Regular Examination for Retinal Detachments

Routine Examination for Retinal Detachment Not Necessary.  Randall V. Wong, Retina Specialist, Fairfax, Virginia, Washington DCRoutine eye examinations looking for retinal detachments are not necessary.  Unlike diabetic retinopathy where the probability is quite high that every patient with diabetes develops the disease, a detachment does not happen often in the general population and usually is associated with symptoms.

Patients are often worried about developing a retinal detachment.  Sometimes they’ve had a previous retinal detachment, they are worried about having an asymptomatic problem or there is a family history of retinal detachment.

Previous Retinal Detachment

I often examine patients who have had previous retinal detachments.  I have never found an asymptomatic (patient is unaware of any symptoms) condition in the same eye once they have had and have healed from previous surgery.

For example, a patient who is fixed with a scleral buckle is highly unlikely to detach again once the retina has been attached for a month or two following surgery.

In the case of scleral buckles, it has been my experience that the other eye is actually at higher risk for developing a retinal detachment than the original eye (once healed).  By actually changing the shape of the eye, the scleral buckle does offer some “protective” effect.

Asymptomatic Retinal Detachments Do Exist

Occasionally, patients are diagnosed with asymptomatic detachments.  These are pretty uncommon.

Once a patient has had one retinal detachment; however, it is unlikely, and very rare, that a  second detachment is missed as patients have a heightened awareness and there are almost always symptoms of vision loss, flashes or floaters.

Family History

Except for a few rare genetic disorders, while myopia is a hereditary, retinal detachments in the general population are not hereditary.

What Does this Mean?

Once diagnosed and treated, a detachment is unlikely to recur.  Despite a family history or a personal history of retinal detachment, once successfully treated, I usually do not see patients again after 6 months to a year.  This may not be a global practice pattern.

Regular examination in patients without symptoms also is unlikely to discover a retinal detachment.

The best advice, however, is to make sure that any new flashes and floaters (the two most common symptoms of a retinal tear) get checked out with a dilated eye exam, especially if you have a personal history of retinal detachment or a family history.

 

Comments

  1. i am a dibetic and i had a viterlomy surgery to take the blood out can the blood come back and how long

  2. Just finished reading your latest post re regular eye exams following retinal detachment. I have had complex retinal detachments. My retina detached for the 3rd time in 3 months after scleral buckle surgery secondary to proliferative vitreoretinopathy. My only history was mild-moderate myopia and 55 yrs old. Also my other eye was diagnosed with lattice degeneration at time of 1st detachment in Sept,2011. My vision is still poor – 20/200 with distortion, double vision, haziness and a permanently (so Ive been told) enlarged pupil What type of follow-up is standard in a case like mine? Right now I am more worried re my good eye. Also is there any treatment /procedure to fix my pupil? Im miserable with re to the enlarged pupil and double vision….so light sensitive I don’t even like going out in daylight. The double vision makes everything worse too. I will try prisms when my doctor gives me the “go a head” but I hear they don’t always do the job. Would appreciate you opinion. Thanks Dr. Wong!

  3. Bonnie Kaiser says:

    Thank you for all the information I receive in your writings. I have W
    et Macular in my right eye, suffered a retina detachment, had surgery, with a buckle etc.
    My question is: I still need treatment for my WMD; since my surgery, the retina specialist I see (who I think is tops), told me that since the vitereous has changed consistency, the injection of medication will last only approximately two weeks. do you have any information on continued treatment after surgery? I’m having cataract surgery April 11th, exactly 3 months since retina surgery, and am hopeful that once my eye can focus, the double vision goes away, Thats an ongoing problem right now. Thank you so much, Bonnie Kaiser

  4. floateredeyes says:

    Dear Dr. Randy,

    We await your video of a vitrectomy for floater removal. :)

    Regards

  5. Cheri LeMay says:

    Dr Wong, In your opinion should silicone oil be used on a patient that has had a previous cataract surgery with a silicone lens implant: How hard is it to get oil out of the eye where a silicone lens has been used during cataract surgery? Is this something that surgeons should consider when deciding on what to use such as gas or oil? If it is not harmful for the patient to wait until medical records can be obtained should surgeon try and obtain all medical records from previous eye surgeries such as cataract surgeries and previous retinal detatchments with vitrectomies? You opinion will be much appreciated. Is it ever o.k. to leave oil in eye? Is there any amount that can be left in eye without possible side effects of injury to the eye? Anxious to here your opinion on this.

  6. Dear Jeanie,

    Yes, the blood can come back if not enough laser were done. I am assuming that you had a viteous hemorrhage due to proliferative diabetic retinopathy?

    Randy

  7. Dear Lynn,

    How long ago was your last surgery?

    There is no great therapy for the pupil, but you might consider a contact lens with a “fake” pupil (it’s a colored contact with a smaller hole in the center for you to see through, the small hole in the center acts like your own pupil….block light). There are a few cataract surgeons who might also consider placing a suture in the iris to physically “cinch” the pupil smaller, but then this would limit the ability of your retina doctor to examine your retina.

    Wait for the go ahead for prisms. They often “fail” because the patients don’t have the right conditions.

    r

  8. Dear Lynn,

    Oh yes, I, too, would be worried about the lattice degeneration in the other eye. You might want to have a discussion with your doc about the value of prophylactic laser treatment.

    r

  9. Dear Floatered,

    Due to unforeseen circumstances………it has been delayed, but I am still optimistic I can “get to it” within the next couple of weeks. Thank you for the reminder and also for your patience and support.

    Randy

  10. Thanks Randy for your last response. My last surgery was 1/19/12 for early SO removal and AC lens placement. Oil was leaking into AC. My last surgery for detachment involving macula and PVR was 11/3/11. I am already developing a new epiretinal membrane. My doctor lasered my good eye early on in my tx back in 9/11 ….the day before I had 2nd detachment! Thanks again for all your thoughts. Really appreciate your time! Lynn

  11. You say that with Scleral buckle in eye, the retinal detachment does not recur in the same eye but other eye is at a higher risk? My question is why other eye is at a higher risk? Is it due to presence of Scleral buckle in the already affected eye?

  12. Dear bmiq,

    Assume both your eyes have the same chance for retinal detachment due to size and structure….whatever risk factors there are for retinal detachment. If one eye sustains a retinal detachment and is repaired with a scleral buckle, that eye is stable and less likely to redetach…once healed.

    Thus, the other eye, however, has not had an operation and is still at risk….

    Randy

  13. Dear Bonnie,

    I am not sure that having a vitrectomy really means the medicine will only work for two weeks. In eyes with vitreous, the medicine leaves in less than a day anyway. My experience has been that intra-vitreal injections work pretty well in eyes that have had vitrectomy and do not seem to need more frequent dosing.

    Randy

  14. Dear Cheri,

    1. Removing an implant with oil attached is sometimes the only option. I have had limited success “vacuuming” oil off a lens.
    2. I don’t think knowledge of the type of implant is really that important. Often silicone oil is not really an elective decision…it may be the only tool remaining to get the retina attached.
    3. It’s usually ok to leave oil in the eye indefinitely. There is an argument that the oil can be toxic. My counter-argument is that usually the oil is used too late…when multiple surgeries have been performed, etc. It might be that the “damage” you witness after the oil is inserted is actually from the trauma of many operations.

    My disclaimer is that this assumes there is exactly the right amount of oil in the eye. Too much oil can damage the cornea, for instance.

    Randy

  15. Mike Mauger says:

    Dr. Wong, I am a 52 year old male who had a successful scleral buckle surgery for a detached right eye retina back in 2000. All was well until I detached the retina in my left eye back in 2010. I have undergone 4 left eye surgeries since then, 2 with gas and one with oil and one for oil removal. After having the oil in for about a year, it was decided to remove the oil – everything was fine and supposedly stable until 3 weeks later when the retina re detached. I am now scheduled for a 4th surgery and the doctor is recommending keeping the oil in forever. A few questions: does it make sense to keep the oil in? Will vision improve over time? My real concern is with my “healed” eye and the possibility of redetachment and scarring there. Is there anything I should be doing to stay ahead of any possible problems? The doctor says I may have to have cataract surgery in the good right eye, but this scares the heck out of me for possible redetachment – am i worrying unnecessarily?

  16. Dear Mike,

    Anyone with one retinal detachment is usually going to be paranoid. Multiple retinal detachments in both eyes? I don’t blame you for worrying.

    There is a practical side to leaving in oil, it will likely keep your retina attached. Sometimes the vision can be useful and sometimes the vision can be lousy (though there is the potential for improvement if the oil were removed).

    I guess what I’m saying is that if the vision is okay (you can tolerate it and there is not toxicity), then leave well enough alone.

    On the other hand, if there is poor vision with the oil (yet removal might improve the vision) there is the argument that you should remove the oil to realize the full potential of your retina.

    Tough call.

    With regard to the cataract….get it done by someone you trust, but from someone who has experience with patients with prior retinal surgery. Having the vitreous removed adds a tiny, tiny bit of change to the cataract surgeon.

    r

  17. Hi, Dr. Wong. I have written to you before and you were most helpful. I am a 61 year old suffering for the past four years from posterior vitreous detachment symptoms. In in the beginning the symptoms were pretty bad and then in about 2 years they got much better. This past month right after my daugher’s the wedding the symptoms returned with a vengence. I saw my opthalmologist two times in a week and a even came back early from vacation because I was so paranoid. They tell me everything is fine and that a little piece is still attached. I now have the problem in both eyes which is making me more anxious. I am normally a worry wart, but this is driving my crazy. I am getting floaters some look like a long string of hair and one looks like a tadpole. Almost every time I turn my eye I get a flash of light. Sometimes its hardly noticeable and sometimes it feels stronger and brigher. It is worse in the dark or when bending over to do something. Will this ever get better and should I worry about it? Also I read the chances or a rd are less after this has been going on for a while. Please advgise as this is literally ruining my life. Thanks so much Doctor.

  18. Dear Ann

    I think that if this is causing you a great deal of problems and anxiety then consider having them removed. Yes, surgery is safe…less than 1% chance of a retinal detachment.

    Look forward to hearing back from you.

    Randy

  19. Thanks for your reply I think surgery to remove this would really stress me out do you think this condition will resolve itself being that I’ve had it four years? And also what do you think the chances of a retinal detachment occurring after all this time? That’s my main worry thanks for your help

  20. Dear Ann,

    I don’t blame you for being concerned about retinal detachment, but I don’t think there is anymore risk compared to anyone else.

    If you have been plagued by floaters for four years….seems unlikely they’ll self-correct.

    r

  21. William says:

    Dear Dr Wong,

    I had a PVD two weeks after Lasek surgery 8 months ago. and BTW I’m not myopic I just had a high astigmatism ( both eyes were greater than 3.5 cylinder). the real cause of the PVD is not known since I’m not myopic, I’m not diabetic and I don’t have lattice degeneration and I’m just 24 years old! I’m still experiencing the periphery flashes ever since getting Lasek like 7 flashes every day with a huge load of floaters. I visited three retinal opthamologists and they all didn’t observe anything dangerous

    I just have a questions that I wish you answer:

    Does the retina become weaker after the vitrous detached from it? I mean is there a difference between a retina without PVD and a retina with PVD? please note that I’m referring to future risks and not the risk associated with holes during a PVD.

    Thanks so much in advance
    William

  22. Dear William,

    I don’t believe the retina is weaker after PVD. Wouldn’t make sense.

    r

  23. William says:

    Thanks Dr Randy for the replay

    I asked this because I looked at many websites stating that the vitreous job is holding the retina or to help keeping the retina in place! but thats not making any sense cuz many retinal surgeries which is vital for the health of the vision require the removal of the Vitreous!

    So what is really the role of the Posterior Vitreous ?

    I have read once that PVD might benefit the retina in enhancing the development of neovascularization ( if it happens later).

    Any input willbe really appreciated

  24. Last year I went in for an eye exam and was sent over to a specialist for a retinal detachment in the right eye. About 3 Weeks ago I. Followed up with the specialist for floaters in my left eye. He said was normal and that I would have to get use to it or eventually will .. Now three weeks later I have notice this spot has gradually gotten a little larger. It has a little blurryness and I notice a greenish color. Could the symptoms have gotten worse? I don’t know if I am overreacting, or getting a little nervous ..

  25. Dear Jen,

    If your symptoms are changing, you should return to the specialist.

    I have no way of knowing if you are overreacting :)

    Randy

  26. Hello I am writing this because I have a question I have lattice degeneration of both retinas with tears also in both retina’s the doctor I am currently seeing does not want to do any surgery cause he feels it would cause more damage and that I might go blind. My question is I am very nervous and do not know should I have the surgery or if what the retina spec is telling me is correct.. Thank You

  27. Dear Doris,

    If you have known tears, they may not need laser treatment, but are using the term “surgery” synonymously with “laser treatment?”

    Not all lattice needs treatment.

    Need more information.

    r

  28. During a routine eye exam with my ophthalmologist last winter, he found that I had a retina problem It wasn’t detached but had a bend in it. When I read the eye chart in his office letters would disappear but then reappear when I read the next letter. He referred me to a Retina specialist who said that he could operate or not and that it was up to me and if I didn’t mind not seeing clearly with that eye, I could wait for the operation. My ophthalmologist was surprised and didn’t agree. Now he wants to see me every three months to keep an eye on it. I don’t mind him doing that but I wonder if the eye drops needed and the new machine he uses to take pictures of it every three months are doing any harm. Could you please give me your opinion. I’m 82 and in good health otherwise.

  29. Dear Marie,

    Please check your other post.

    I think you may have an epiretinal membrane. That would explain your symptoms and the differences in concern between your retinal specialist and general eye doc.

    r

  30. Thank you for taking the time to write this blog. I had a retinal tear the middle of September, which was repaired with laser. A few days later another tear developed, had that repaired. Then one of the repairs was starting to give way. A bubble was inserted and a few days later the doctor did a 360 degree laser repair on the retina. That was on October 11th. My vision is approximately 20/60 as of my last visit and my pupil is dialted. The doctor thinks the nerve will regenerate for the dilation, but that it could take several months. My question is how long does it normally take for the bluriness to go away? The doctor says everything looks good, but the vision just doesn’t seem to improve. Thank you.

  31. Dear Cara,

    Just guessing, but the blurriness may be due to difficulty reading (accommodating) and is possible side effect of this particular type of laser.

    Give it 4-6 weeks, but, of course, stay close to your doctor.

    r

  32. Sheila Johnson says:

    Dr. Wong,
    I was so glad to see your blog. While some don’t like going to the dentist…I am always nervous about my eye appointments – just due to my history. I have had glasses since I was 5 – I have a significant stigmatism. When I was 25, my optometrist recommended I see a specialist because there was “thinning of the retina”. Then at 29, my dr. said I had cataracts (not due to any eye trauma). They corrected the right eye with a lens implant and then the left eye a year later. I also had to have the laser operation to re-correct the cataract surgery at age 34. At age 39, I had a detached retina and had the Scleral buckle. Surgery was successful and I have had positive reports for the past three years. As a weird note, my brother has experienced similar problems – cataracts and retinal detachments in both eyes (most recent detachment was 4 weeks ago). At my annual exam with the retina specialist yesterday, he noted that everything was great (in regard to the retina), but my eye pressures were high – 24. This was something I’ve never had before. He referred me to another doctor in the office – a glaucoma specialist. This has definitely concerned me. I was wondering if there is a correlation between having cataracts at a young age, detached retina and now this increased eye pressure? Could there be another underlying condition ? I appreciate your feedback!

  33. Dear Sheila,

    No. I don’t think much of a correlation. I’d respectfully as the glaucoma doctor if she is concerned.

    Randy

  34. Dear Dr Wong,
    I am so glad to have come across your blog.
    I have high myopia (-5.50 in left, -8.75 in right). I have always been told I have thin retinas and so I attend regular eye exams every year.
    Last year, I was found to have retinal traction on the bottom of my right eye, and a few tears on the top.
    I got them both fixed by laser.
    Since my laser surgery, I have noticed a moving orb of light from the top of my right eye, and now I can also see what appears to be a pocket of liquid that I can sometimes see especially if I move my head or bend down.
    I had it checked out, the doctor told me it was a pocket of liquid as my vitreous is liquefying but not yet detached. She did not see anymore new tears.

    My question for you is, what would you estimate my lifetime risk for detachment would be? I am so paranoid now, I am constantly checking my field of vision to make sure I am not seeing any black curtains.

    I just gave birth as well, and I am petrified I would not be able to see my baby one day. Is it safe to bend and lift my baby out of the crib or will this stress out my retina?

    Because I can see this pocket of liquid in my eye occasionally, as my vitreous becomes more and more liquid will I start to have decreased vision like looking through a fish bowl?

    I am so scared I will eventually be blind.

    Thank you so much for your help

  35. Hi, sorry I forgot to mention that I am 29 years old only. Thank you.

  36. Joy,

    Based upon your myopia and history of tears, I would estimate your lifetime chance of detaching is about 5-10%.

    It is very safe to bend, lift and care for your baby!

    Keep up regular exams and see your doctor if you develop new flashes, new floaters or a decrease in your vision.

    Hang in there!

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  37. Joy,

    got it!

    r

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