A detached retina is a serious condition that occurs when the retina separates from the back of the eye. The retina is a thin layer of light-sensitive tissue that lines the inside of the eye and sends visual messages to the brain. When the retina detaches, it is lifted or pulled from its normal position, causing vision loss. A detached retina is an ophthalmologic emergency that requires prompt treatment to prevent permanent vision loss. Understanding your risk factors and symptoms can help ensure early detection and treatment if a retinal detachment occurs.
What is the retina and how does it work?
The retina is a critical part of the eye and vision system. It lines the inside back wall of the eye and contains photoreceptor cells called rods and cones. These photoreceptor cells collect light that enters the eye and transform it into electrical impulses. The electrical signals travel from the photoreceptors through the retina and optic nerve to the brain, which interprets them into the images we see.
The retina has multiple layers, including:
- Photoreceptor layer – contains the rods and cones that detect light
- Bipolar cell layer – bipolar cells connect the photoreceptors to the next layer
- Ganglion cell layer – contains ganglion cells with axons that form the optic nerve
The retina requires a steady blood supply from the retinal blood vessels to function normally. It also needs to maintain close contact with the underlying tissues at the back of the eye. If the retina is pulled away from the back of the eye, its cells may not receive enough oxygen and nourishment, causing vision loss.
What causes a detached retina?
There are several factors that can cause the retina to detach:
- Posterior vitreous detachment – As we age, the vitreous gel inside the eye begins to liquefy and separate from the retina, which can pull on the retina and cause tears.
- Retinal tears – Small tears or holes in the retina allow fluid to get under the retina and separate it from the back of the eye.
- Injury to the eye – A blunt force trauma, like a ball hitting the eye, can create a retinal tear. Injuries that cause the gel inside the eye to shrink rapidly can also create traction on the retina.
- High myopia – People with severe nearsightedness are at higher risk as their eyeballs are longer.
- Previous cataract surgery – The vitreous humour may tug on retinal tissue after its connections have been disturbed during cataract removal.
- Diabetic retinopathy – Damaged blood vessels in the retina related to diabetes can increase risk.
- Family history – There may be an inherited weakness in the retina.
In younger people, trauma and high myopia are the most common causes. In older adults, posterior vitreous detachment and age-related changes to the vitreous are more often the cause.
Who is at risk for detached retina?
Some factors that increase the risk of detached retina include:
- Age – People over age 50 are at higher risk, as the vitreous gel begins to thin and pull away from the retina.
- Nearsightedness – High myopia stretches the retina, making it thinner and more vulnerable to tears.
- Eye injury – A significant blow to the eye can cause a retinal tear.
- Previous retinal detachment in the other eye – If one eye has had a detachment, there is higher risk of the second eye detaching.
- Family history – There may be inherited weaknesses in the retina and vitreous.
- Eye surgery – Cataract surgery can increase risk due to changes to the vitreous gel.
- Other eye conditions – People with lattice degeneration, retinoschisis, and other retinal abnormalities have heightened risk.
While a detached retina can occur at any age, it is more common in people over age 40. Men are affected more frequently than women.
What are the symptoms of a detached retina?
Common symptoms of a detached retina include:
- Sudden appearance of floaters – Small specks or clouds moving in your field of vision
- Flashes of light – Brief flashes of light that seem to come from nowhere
- Blurred vision – Vision may become blurry or distorted
- Partial vision loss – A curtain-like shadow or loss of peripheral or side vision
- Decreased visual acuity – Blurry spot in central vision or overall blurriness
In some cases, a detached retina causes no symptoms at all. That’s why regular eye exams are critical to detect a detached retina early. Symptoms typically start in one eye only. The most common early signs are seeing a sudden increase in eye floaters and flashes of light. As a detached retina worsens, blurry vision and vision loss develop. Seek emergency medical attention at the first symptoms, as prompt treatment is vital.
How is a detached retina diagnosed?
To diagnose a detached retina, an eye doctor performs a dilated eye exam. Eyedrops are used to dilate or widen the pupil, allowing a better view inside the eye. Using specialized lenses and bright lights, the retina is examined for abnormalities, tears, or detachments. Further testing may include:
- Visual acuity test – Measures sharpness of vision using a standardized eye chart.
- Tonometry – Measures pressure inside the eye.
- Slit lamp exam – A slit lamp is used to view structures in the front of the eye.
- Optical coherence tomography (OCT) – This imaging scan can detect subtle retinal changes.
- Ultrasound – Sound waves create images of structures in the eye.
These tests help pinpoint areas of retinal detachment and inform treatment options. Early diagnosis and treatment are critical to prevent permanent vision impairment from a detached retina.
How is a detached retina treated?
Several options are available to treat a detached retina:
- Pneumatic retinopexy – Gas bubble injected into the eye to push the retina back in place. Laser or cryotherapy seals retinal tears.
- Scleral buckle – Silicone band placed around the eye to counteract vitreous traction on the retina.
- Vitrectomy surgery – Removal of vitreous gel from the eye so it stops pulling on the retina.
- Laser photocoagulation – Laser used to “weld” tears in the retina and prevent fluid leakage.
The best treatment option depends on factors like age, extent of retina detachment, severity of tears, and presence of other eye conditions. Your ophthalmologist will recommend the treatment most suitable for your specific case.
Prompt surgery is almost always needed to prevent vision loss from a detached retina. The longer the retina is detached, the greater the vision loss. After reattachment surgery, vision recovery can take several weeks or months. Some visual impairment may be permanent.
What are the chances of getting a detached retina?
The overall incidence of retinal detachment is approximately 1 in 10,000 people per year. This equals about 0.01% per year.
Here are some key statistics on the chances of developing a detached retina:
- Age – Retinal detachment affects about 1 in 3,000 people over age 60 per year, compared to around 1 in 10,000 for those under age 60.
- Myopia – Up to 1 in 50 of those with myopia over 5 diopters will experience a retinal detachment.
- Previous detachment – Risk rises to 1 in 3 if the other eye has had a detachment.
- Family history – 5-10% risk of retinal detachment if a close relative had one.
- Cataract surgery – Detachment risk rises to around 1 in 200 after cataract removal.
While a detached retina is not extremely common overall, certain groups have significantly elevated risks. Regular eye exams can help detect tears and early detachment before extensive vision loss occurs.
Risk of detached retina by age:
| Age Group | Annual Incidence |
|---|---|
| Under age 40 | 1 in 10,000 |
| Age 40-49 | 1 in 8,000 |
| Age 50-59 | 1 in 5,500 |
| Age 60-69 | 1 in 3,500 |
| Over age 70 | 1 in 2,500 |
Can a detached retina be prevented?
While you can’t eliminate the risk entirely, these measures may help reduce your chances of retinal detachment:
- Get regular eye exams – Early detection of retinal abnormalities can allow preventive treatment.
- Wear protective eye wear – When participating in sports or activities with eye injury risks.
- Control other conditions – Keep diabetes and high blood pressure under control.
- Stop smoking – Smoking promotes vascular dysfunction that can damage the retina.
- Record your family history – So your doctor knows if you have elevated genetic risk.
- Use caution after surgery – Avoid strenuous activity after cataract or other eye surgery.
Prompt surgery to repair retinal tears can also lower detachment risk in some cases. People with hereditary retinal conditions or extensive lattice degeneration may opt for preventive laser treatment around retinal tears.
What is the outlook for a detached retina?
With prompt surgical treatment, the long-term outlook for a detached retina can be good. Generally, over half of detachment patients regain 20/50 vision or better after successful reattachment and healing. However, the visual prognosis depends on factors like:
- Duration of detachment – The longer detached, the more vision loss.
- Location of detachment – Macula (central retina) detachment causes worse vision loss.
- Amount of detachment – More extensive detachments have poorer prognosis.
- Clarity of vitreous gel – Blood in the vitreous can reduce vision recovery.
- Age and general health – Younger, healthy patients tend to regain more vision.
If macula-off detachment persists for 6 to 8 days, there is high risk of severe, permanent vision impairment even after successful surgery. Seeking emergency care quickly at the first symptoms provides the best chance of visual recovery.
With timely modern retinal reattachment surgery, most patients can still recover functional vision. However, detached retina remains a leading cause of monocular blindness when undetected or untreated. That’s why it is so important to have regular eye exams to reduce vision loss risk.
Conclusion
A detached retina is a serious condition where the retina separates from the back of the eye, causing vision impairment. Your overall lifetime risk is around 1 in 300. However, the chances of detached retina are significantly higher for those with high myopia, cataract surgery, family history, and aging over 50. Seeing new floaters, flashes, and blurred vision are key warning signs warranting urgent medical attention. While retinal detachment cannot always be prevented, regular eye exams, protective eyewear, and prompt treatment of retinal tears can reduce risk. Reattachment surgery before extensive detachment can optimize visual outcomes. With appropriate examination and care, most retinal detachments can be managed before extensive vision loss occurs.