The latest belief is that no such restriction is required, direct trauma should be avoided and the person should periodically have their eye checked. Retinal detachments occur due to abnormal vitreo retinal relationship rather than due to reading, watching television, carrying weight or bending down. These could be just due to coincidence. A retinal detachment on the other hand, can occur even during sleep. Restrictions, if any, are laid temporarily before and after surgery. Following that, the person can lead a normal life.
Rotarians ask
You have said that there is nothing one can do to prevent it. Is there anything nutritionally, like in vitamins or supplements, that one can do for the vitreous?
No, even Vitamin A which is given to a growing child is only in the developmental stages and after that it doesn’t have a role. Vitamin A has a role in the body for other things but there are no nutritional supplements for preventing RD. It is pure physical. Detachment is not hereditary. But be aware. The idea is to be self-aware. Be vigilant and think positive.
So, the take away really is that there should be a yearly eye-check up after a certain age, just in case.
Yes.
A lot of children go in for laser surgery for myopia correction. Does that weaken the eye?
No, the myopic eye compared to a normal eye already has a stretched retina; it can give way and a retina tear can happen. Laser surgery reduces the number, you are not changing the length, but you have to check your peripheral retina and the eye should be perfectly normal. Myopia is not a disease; it is a condition. With proper discussion with the doctor, it can be done.
How can we help patients who are monetarily weak?
At J.J. hospital, I used to operate free and now I am happy to say that in KEM we are well-equipped. The same goes for Nair Hospital thanks to Lion’s Club. Sion hospital doesn’t have enough equipment, but with some donations and help we can have the equipment and then train the staff for free. We have trained hundreds of retina doctors all over the country and affordability is a point. KEM and Nair Hospital have well-trained and experienced doctors doing the treatments for free. Awareness has to be created by Rotary or the press about the same.
TO WATCH THE REST OF DR. S. NATARAJAN’S TALK, CLICK HERE