Retinal Detachments Can Blind

The natural history of a retinal detachment is blindness.  “Natural history” of a disease is the same as the usual outcome.  So, the usual outcome of a retinal detachment is complete blindness if eye surgery is not performed.

Retinal Detachments Only Become Larger

Retinal tears and holes cause a retinal detachment.  A small amount of fluid goes through the tear and gets underneath the retina causing the detachment.  With time the amount of fluid increases underneath the retina, and so, too, the size of the retinal detachment enlarges.

Always Lose Side Vision First

Because all tears and holes occur  in the peripheral retina (the portion of the retina giving us peripheral, or side, vision), you always lose your side, or peripheral vision, first.  As the detachment grows, the macula becomes detached and central vision will eventually be lost.  The initial goal of retinal detachment surgery is to fix the detachment before the central eyesight is affected.  By doing so, you minimize the risk of permanent loss of your central.

We usually try to operate within days.

When the macula (central portion of the retina responsible for reading, etc.) detaches, there can be permanent loss of eyesight despite successful surgery.

Rods and Cones

The retina is a laminated tissue.  It has several layers.  The rods and cones are underneath the top layer.  Loss of vision from a detachment is due to the physical separation of the rods and cones (aka photoreceptors) from the layer beneath them.

Retinal Detachment Surgery Prevents Blindness

There are several ways to fix a retinal detachment.  These are outlined in the overview of retinal detachments.  The goal of any retinal detachment surgery is to prevent blindness by reattaching the retina and, if possible, fix the eye before central vision is affected.

Longstanding Retinal Detachments

Chronic, or longstanding, retinal detachments are those unfortunate eyes that were never diagnosed or operated upon.  In general, eye surgery doesn’t always work to restore sight in these cases.  Permanent damage to the rods and cones occurs with time, and, despite success in reattaching the retina, vision does not return.

By chronic, I’d say conditions lasting months to years.

Losing the Eye Can Happen

In extreme cases of retinal detachments that never get repaired, the eye can start to die and shrink.  This condition, phthisis bulbi, occurs when the retina has not been attached for years (generally).  While it doesn’t always occur, it can be extremely disfiguring and can be a psychological nightmare.

What Does This Mean? Because the outcome of a retinal detachment is so grim, surgery is almost always recommended.  If the natural history is blindness, that is, the chance of going blind is 100%.  Though there are risks of eye surgery (blindness), the chances are small.  Thus, there really isn’t much to lose by operating.

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Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

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Comments

  1. Dr.

    I have been trying to get a clear answer regarding AMD as I now have been seeing grey spot ONLY at night when I go to bed when it is dark. During the day I am ok…How far along am I with AMD?. I was told I have a tremendous amount of Drusens around the retina but not specifically the Macular area. I am only 44 yrs old an is very concern about my future ability to work, etc…

  2. my son lost left eye sight. i took the hospital and doctor told me there is some mass like substances, he is only 2 and 9 months old. I request your good self to give me some advice on this. I doubt it is retina attached or something like that. Is there any possible to gain the sight again. i am worried a lot

  3. Dear Karma,

    There are so many possibilities that I can’t really comment constructively without examining your child.

    r

  4. April Anderson says:

    Hello,

    I am the typical patient that has waited too long to see a physician regarding my symptoms. I have had floaters that have slowly gotten larger over a few years time. One time a few years ago I remember right after getting out of a tanning bed, I noticed that everything went grey or blacked out for a minute. Very scary to say the least, but my vision was fine again within a few seconds. Now, very slowly, what I thought were floaters have now been getting much larger. If I look into the light sky or even a computer screen, I can see some of these floaters in my field of vision. At dark it does not seem to bother me much. However, today I walked outside to and the sunlight hit my eye just right and I saw nothing but squiggly lines in my entire line of vision in this one eye. When I turned away, the problem went away, but if I turn back and the sun hit it just right, the lines returned. I started doing some research on the fact and realize that I may indeed have a detached retina in one or both eyes. Is this what this appears to be to you? How long can you go with symptoms like this before you may lose sight in one or more eyes? When I first noticed some of these symptoms, it has been several years, and just seemed to progressively gotten worse. I really did not realize just how bad it may actually be until I went outside today and saw the squiggly lines. Just some thoughts on this situation would be much appreciated. I am very scared about it ! Our local hospital is a joke and I would never go there to have a procedure done. Is this type of thing done in the office, or is a hospital visit needed.

    Thanks for all of your help- any thoughts or ideas are much appreciated.

    Thanks again,

    April

  5. Dear April,

    Obviously, I can’t tell if you’ve new or old floaters, but it sounds as though you’ve got new symptoms. Regardless, please get checked out. You don’t want to have a retinal detachment and not now about it!

    Randy

  6. Dr i have a retinile detachment and i can not afford a surgery what will happen to my eye

  7. nauman javed says:

    my elder brother lost eye sight of both eyes due to retinal detachment in 1999. After getting both eyes operated, he regained eyesight of one eye while the other is dis-functional. The functioning of the left eye was further reduced when it was revealed that he suffers glucoma and that glucoma has affected his vision adversely.. now he can barely undertake his routine activities due to reduced vision. he says he is able to see through sides of his eye and not through centre.. Can his eyesight be regained at least for one eye??

  8. Dear Buddy,

    Retinal detachments can lead to complete blindness. The longer the retina is detached, the worse the prognosis.

    Best of luck.

    Randy

  9. Dear Nauman,

    I am going to err on the conservative…both glaucoma and retinal detachment can lead to permanent loss of vision.

    I can’t really be specific because I have not examined your brother.

    r

  10. Dear Dr Randy,

    My boyfriend had a retinal detachment in his right eye last August 2011. Unfortunately, after a vitrectomy and even a scleral buckle, he never regained his vision. He is extremely near sighted in both eye. He has glaucoma and the detachment was due to lattice degeneration. If I’m not mistaken his grade is 1400 in his left eye.

    I have read about extreme High probability of a detachment to the fellow eye within 2-5 years. If this happens, he will be completely blind.

    I would like to know if there’s anything that we can do right now to prevent this from happening. Do you have any suggestions for us? Can laser be performed to the good eye as a preventive measure?

    Also, is there any truth that eye transplant can be done in cases of retinal detachment? (Ex. Bionic eye )

    Thank you very much.

  11. Ami,

    In my estimation, he has 10% chance of detaching in his good eye. No reason to think he’ll go blind. First eye probably detached too long and perhaps a complicated situation.

    Nothing on bionic eyes. There is a retinal implant which is still experimental…but it may, at best, allow a completely blind person navigate a sidewalk.

    Randy
    Randall V. Wong, M.D.
    Ophthalmologist, Retina Specialist
    Fairfax, Virginia

    http://www.TotalRetina.com
    http://www.RetinaEyeDoctor.com

  12. Zita Stephens says:

    Hi Dr, Wong…
    PLEASE TAKE THE TIME TO READ THIS ANS RESPOND>.>>>>>>>

    My husband James had retinal detachments in both eyes in 1994(cause unknown alttho he had bad nearsightedness ). He has since had about 10 surgeries. Dr. William Mieler performed his earlier surgeries. He had the gas treatment done initially(sorry if I don’t know the correct terminology) and the retina would re detach so they did the silicone oil treatment on both eyes which actually allowed the retina to stay flat. The left eye had so many tears that the Dr. didn’t feel comfortable going back in. the right eye was the healthier eye.

    Over the years the silicone oil caused calcium deposits on the cornea…in 2003 and 2004 he had corneal scrapings…which calcium deposits only returned. In 2005 his Dr., Dr. Rubenstein…at Rush Medical Center in Chicago, performed a corneal transplant using a human donor cornea. We were so excited because his vision returned..he could tell what time it was on the microwave and could see using his magnifier. 6 months later..he started to “reject” the donor cornea…and his symptoms returned,( cloudy murky white vision). The Dr. then informed him of a prosthetic corneal transplant. Said the chances for rejection were lower. He got the prosthetic corneal surgery and he never saw again. Vascularized tissue began to form on the back of the eye so now he is completely blind in the right eye with the left of course, having not been touched in years from the multiple tears has no sight either.

    I believe that if he can get the prosthetic cornea taken off, maybe he will be able to get some form of vision again, light perception,etc. The doctor can’t even see what condition the retina is in because of the vascularized tissue. I have read info on the bionic eye but it doesn’t seem like it’s currently for patients with retinal detachments, in fact I’ve heard one of the negative effects is retinal detachments. We are looking for some glimmer of hope. Would you recommend removing the prosthetic cornea so that we can see the condition of the retina? and maybe if another human donor transplant may work? My husband has been living with this since his teenage years and he now has been really talking about options which he really never has…I guess previously he’s resigned himself to the fact that” it is what it is”. He now has expressed wanting a different set of eyes to look at him. The Dr. who performed the last surgery to remove the vascularized tissue basically just told him that he should just live with his condition. If that is the case, it would have been nice to hear why. Your input and professional thoughts are greatly appreciated. Should we continue to try options…or could there be hope for the left eye? Thanks in advance Dr. Wong.

  13. hi!
    my relative got complete blind cos of retinal detachment when he was 1. now he is 2 yrs old. was wondering can it be repaired?

  14. Dear Zita,

    I think the best idea is to have a second opinion as you suggested. I’d first seek the opinion of a corneal specialist as she’d be the first to consider if a second graft could be possible.

    She’d also be the person to determine if there is any visual hope at all.

    All the best.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia
    http://www.RetinaEyeDoctor.com

  15. Dear Ali,

    I am wondering if your relative has a retinal detachment from retinopathy of prematurity.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia
    http://www.RetinaEyeDoctor.com

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