Our retinal specialist gives Melbourne residents expert care of various retinal conditions

The retina is the light-sensing tissue at the back of the eyeball and is crucial for vision. A complex structure, the retina is formed of 10 interconnected layers and is supported by additional purpose-specific tissues and structures that provide oxygen and nutrients to the retinal cells. Despite being such a delicate structure, some retinal diseases may simply be monitored closely; conversely, other retinal conditions are considered emergencies and must be treated immediately.

There are two broad classifications of retinal disease and treatment – medical, such as those requiring intravitreal injections, or surgical. Retina specialists may have a preference for managing one or both types. At Mornington Peninsula Eye Clinic, we are pleased to provide management of both medical and surgical retinal conditions under the care of our experienced retina specialist for the Melbourne community. We have access to facilities equipped to perform both medical interventions and retinal surgery and Melbourne residents are welcome to seek the care of our retina specialists for any variety of retinal conditions. In Melbourne, we are fortunate to also have access to the Royal Victorian Eye and Ear Hospital, where most of our ophthalmologists also hold public appointments. Afterhours emergencies can often be attended to at the Eye and Ear Hospital.

Retinal Detachment

This is considered an eye emergency requiring urgent attention from an appropriately experienced retinal specialist. During a retinal detachment, the sensory retinal layers separate from the underlying supportive tissues, resulting in an inability for the high energy-demand cells of the retina to receive adequate metabolic support. If not treated promptly, a retinal detachment can result in permanent and irreversible vision loss in the affected area. A retinal detachment may occur without any obvious symptoms, but many patients will report seeing dark floating spots or lines in their vision, flashing lights, or the sensation of a dark curtain coming across part of their field of view. Patients experiencing these symptoms are encouraged to seek immediate attention from an eye care professional as prompt retinal surgery in our Melbourne facilities is indicated to save your sight in the case of a retinal detachment.

Retinal detachment symptoms and warning signs

The above symptoms typically come on suddenly, are painless, and almost always affect one eye only. Because the other eye compensates, a detachment is sometimes only noticed when the better eye happens to be covered. Additional warning signs include:

A loss of peripheral vision, described as part of the side vision going missing rather than becoming blurred
A drop in central vision or visual acuity, which suggests the detachment has reached the macula
Symptoms that spread or worsen across hours or days as more of the retina detaches

Light flashes can also occur with a posterior vitreous detachment that has not torn the retina, and the two cannot be told apart without an examination. New symptoms of retinal detachment should therefore be checked rather than watched.

When urgent care is required

A retinal detachment usually begins in the peripheral retina and extends towards the macula, the small central area responsible for detailed vision. While the macula is still attached the detachment is described as macula-on; once it is involved, macula-off. The distinction affects how quickly surgery is scheduled and the visual acuity that can realistically be recovered, which is why an eye is best examined on the day symptoms appear rather than after waiting to see whether they settle.

Patients noticing these changes can contact our clinic directly or ask their optometrist to arrange an urgent referral. Where no eye specialist appointment is available the same day, a hospital emergency department is the alternative.

How a detached retina is diagnosed

Diagnosis is made by examining the retina directly. A dilated eye exam widens the pupil, after which the retina is viewed with an indirect ophthalmoscope, often with gentle scleral indentation to bring the far peripheral retina into view. This is where most retinal breaks sit, and mapping their number and position guides the repair.

Optical coherence tomography provides cross-sectional images of the back of the eye, confirming whether the macula is detached and allowing the macula and optic nerve to be assessed. Where the view into the eye is obscured, for example by a vitreous haemorrhage or a dense cataract, a B-scan ultrasound is used instead.

Treatment pathways for retinal detachment

The pathway depends on how the retina came away. A rhegmatogenous retinal detachment follows a retinal tear or hole; a tractional detachment is caused by scar tissue contracting on the retinal surface, most often in advanced diabetic eye disease; a serous retinal detachment involves fluid collecting beneath the retina with no break present.

Where retinal holes or breaks are found before the retina has detached, sealing them can prevent a detachment developing, as described under Retinal Tear below and on our retinal laser treatment page. Once the retina has detached, surgery is required. Options include:

Pneumatic retinopexy. A gas bubble is injected into the vitreous cavity and positioned so that it holds the retina against the wall of the eye while the break is sealed. Suitable for selected uncomplicated cases, and the patient must hold a particular head position for several days afterwards.
Scleral buckle surgery. A soft silicone band is secured around the outside of the eye to indent the wall slightly, relieving the traction pulling on the retina and allowing it to settle back.
Vitrectomy surgery. The vitreous gel is removed from the vitreous cavity, the retina is returned to its normal position and the eye is filled with gas or silicone oil to support it while it heals. Often used for larger or more complex detachments and for tractional detachment. Silicone oil generally requires a second procedure to remove it.

More than one technique may be used in the same procedure, and further surgery is sometimes needed if the retina does not stay attached. Where an underlying condition contributed to the detachment, ongoing management may also involve intravitreal injections or retinal laser treatment. Your ophthalmologist will explain which retinal detachment repair is being recommended, what it involves and the risks associated with it.

To arrange an assessment or to discuss symptoms you are concerned about, contact Mornington Peninsula Eye Clinic.

Retinal Tear

Similar to a retinal detachment, retinal tears may present with floating spots and flashing lights or can be entirely asymptomatic and only detected incidentally on routine examination. Although not considered as severe as a retinal detachment, many retinal tears or holes can have high-risk characteristics of developing into a detachment, and your retinal specialist may recommend preventative laser treatment to avoid deterioration. At Mornington Peninsula Eye Clinic, our rooms are equipped with argon laser technology for the treatment of retinal tears in a procedure known as photocoagulation, which aims to firmly adhere to the retinal tissue to the underlying structures by taking advantage of the body’s natural scarring process.

Central Serous Chorioretinopathy

Patients experiencing a central serous chorioretinopathy often find that though their vision is affected, they are still quite functional in their day-to-day tasks. Symptoms may include blurred or distorted central vision, or micropsia, the sensation that objects appear smaller than they actually are, especially when compared to the unaffected eye. Central serous chorioretinopathy involves the accumulation of fluid underneath the retina, causing a distortion of the anatomy. This condition is typically associated with males aged from their 30s to 50s, type-A personalities, and corticosteroid use, but many patients with central serous chorioretinopathy do not have any of these risk factors. Cases taking a long time to resolve or recurrent episodes at risk of permanent retinal damage may be treated by retina specialists using laser therapy or eye injections; however, many cases are suitable to simply monitor.

Other Retinal Conditions

Other retinal diseases such as macular degeneration, diabetic retinopathy, and various genetic conditions may also require the care of our retina specialists. Melbourne residents may obtain a referral from their optometrist or GP to access high-quality care for a variety of retinal conditions at our clinic.

At Mornington Peninsula Eye Clinic we are proud to provide expert care with our experienced retinal surgeons to Melbourne and surrounding communities. Organise your appointment with us today by calling us now.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.