The Risk of Ignoring Signs of Retinal Damage

As people age, they are more prone to a tearing of the retina. Left untreated, it can progress to permanent vision loss.

Dr. Philip Ferrone, a retina specialist, goes over some examination results with one of his patients.

Photo: Philip Ferrone

It may begin as a few dark specks or wavy lines floating across the field of vision, or lightning-like flashes in the corner of the eye.

香蕉视频苹果下载Although painless and often no cause for alarm, such symptoms can signal  a tear in the retina, the layer of tissue at the back of the eye that processes light and sends images to the brain.  In most cases, unless treated promptly, a tear can progress to permanent vision loss. 

香蕉视频苹果下载Fortunately, treatments to fix retinal tears have advanced in recent years, and surgical procedures to repair retinal detachments have relatively high success rates. In addition, researchers are exploring how lifestyle and nutritional factors may influence the health of the retina.

Christina Weng, a retina specialist and associate professor at Baylor College of Medicine in Houston, says patients typically start noticing floaters in their 50s and 60s, especially if they are nearsighted. Because the brain can adapt and make them possible to ignore after a while, “people are often quick to brush off floaters or occasional flashes of light, but they can indicate something a lot more serious is going on,” Dr. Weng says.

Simply getting older is a major risk factor in many eye diseases, including macular degeneration and cataracts. As part of aging, the gel that fills the eyeball starts to shrink and pull away from the retina, a condition known as a posterior vitreous detachment, or PVD. The pulling releases small particles of connective-tissue fibers that float through the field of vision, and the tugging on the retina can cause what look like flashes of light.  

Early signs

Most PVDs don’t require treatment, although it can be disconcerting to know you have the condition.  About 15% go on to become a tear, and there is no sure way to predict if or when that will happen. Retina specialists warn patients to be vigilant about new symptoms, such as an increase in the volume of floaters, more frequent flashes, blurry vision or the appearance of a dark curtain over the field of vision.  These could be signs that the retina is peeling away from the underlying supportive tissue, much like wallpaper peeling off a wall. 

To make a diagnosis, retina specialists use eye drops to dilate the pupil and then may use special imaging equipment, scopes with bright lights and manual examination to look deep into tissues of the eye.  The exams can be slightly uncomfortable and vision may be blurry for a couple of hours afterward.  

香蕉视频苹果下载To treat tears, retina surgeons use a laser or a freezing procedure under topical or local anesthesia, spot-welding around the edges of the tear to prevent it from progressing. Although the prognosis is usually good if the tear is diagnosed early, there is still a risk of additional tears so it is important to keep monitoring patients. 

“When it’s a tear, we can nip it in the bud. But when we have a full-blown detachment, it’s another story,” says Philip Ferrone, who treats patients at Vitreoretinal Consultants of New York, in Great Neck, and is president of the American Society of Retina Specialists.  (The society offers a where patients can find a retina specialist in their geographic area.)  

Surgery to repair a detached retina involves reattaching the retina to the back of the eye and sealing the tears or holes. Dr. Ferrone says surgery succeeds 9 out of 10 times with one operation, although more than one procedure might be required.  Techniques include a scleral buckle, which places a silicon band outside the eye to push the wall of the eye toward the retinal tear, using a freezing treatment to induce scarring, thereby permanently sealing it.

Gas bubbles

In another procedure, called a pneumatic retinopexy, the doctor injects a gas bubble into the eye to push the retina back in place then follows up with a freezing treatment or a laser surgery. Surgeons may also perform a vitrectomy, which involves making incisions in the eye, removing the vitreous gel, draining the fluid under the retina, injecting a gas bubble, replacing the gel with a clear fluid like silicone oil that is removed surgically when the retina is stable.

Recovery can be arduous, requiring the head to remain face down as much as possible for up to several weeks to keep the gas bubble in the right place. Patients must avoid air travel or high altitudes while the gas bubble is in the eye.

Dr. Ferrone says the risks of delaying care in such situations was apparent during the pandemic, when patients delayed appointments, waiting for their vision to be more affected and compromised before seeking care. Pandemic guidelines and testing requirements made it harder to get prompt care, and doctors sometimes had trouble getting access to operating rooms. In addition, anesthesiologists had  limited  availability due to demands the pandemic placed on their time. 

香蕉视频苹果下载One study showed that in 259 retina-detachment repairs during the pandemic, patients went to a doctor for care an average of roughly three weeks later than they would have before Covid. Some postoperative outcomes were more complicated as a result. 

Delays for women?

Research also suggests that women and men might be treated differently by surgeons. A 2020 of more than 60,000 cases of retinal detachment between 2007 and 2015 by Natalia Callaway, a  clinical assistant professor of ophthalmology at Stanford University,  found that women, who  made up 43% of cases, were 34% less likely than men to get surgical repair, were more often delayed when they did get a repair, and were treated with different types of surgery than men.

The study concluded that 781 more women in the U.S. would receive the surgery each year if the odds were more equal and that more research is needed to find reasons for the difference and the potential impact on vision. 

Study co-author Vinit Mahajan, associate professor and vice-chair of ophthalmology research at Stanford, says women are often taking care of other family members and in surveys have reported delays in taking care of their own medical needs. They might avoid retinal procedures for fear of being unable to care for dependents during the recovery period. And there may be unconscious bias in the way healthcare providers triage and respond to women reporting symptoms of retinal detachment, Dr. Mahajan says. 

Dr. Mahajan’s lab is also investigating the role of genetics and how the health of the retina might be improved despite the effects of aging. His team is studying the fluid taken out of the eye during retina-detachment surgery and comparing the difference in proteins and sugars at the molecular level with patients who don’t have retinal detachments. 

One intriguing area of investigation is whether retinal aging and degeneration could be addressed with dietary supplements such as a-ketoglutarate, which is typically associated with the health of muscle tissue. Exercise might also be beneficial by increasing nutrients to the retina.

“The worst thing you can do to rapidly age the retina is smoke,” Dr. Mahajan says. “Every time you make a healthy choice, give yourself a high-five for taking care of your eyes.” 

Ms. Landro, a former Wall Street Journal assistant managing editor, is the author of “Survivor: Taking Control of Your Fight Against Cancer.” She can be reached at reports@wsj.com.

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香蕉视频苹果下载 Appeared in the April 18, 2022, print edition as 'The Risk of Ignoring Retinal-Damage Signs.'