From the Guidelines
Retinal detachment requires immediate medical attention, ideally within 24-48 hours of noticing symptoms, to prevent permanent vision loss and improve the chances of successful reattachment 1. The goal of retinal detachment treatment is to allow patients to maintain their abilities to read, work, drive, care for themselves, and maintain their quality of life 1.
Key Considerations
- The rate of successful reattachment is higher and the visual results are better when repaired early and especially before the retinal detachment involves the macula 1.
- Approximately 5% of eyes with asymptomatic horseshoe tears progress to retinal detachment, and patients should be encouraged to have follow-up 1.
- A symptomatic retinal break is defined as a break caused by vitreoretinal traction in a patient with a new posterior vitreous detachment associated with new-onset flashes and/or floaters, and at least half of untreated symptomatic retinal breaks with persistent vitreoretinal traction will lead to a clinical retinal detachment unless treatment is applied 1.
Treatment Options
- Treatment by prompt creation of a chorioretinal adhesion around symptomatic tears reduces the risk of retinal detachment to less than 5% 1.
- Surgical procedures such as pneumatic retinopexy, scleral buckling, or vitrectomy may be used to treat retinal detachment, depending on the type and severity of the detachment.
Urgency of Treatment
- The urgency of treatment stems from the fact that photoreceptor cells in the retina begin to die when separated from their blood supply, leading to permanent vision loss if not reattached quickly 1.
- Even with prompt treatment, complete vision recovery isn't guaranteed, especially if the macula was detached for more than 24 hours.
From the Research
Time Frame for Treating Retinal Detachment
The time frame for treating retinal detachment is critical to prevent vision loss. According to the studies, the ideal timing of surgery varies depending on the type of retinal detachment and the presence of macular detachment.
- When the macula is detached, surgical treatment should be undertaken within a few days 2.
- When the macula is still attached, the near fovea and bullous superotemporal detachment should be classified as an emergency 2.
- The median interval between first symptoms and surgery was 14 days, with a shorter patient's delay in macula-ON patients (median 3 days) compared to macula-OFF patients (median 5 days) 3.
- The mean time between diagnosis and surgery was 4.4 days, and was increased by the presence of a weekend, or of a weekend with public holiday, and by macular detachment 4.
Factors Influencing Treatment Delay
Several factors can influence the treatment delay for retinal detachment, including:
- Patient's delay and doctor's delay 3
- Patient-reported causes for delay 3
- Symptoms as early warning signals 3
- Patient's prior knowledge about retinal detachment 3
- Trait anxiety 3
- Distance between home and surgical center 4
- Occurrence over a weekend or public holiday 4
- Macular detachment 4
Importance of Early Intervention
Early intervention is crucial to prevent retinal detachment after formation of retinal breaks and to improve visual outcomes of retinal detachment surgery 5. Patients with acute onset of flashes or floaters should be referred to an ophthalmologist promptly 5. Increasing awareness, especially about floaters, might increase the proportion of patients with macula still on at the moment of referral to the ophthalmologist 3.