laser photocoagulation

Laser photocoagulation for the retina was first used in the 1940s and since then became a major advancement in the treatment of retinal pathology. Laser application for treatment of retinal problems is vast and it is difficult to imagine a contemporary retinal practice without laser delivering devices.

Retinal laser essentially delivers heat energy to treat the retina. This energy can create adhesion between the retina and eye wall (to treat retinal tears, holes, and retinal detachment), ablate diseased tissue causing abnormal blood vessel growth (panretinal photocoagulation), or seal areas of leakage which cause retinal swelling (focal and grid laser).

Laser is delivered using specialized lenses held by the physician. Some lenses may rest against the patient's eye, while others may be held just in front of the patient's eye.

Laser treatment is generally well tolerated in the office, but may be performed in the hospital when treating children and some adults. Laser usually has no appreciable side effects, but can cause transient pain and may cause temporary blurred vision for 15 to 20 minutes after the procedure. Rarely, laser can cause difficulty reading, poor pupil function, decreased peripheral vision, and occasionally spots in the central vision.

cryotherapy

Cryotherapy consists of the transmission of freezing temperatures to the retina, by applying a very cold probe to the outside of the eye (the sclera).

Like a laser, the intense cold applied to the retina can seal abnormal retinal tears and leaking retinal blood vessels. Cryotherapy may be used to treat retinal tears, small retinal detachments, tumors, vascular lesions, and different retinopathies. It may also be combined with pneumatic retinopexy for treatment of certain types of retinal detachments. This treatment is also helpful when there is a vitreous hemorrhage or when a cataract obscures light reception.

Pneumatic Retinopexy

For certain locations of retinal detachment, our ophthalmologists may perform a pneumatic retinopexy. During this procedure, your doctor places numbing drops in your eye, then inserts a small needle and removes a small amount of fluid to soften the eye. 

Your doctor then injects a small amount of intraocular gas into the vitreous. The gas lasts for several days and gently pushes the retina against the back of the eye. The goal is to reattach the retina. Your doctor then performs laser photocoagulation or cryotherapy to seal the retinal tear. This procedure takes about one hour.

What you might see (or something like this) when looking through your eye shortly after procedure. (Gradients and lighting effects around edges not illustrated.)

Macula

The macula is a small but important area in the center of the retina. You need the macula to clearly see details of objects in front of you, like faces and written text.

A number of eye problems can affect the macula and can lead to vision loss if they are not treated. Macula-related problems include:

Retinal Detachment

Retinal detachment refers to separation of the inner layers of the retina from the underlying retinal pigment epithelium (RPE, choroid). Next to central retinal artery occlusion, chemical burns to the eye, and endophthalmitis, it is one of the most time-critical eye emergencies encountered in the emergency setting.

The annual incidence is approximately one in 10,000 or about 1 in 300 over a lifetime. Other sources suggest that the age-adjusted incidence of idiopathic retinal detachments is approximately 12.5 cases per 100,000 per year, or about 28,000 cases per year in the US.

Retinal detachment describes an emergency situation in which a thin layer of tissue (the retina) at the back of the eye pulls away from its normal position.

Retinal detachment separates the retinal cells from the layer of blood vessels that provides oxygen and nourishment. The longer retinal detachment goes untreated, the greater your risk of permanent vision loss in the affected eye.

Warning signs of retinal detachment may include one or all of the following: the sudden appearance of floaters and flashes and reduced vision. Contacting an eye specialist (ophthalmologist) right away can help save your vision.

Symptoms

Retinal detachment itself is painless. But warning signs almost always appear before it occurs or has advanced, such as:

The sudden appearance of many floaters — tiny specks that seem to drift through your field of vision

Flashes of light in one or both eyes (photopsia)

Blurred vision

Gradually reduced side (peripheral) vision

A curtain-like shadow over your visual field

When to see a doctor

Seek immediate medical attention if you are experiencing the signs or symptoms of retinal detachment. Retinal detachment is a medical emergency in which you can permanently lose your vision.

Types and Causes of Retinal Detachment

Retinal detachment happens when your retina (a light-sensitive layer of tissue at the back of your eye) is pulled away from its normal position.

Learn more about retinal detachment

There are 3 types of retinal detachment:

  • Rhegmatogenous (“reg-ma-TAH-juh-nus”)

  • Tractional

  • Exudative

Any type of retinal detachment is a medical emergency. If you have symptoms of a detached retina, go to the eye doctor or the emergency room right away. Early treatment can help prevent permanent vision loss.

Rhegmatogenous retinal detachment

Rhegmatogenous retinal detachment is the most common type of retinal detachment. It can happen if you have a small tear or break in your retina.

When your retina has a tear or break, the gel-like fluid in the center of your eye (called vitreous) can get behind your retina. The vitreous then pushes your retina away from the back of your eye, causing it to detach.

What causes rhegmatogenous retinal detachment?

Aging is the most common cause of rhegmatogenous retinal detachment. As you get older, the vitreous in your eye may change in texture and may shrink. Sometimes, as it shrinks, the vitreous can pull on your retina and tear it.

Other things that can increase your risk of rhegmatogenous retinal detachment are eye injuries, eye surgery, and nearsightedness.

Tractional retinal detachment

Tractional retinal detachment happens if scar tissue on your retina pulls your retina away from the back of your eye.

What causes tractional retinal detachment?

The most common cause of tractional retinal detachment is diabetic retinopathy — an eye condition in people with diabetes. Diabetic retinopathy damages blood vessels in the retina and can scar your retina. As the scars get bigger, they can pull on your retina and detach it from the back of your eye.

If you have diabetes, it’s important to get a comprehensive dilated eye exam at least once a year. Managing your diabetes — by staying physically active, eating healthy foods, and taking your medicine — can also help you prevent or delay vision loss.

Other causes of tractional retinal detachment include eye diseases, eye infections, and swelling in the eye.

Exudative retinal detachment

Exudative retinal detachment happens when fluid builds up behind your retina, but there aren’t any tears or breaks in your retina. If enough fluid gets trapped behind your retina, it can push your retina away from the back of your eye and cause it to detach.

What causes exudative retinal detachment?

The most common causes of exudative retinal detachment are leaking blood vessels or swelling in the back of the eye.

There are several things that can cause leaking blood vessels or swelling in your eye:

Outlook

The outlook for a person with retinal detachment will depend on the reason for the detachment, the type of detachment, the extent of the damage, and whether or not the macula remains attached.

If the macula remains attached, some statistics suggest that 83% of people will have 20/40 vision or better after treatment. If it does not, figures show that 37% of people will recover 20/50 vision as long as they have surgery within the first week.

In around 8–10% of cases, the repair will not be successful due to proliferative retinopathy. This is scarring that happens as additional cells form and develop unwanted membranes as the body attempts to save the retina. The membranes can contract, causing the retina to shrink and pull away again from the back of the eye.

pterygium

Pterygium is an abnormal growth of tissue on the conjunctiva (the clear membrane that covers the white of the eye) and the adjacent cornea (the clear front surface of the eye).

Causes & risk factors

  • Most common in tropic regions.

  • Associated with chronic sun (ultraviolet [UV]) exposure.

  • It can grow over a period of months to years.

Symptoms

  • It can cause redness, irritation, and a change in the appearance of the eye.

  • May cause astigmatism which can result in blurry vision.

  • Whiteish or pinkish growth covering the front of the eye.

  • It can be in one or both eyes.

Diagnosis

  • Diagnosed through a comprehensive eye examination, typically while examining the front structures of the eye with a microscope.

  • Based on the appearance of tissue growth from the white part of the eye onto the cornea.

  • Often whitish, flat or raised area of tissue, and bilateral.

Treatment

  • Lubrication, in the form of artificial tears, gels, or ointments to help with redness and or irritation.

  • Surgery: Pterygium can grow back after surgery, so surgery is usually only considered in serious cases.

Prevention

  • Use of sunglasses that block UVA and UVB rays.

  • Wearing a hat when outdoors.

  • Prescription glasses should have a UV protective coating and could be a wrap-around design.