Retina

This is a situation where you notice things floating in your vision. There are many different causes, some of which are harmless, and others can be the sign of serious problems such as a retinal detachment or inflammatory disease of the eye. If you have floaters in your vision, it is important to be examined by a retina specialist within 24-48 hours to identify the cause and whether there is any underlying problem that needs to be addressed (see below).

In many cases, floaters are not indicative of a serious underlying problem. In this scenario, they can be annoying as they might interfere with your vision, but they do not cause harm and often will become less noticeable with time. Laser or surgery can be performed for persistent troublesome floaters.

An epiretinal membrane is a condition where a thin layer of scar tissue forms on the surface of the retina at the macula. The macula is the central part of the retina which is important for achieving fine vision. Sometimes epiretinal membrane does not cause any visual symptoms and it can be left alone. However, in some cases, it can contract and result in visual deterioration, often with distortion of vision. Patients often report this as seeing bends or kinks in straight lines. If your vision is affected by ERM, a surgical procedure can be performed to remove the membrane and improve the vision. Mr. Neffendorf can advise you on whether surgery would be helpful for you.

A macular hole is a when a hole develops at the back of the eye in the part that is responsible for fine vision, called the macula. Most of the time, this causes the vision to become blurred and some people notice distortion of their vision, including parts of their central vision having a gap. Some macular holes are not full thickness holes, and these tend to not cause severe vision loss. Most of the time, they do not require surgery. For full-thickness holes, the vision is usually significantly reduced, and surgery is usually recommended in these cases. Surgery is highly successful in closing a macular hole (over 90% chance), and this usually results in visual improvement. It is important to be aware that even with successful surgery, the vision does not usually return to as good as it was before the hole developed. Mr. Neffendorf is happy to discuss your options if you have a macular hole, and his academic thesis included chapters on the management of macular holes.

When we are born, the vitreous gel inside the eyeball is firmly attached to the inner wall of the eye. With time, the normal aging process results in detachment of the vitreous gel away from the inner lining of the eye. This tends to occur from the age or 40 onwards, and usually happens more often and earlier in short sighted people (myopia). It is an important situation because it is often the condition which can cause a number of problems that require the expertise of a retina surgeon such as Mr. Neffendorf.

The main symptoms of a PVD are flashing lights and/or floaters. If you develop these, it is important to be examined by a retina specialist within 24-48 hours. Approximately 10% of patients who develop a PVD have a retinal tear which requires urgent laser or cryotherapy treatment to reduce the chance of a retinal detachment (see below) developing. Untreated retinal tears carry a significant risk of a retinal detachment which is a sight threatening emergency.

The main cause of a retinal tear is a PVD. This is when the vitreous gel detaches from the retina, causeing traction on the retina. Other scenarios such as trauma can cause a retinal tear. Most patients who have a retinal tear notice a sudden increase in vitreous floaters. A retinal tear requires urgent laser or cryotherapy treatment to significantly reduce the likelihood of progression to retinal detachment.

The retina is the part of the eye which is responsible for collecting the light that enters the eye and allowing us to see. It cannot work properly if it is detached. The usual cause for a retinal detachment is a PVD (see above) that results in a retinal tear. This allows fluid to pass through the tear and peel away the retina from the wall of the eye. It is a sight threatening emergency that requires urgent surgical intervention in the majority of cases to preserve sight.

It is more common in short-sighted people (myopia), those who have previously had cataract surgery, and those with a history of trauma to the eye. There are other forms of retinal detachment without retinal tears due to traction on the retina (e.g. in diabetic patients) or excessive fluid production under the retina. The symptoms that might indicate a retinal detachment has occurred are flashing lights, floaters and a curtain/shadow in the vision. Some patients do not present with all symptoms, and sometimes a retinal detachment can be asymptomatic (have no symptoms). The majority of retinal detachments progress and with time will cause a rapidly progressing shadow of vision loss that eventually affects the central vision and ultimately entire vision of the eye. It is therefore important that if you develop any of these symptoms you are seen urgently by a vitreoretinal surgeon, such as Mr. Neffendorf.

The vast majority of retinal detachments need to be repaired urgently. Delay in surgery can result in severe loss of sight and blindness. The earlier a retinal detachment surgical repair is performed, the more likely you are to preserve your sight. There are different ways to repair a retinal detachment, which Mr. Neffendorf will discuss with you in a consultation. Further information is available in the Patient Information Leaflet in the Patient Info. section.

In some operations, Mr. Neffendorf will insert a gas bubble into your eye during surgery. This is done to maximise the chance of surgical success or support the eye during the recovery period. You will be informed if you have gas in the eye, as well as the likely duration that it will be present before it is naturally absorbed by the body. You must not travel in an aeroplane whilst you have a gas bubble in your eye. This would result in severe pain and irreversible loss of sight.

After some operations where a gas bubble is inserted into your eye, Mr. Neffendorf will ask you to keep your head in a certain position as much as you can for a specific period of time (up to 1 week). This is known as posturing, and the exact positioning (e.g. lying left cheek to pillow) will be explained to you. The reason this is done is so that the gas bubble moves via gravity to exert a pushing affect on a specifc area of the retina in order to help the retina heal and maximise the chance of surgical success.