Retinal Detachment & Macular Degeneration

What happens. "Retinal detachment is an eye problem that happens when your retina (a light-sensitive layer of tissue in the back of your eye) is pulled away from its normal position at the back of your eye." Separated from the layer beneath, the retina loses what keeps it alive: "The photoreceptors lie on the outer portion of the neurosensory retina, and the choroid supplies oxygen and nutrition for the photoreceptors." "If the retinal detachment isn’t treated right away, more of the retina can detach — which increases the risk of permanent vision loss or blindness."

Why it happens. "There are 3 types of retinal detachment: rhegmatogenous, tractional, and exudative." The common, tear-driven type "is associated with a retinal break where liquefied vitreous enters the subretinal space." The NHS: "A detached retina is usually caused by changes to the jelly inside your eye, which can happen as you get older. This is called posterior vitreous detachment (PVD)." Risk is higher after a previous detachment, a serious eye injury, eye surgery such as cataract surgery, with diabetic retinopathy, and with extreme nearsightedness.

What the patient sees. NEI: "A lot of new floaters (small dark spots or squiggly lines that float across your vision)", "Flashes of light in one eye or both eyes", and a dark shadow or curtain across part of the visual field. "The symptoms of retinal detachment often come on quickly." Vision loss typically starts "in the periphery and moving centrally." A few floaters are normal: "Seeing a few floaters (small dark spots or squiggly lines) in your vision is normal — but if you suddenly see a lot more floaters than usual, it’s important to get your eyes checked right away".

It is an emergency. "Retinal detachment is a medical emergency. If you have symptoms of a detached retina, it’s important to go to your eye doctor or the emergency room right away." "Retinal detachment can cause permanent vision loss — but getting treatment right away can help protect your vision." (The NHS routes these symptoms to NHS 111; this page follows the NEI emergency framing.) StatPearls: "Educate patients not to wait to be seen by an ophthalmologist or optometrist if they have changes in their vision." When surgeons plan the operation for a detachment that already involves the macula, timing is their decision — that planning does not make symptoms less urgent.

Repair. "If you have a small hole or tear in your retina, your doctor can use a freezing probe or a medical laser to seal any tears or breaks in your retina." "If a larger part of your retina is detached from the back of your eye, you may need surgery to move your retina back into place." The NHS describes the three operations: "removing and replacing the jelly inside your eye (vitrectomy)", "attaching a small band around your eye to push the wall of your eye and retina closer together (scleral buckling)", and "injecting a bubble of gas into your eye to push the retina against the back of your eye (pneumatic retinopexy)". Treatment "is ultimately successful for about 9 out of 10 people."

Positioning is surgeon-specified. "You may be asked to lie or sit in a particular position for up to 7 days after the surgery. This is so that your retina is in the correct position to help it heal." After pneumatic retinopexy, "Hold your head in a certain position for several days to keep the air bubble in the right spot". Follow the position the surgeon gives — the sources do not set one universal position.

No flying with a gas bubble. "When intraocular gas is present, patients should avoid air travel as it can cause expansion of the gas bubble and extreme rise of the intraocular pressure with possible permanent optic nerve injury and vision loss." NEI also lists heavy lifting and intense exercise to avoid while the eye heals. "You’ll be able to see the air bubble in your peripheral (side) vision after the surgery. The bubble will disappear on its own over time."

What is normal and what is not. For 2–6 weeks: "your vision may be blurry", "your eye may be sore and red – take paracetamol if you need to", "you may not be able to drive". But "Call the hospital or go to A&E if the pain, redness or blurriness gets worse after surgery." And "You can get a detached retina more than once. Get medical help as soon as possible if the symptoms come back."

What it is. "Age-related macular degeneration (AMD) is an eye disease that can blur your central vision. It happens when aging causes damage to the macula — the part of the eye that controls sharp, straight-ahead vision." "AMD is a common condition — it’s a leading cause of vision loss for older adults." It spares the edges: "Age-related macular degeneration (AMD) affects the middle part of your vision, not the edges (peripheral vision)." "AMD doesn’t cause complete blindness, but losing your central vision can make it harder to see faces, read, drive, or do close-up work like cooking or fixing things around the house." "AMD is not painful and does not affect the appearance of your eyes."

Dry and wet. "Most people with AMD have dry AMD (also called atrophic AMD). This is when the macula gets thinner with age." The Syfovre label describes geographic atrophy (GA) as "atrophic nonexudative age-related macular degeneration". "Wet AMD (also called advanced neovascular AMD), is a less common type of late AMD that usually causes faster vision loss. Any stage of dry AMD can turn into wet AMD — but wet AMD is always late stage. It happens when abnormal blood vessels grow in the back of the eye and damage the macula." The driver of wet AMD is a growth factor: "Vascular endothelial growth factor (VEGF) drives the development of choroidal neovascularization (CNV)", and the new vessels leak fluid and blood and scar the retina.

Symptoms. "Early dry AMD doesn’t cause any symptoms." "In late AMD (wet or dry type), many people notice that straight lines start to look wavy or crooked. You may also notice a blurry area near the center of your vision. Over time, this blurry area may get bigger or you may see blank spots." NHS: "The first symptom is often a blurred or distorted area in the centre of your vision." Some people see "things that are not there (hallucinations)" — listed by the NHS as an AMD symptom.

Wavy lines are the warning. "Straight lines looking wavy is a warning sign for late AMD. If you notice this symptom, see your eye doctor right away." People with drusen "should be educated on the importance of regular Amsler grid use to check for metamorphopsias or scotomas that may indicate conversion from dry to wet AMD. Any change in near or distance vision may also indicate developing CNV, prompting patients to contact their ophthalmologist immediately." "Having late AMD in 1 eye puts you at higher risk of developing late AMD in your other eye".

Lower the risk. NEI: "Research shows that you may be able to lower your risk of AMD (or slow vision loss from AMD) by making these healthy choices:" quit smoking, get regular physical activity, keep blood pressure and cholesterol healthy, and eat leafy greens and fish. Risk rises from 55 and with a family history or smoking.

AREDS 2 — who it helps. "If you have intermediate AMD in 1 or both eyes, they may be able to stop it from turning into late AMD. AREDS 2 supplements can’t prevent early AMD from developing into intermediate AMD." "If you have late AMD in only 1 eye, AREDS 2 may slow down the progression of AMD in the other eye. If you already have late AMD in both eyes, AREDS 2 supplements probably won’t help." Smokers need the newer formula: the older AREDS supplements "have beta-carotene, which can increase the risk of lung cancer in people who smoke or used to smoke." "You can’t get the right mix of these vitamins and minerals from food or from regular multivitamins." And "They can also change the way that other medicines work in your body."

Wet AMD — anti-VEGF injections. "If you have wet AMD, there are other treatments that may be able to stop further vision loss: Medicines called anti-VEGF drugs that the doctor injects in your eye". Aflibercept is "a vascular endothelial growth factor (VEGF) inhibitor indicated for the treatment of patients with" neovascular (wet) AMD.

Geographic atrophy now has a treatment. "SYFOVRE is a complement inhibitor indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD)." In its trials, "There was a reduction in the mean rate of GA lesion growth observed in both studies." — it slows the atrophy; the label does not claim vision is restored. It carries its own risk: it "was associated with increased rates of neovascular (wet) AMD or choroidal neovascularization", so "Patients receiving SYFOVRE should be monitored for signs of neovascular AMD."

After any eye injection. Aflibercept: "In the days following EYLEA administration, patients are at risk of developing endophthalmitis, retinal detachment, or retinal vasculitis with or without occlusion. If the eye becomes red, sensitive to light, painful, or develops a change in vision, advise patients and/or caregivers to seek immediate care from an ophthalmologist". Pegcetacoplan uses the same instruction, adding "flashing lights, blurred vision or metamorphopsia". "Acute increases in intraocular pressure have been seen within 60 minutes of intravitreal injection", and "There is a potential risk of arterial thromboembolic events following intravitreal use of VEGF inhibitors." "Advise patients not to drive or use machinery until visual function has recovered sufficiently."