Vision Loss: Retinal Detachment
Guest: Dr. Esther Bowie - Ophthalmology/Storm Eye Institute
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. Esther Bowie, who is Assistant Professor of Ophthalmology and a specialist in the area of the vitreous and the retina; two areas of the eye. Dr. Bowie, a very common disorder that you treat is retinal detachment. First of all, what is the retina?
Dr. Esther Bowie: The retina is, really, a layer of the back of the eye that helps you see. We commonly refer to it as the film of the camera. Without it, you would not have vision.
Dr. Linda Austin: So, it’s what the doctor sees when they peer into your eye, right? It’s the lining on the back part.
Dr. Esther Bowie: Correct.
Dr. Linda Austin: Now, what is it, exactly, that happens when that begins to detach? What is it detaching from?
Dr. Esther Bowie: When you have a retinal detachment, there’s usually a break or an opening that develops in the retina, and fluid gets beneath the retina, or behind the retina, and lifts if off. So, it’s lifted off the back wall of the eye. And that’s what’s known as a retinal detachment.
Dr. Linda Austin: What causes that?
Dr. Esther Bowie: Generally, it’s idiopathic; just one of these things that happens. There’s no definite cause. You know, it just happens. It happens a lot as you get older, without any health problems, or anything. But it can occur following trauma, or following surgery. Or, as a part of the aging process, the vitreous, or the jelly in the eye, usually separates from the retina. And when it’s separated, in some patients, it can pull and cause a tear in the retina. As a result, fluid gets behind the retina, causing the detachment.
That’s probably the most common reason why this occurs. But most patients who have the vitreous, or jelly, separating from the retina have no problems as a result. They’ll see floaters, but it does not cause a tear in the retina. But it’s important to get the eye examined if you see new floaters because it could mean that there’s a tear in the retina that needs to be treated soon, before it develops into retinal detachment.
Dr. Linda Austin: What is a floater?
Dr. Esther Bowie: A floater is just a spot that you see in your vision. It’s in the vitreous of the eye. You can see it, but nobody else can see it.
Dr. Linda Austin: So, it’s like something just kind of floating by, like a shadow or something?
Dr. Esther Bowie: Right, like a little shadow. It’s usually either a dot, or it may look like a cobweb, or a hair strand that you see moving across your vision.
Dr. Linda Austin: It’s within the eyeball?
Dr. Esther Bowie: It’s within the eyeball.
Dr. Linda Austin: And, you mentioned, this could be a symptom of retinal detachment. What else can be a symptom?
Dr. Esther Bowie: Flashing lights. If you see lights that are arch-like, like a lightening strike, which was not previously present, that could indicate that you have a tear and a retinal detachment.
Dr. Linda Austin: It sounds like, clearly, anytime you start seeing something that’s new, and that you know is not supposed to be there, you should get that looked at.
Dr. Esther Bowie: Right. So, new onset of floaters, flashing lights, or if you see a shadow coming in from your vision that doesn’t go away, that’s reason to call.
Dr. Linda Austin: How serious is a retinal detachment?
Dr. Esther Bowie: It’s probably one of the more serious problems that can affect the eye, and it’s really important to get seen early; the earlier seen, the better the prognosis for treatment, and for maintaining good vision.
Dr. Linda Austin: And, how do you treat it? What do you do?
Dr. Esther Bowie: It all depends on the stage. If it’s just a tear, with just a small amount of fluid, you can just use a laser in the office. If the detachment is more advanced, there a few procedures that can be done. One is called a pneumatic retinopexy, which is an in-office procedure, where we apply a freezing treatment, called cryotherapy, and inject a gas bubble in your eye. That can be done, in some cases, to fix a retinal detachment.
In other cases, you actually need to go to the operating room, where you have a scleral buckle, or a band, placed around the eye. This can be done alone or in combination with what we call a vitrectomy, where we remove fluid from the eye and place a gas bubble in the eye. Or, it can be fixed with just a vitrectomy alone, without a scleral buckle. So, there are multiple options. The doctor evaluates each case on its own merit.
Dr. Linda Austin: To figure out which is the best way to go?
Dr. Esther Bowie: Correct.
Dr. Linda Austin: Now, you’re a specialist in this area. You’ve done fellowship training, advanced training. Can a general ophthalmologist in a community perform these procedures, or is this a situation where someone really needs to go to a specialist?
Dr. Esther Bowie: Generally, a retina specialist does this. A retinal tear, a tear without retinal detachment, a general ophthalmologist, in some cases, if they feel confident, can treat it; and that’s okay. But most cases of retinal detachment are referred to a retinal specialist.
Dr. Linda Austin: If it happens in one eye, is it likely, at some point, to happen in the other, or not necessarily?
Dr. Esther Bowie: If you have a retinal detachment in one eye, it does increase your risk of getting it in the other eye. But it doesn’t necessarily mean that it will happen.
Dr. Linda Austin: So, it’s one of those fluke things, like a shoulder dislocation, or all the other weird things that happen to the human body.
Dr. Esther Bowie: Right. And, you know, there are certain features in the eye that predispose you to having a retinal detachment. If you’re very nearsighted, you’re at increased risk of getting a retinal detachment. If you have certain changes, such as lattice degeneration; a thinning in the peripheral retina, you’re at increased risk of getting a retinal detachment. If you have a family history of retinal detachment, that also predisposes you. But without any of these factors, you can still get it. So, if you have any of these symptoms, it’s important to be seen by an ophthalmologist and have your retina evaluated.
Dr. Linda Austin: Dr. Bowie, thanks so much for talking with us.
Dr. Esther Bowie: Thank you.
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