Eye Care Blog

The nerve layer of the retina is adherent to the pigment layer behind or outside it, and the pigment layer in turn is connected to the choroid blood vessel membrane. When, as may sometimes happen, the nerve layer separates off from the pigment layer the result is retinal detachment. Next to natural senile atrophy of the retinae, detachment is probably the single most common condition affecting the back of the eye. At big eye hospitals whole wards and departments are set aside to deal with this problem.

The circumstances in which retinal detachment occurs are varied. Sometimes the retina peels off as a result of complications of other diseases. Detachment occurs in about two per cent of cataract operations. Or the retina may detach following an accident or trauma to the eye. But in the majority of cases a retina separates with little or no warning, the old and the very short-sighted being at most risk. But although in some cases it is very difficult to know why detachment has occurred at one particular moment and not the next, the general causes are very well established. These are a degeneration of the equatorial and peripheral areas of the retina, often with small holes and tears in the retina itself. A practitioner who finds that you have such motheaten retinae will generally advise you to avoid vigorous activities like tennis or horse-riding, since even a moderately severe jolt can precipitate detachment. However, provided treatment can be applied reasonably quickly, detachment in most cases no longer carries the fears that it used to.

The signs of detachment, where they present themselves, are flashes of light in one area of the vision of the affected eye with shadow or curtain loss of visual field. Sometimes a small haemorrhage into the vitreous fluid in front of the retina precedes detachment by a day or two. However, it must be stressed that not all flashes of light in the eye inevitably indicate that detachment is about to occur. They may mean that you are vulnerable to detachment at some time in your life, but entoptic imagery, as flashes are called, can be caused by a multitude of normal as well as abnormal factors affecting the cells of the retina or the nervous system serving sight. Flashes may even occur when you are simply overtired. But nonetheless if you do experience entoptic imagery you are strongly recommended to visit an ophthalmologist, particularly if you don’t visit an opthalmic practitioner regularly.

The treatment of detachment is to make the nerve layer once again adhere to the pigment layer and seal up any holes or tears if possible. Surgery to accomplish this is now available in many cities throughout the world, and with very good results. Various techniques are used, including lasers and freezing probes, and where one fails very often another succeeds. Indeed, the treatment of detachment, which once meant long periods of blindness or even permanent loss of sight, is one of the triumphs of recent medicine.

As was said, spontaneous detachment is more likely to happen in short-sighted individuals. Possibly the increased length of the myopic eye causes the vitreous to dislocate and pull on the already stretched retina. But detachment can also be induced by blows or punches to the eye. For this reason boxing has been condemned by most ophthalmologists. And of course there are other sports which carry with them a high risk of sustaining just the kind of injury to knock either one or both retinae loose. Sportspeople know what the risks are, however, and know what the consequences may be. Schoolchildren and parents do not. So at least in schools and colleges other manly arts of self-defence should be preferred to boxing.

Diabetic Retinopathy

Once again it is necessary to say that the eye and kidney complications of long-standing diabetes that is supposedly adequately treated and controlled by diet are not completely understood. In general, however, the severity and time-period of diabetes determines the onset of eye-problems. The retinal blood vessels exude fluffy deposits at their smaller branches, and haemorrhages into the retina also occur. Severe haemorrhages can result in loss of vision, and there may be episodes of detachment. In older patients the problem can be further complicated by high blood pressure. It is hoped that in the future either a better method of administering insulin or even some other as yet unspecified hormone will be found and thus alleviate diabetic eye and kidney problems. Even so, treatment of the diabetic eye is already well advanced. In severe cases the vitreous jelly obscuring vision is removed, and areas of arteriole leakage are sealed with laser beams. The latter part of this treatment can even be done by an outpatients’ department.

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