Vitreous & Retinal Disorders
Diagnosis and treatment of conditions affecting the retina and vitreous gel
What is vitreous & retinal disorders?
The retina is the light-sensitive lining at the back of the eye and the vitreous is the clear gel that fills the space in front of it. Problems in the two are grouped together because the gel and the lining are physically attached, and much of what goes wrong at the back of the eye starts at that junction.
With age the gel liquefies and collapses away from the retina. In most people that passes with nothing more than new floaters. Where the gel is stuck firmly to the retina, the same pull can tear it, drag on the central retina, or leave a membrane on the surface that puckers what is underneath.
The other large group has nothing to do with the gel. The retina is fed by fine vessels that can block or leak, and the central patch used for reading and faces wears with age in its own way. Strong short sight, diabetes, high blood pressure, previous eye surgery and age are the common threads. Almost none of it hurts, so change in vision is the only signal you get.
What you might notice
- Floaters and flashes of light
- Straight lines looking bent
- Sudden loss of vision
How it is diagnosed
The pupils are dilated and the retina is examined all the way to its far edge with a bright light and a hand-held lens, which takes a few minutes per eye and is uncomfortable but not painful. Your doctor is separating the changes that need action from the ones that need only a date to come back.
A scan of the central retina is taken in almost every case. It cuts through the layers and measures thickness, showing fluid, a membrane on the surface or a hole in the centre far more reliably than the eye can be seen.
The pressure in the eye is measured, the front of the eye is examined, and the other eye is assessed with the same care, because these conditions are frequently bilateral and an early change in the second eye is worth knowing about. Where blood inside the eye blocks the view, an ultrasound probe on the closed lid shows the shape of the retina behind it and answers the one urgent question, which is whether the retina is still in place.
Recovery
Treatment given in the clinic takes minutes. Expect blurring for a day and arrange not to drive yourself home, then go back to normal activity the next day. Courses of treatment run over months with visits every four to eight weeks at first.
An operation inside the eye is a day case or one night. If a gas bubble is used, your surgeon will give you a head position to keep and a length of time to keep it, and you must not fly until the bubble has gone. Vision is poor while it absorbs, over two to eight weeks, and useful sight comes back in stages.
Allow two to six weeks off work depending on the job, and avoid heavy lifting and swimming for a month. Vision after retinal work keeps improving for six months to a year, so the level at the first review is not the level you finish with.
If it is left untreated
What waiting costs depends entirely on which problem you have, and that is the reason a new symptom is assessed before it is watched. Some changes at the back of the eye are stable for years and need nothing. Others take sight away within days and cannot give it back.
Fluid or a pulling membrane at the centre of the retina damages the cells there slowly. Treated early, the centre usually recovers; left for months, the blurring and distortion become fixed even after the cause is dealt with.
Three symptoms mean being examined the same day and not at the next convenient appointment: a sudden shower of new floaters, flashes of light seen in the dark, and a curtain or shadow coming across part of your vision. Any of them can mean a tear or a detachment, and a tear sealed in the clinic in minutes is a far smaller matter than a retina that has already lifted. Sudden loss of vision in one eye is also a same-day problem.
Questions about vitreous & retinal disorders
I have started seeing floaters. Is it serious?
Usually not. Floaters are shadows cast by strands in the vitreous gel, and most people develop them as the gel liquefies with age. A few floaters that have been there for months and drift when you move your eye are almost always harmless, and the brain learns to ignore them over several months. What needs assessing the same day is a change: a sudden shower of many new floaters, black specks like soot, flashes of light in a dark room, or a shadow coming across part of your vision. Those suggest the gel has pulled on the retina and may have torn it, and a tear sealed early prevents a detachment.
How soon do I need to be seen?
Same day for a sudden change: new floaters in a shower, flashes of light, a curtain or shadow across the vision, or sudden loss or distortion of central vision in one eye. Within a week or two for a gradual change you have noticed over a month, such as straight lines starting to bend or reading becoming effortful in one eye. At the routine interval your doctor has set for anything stable. The distinction matters because some of these conditions cost sight in days and others are unchanged over years, and only an examination tells you which one you have.
Am I going to go blind?
For the great majority of people, no. Most retinal conditions affect one part of the retina and leave the rest working, so even where central reading vision is damaged, the vision used for moving around is usually preserved. Treatment for the common conditions is now good enough that holding vision steady is a realistic aim, and many people gain some back. What changes the outcome most is how quickly a new symptom is assessed and how reliably you attend the follow-up your doctor sets. Cover each eye in turn once a week to check them separately, since one good eye hides a lot.
Other ophthalmology treatments
Removal of a cloudy natural lens and replacement with an artificial lens to improve vision
Day CareLaser vision correction that reshapes the cornea to reduce dependence on glasses or contact lenses
Day CareTalk to a care coordinator about vitreous & retinal disorders
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one