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Retinal Tears/Retinal Detachments and the Optomap

The posterior part of the eye is filled with a gel-like substance called the vitreous. The vitreous starts off life attached to the back of the eye called the retina. The retina is the inner lining of the back of the eye that senses light and transmits visual images to the brain. As we get older the vitreous gel separates from the retina. In most cases this happens without any issue.

Sometimes, however, a portion of the vitreous can remain attached to the retina and pull on the retina. This can lead to a retinal tear. Retinal tears often have symptoms such as increased floaters, flashing lights, or the symptom of a curtain or shade coming over the vision. Although retinal tears are not always found in patients with these symptoms, sudden increases in these symptoms warrant a prompt evaluation by an eye doctor. Retinal tears are usually treated with lasers to prevent a retinal detachment.

If retinal tears are left untreated, fluid can leak into the tear causing a retinal detachment. Retinal detachments can cause loss of vision. Retinal detachments usually are treated with incisional surgery and have a variable prognosis. Therefore it is critical to detect and treat retinal tears whenever possible before they result in retinal detachment.

The Optomap is a valuable tool in detecting the presence of retinal tears and detachments. Below are examples of Optomap images taken by Dr. Lewis with actual patients from our office.

Patient 1: 64 year old male. This new patient started noticing floaters in the right eye about a week prior to coming in for an exam. He remembered hearing about a friend having a retinal detachment and thought he should be checked out. Based on his symptoms we dilated his eye and took multiple Optomap images using a technique called “eye steering”. Eye steering allows us to image further into the periphery through the dilated pupil. In the image below you can see a classic “horseshoe” tear where the green arrow is pointing. We immediately referred him to our local retinal specialist who performed laser retinopexy around the tear to prevent retinal detachment. He is now doing fine and we continue to monitor for future changes in retinal health.

Image lewis 1

Patient 2: 18 year old female. She had an exam two years ago at another office, and came in for a routine exam. She had no symptoms of flashes, floaters, or curtains over her vision. Routine Optomap imaging in the left eye revealed an operculated hole surrounded by a cuff of fluid where the green arrow indicates. We referred her to our local retinal specialist, who treated the eye with prophylactic laser treatment to prevent future detachment. She is now doing fine and currently being monitored during routine exams. This case illustrates both how problems of the retina can occur in even young, asymptomatic patients.

Image lewis 2

Patient 3: 28 year old male. This patient has been coming in for routine exams to monitor the status of a freckle of the back of his right eye, but had noticed more floaters in each eye over the last couple months. Optomap imaging in his left eye showed changes not seen in the prior year. The green arrow indicates an area with multiple retinal atrophic holes. The red arrows show the “high water” mark of fluid that has leaked into the retina through the retinal holes. This is a retinal detachment in his left eye. We referred him to our local retinal specialist who recommended scleral buckle surgery to his left eye. Thankfully, the retinal detachment did not reach the center of his vision, so this patient avoided any long term problem to the vision in his left eye. This is another example of the Optomap providing clear cut evidence of a new problem that was not present in the prior exam. It also indicates how even young patients (this patient was 28 years old) can be at risk for retinal tears and detachments.

Image lewis 3

Discussion

The Optomap is a valuable tool to detect retinal tears and detachments. Prompt and appropriate referral greatly reduces the risk of long term vision impairment from these conditions. These examples illustrate how retinal problems can occur in patients of all ages (sometimes without symptoms) and why we recommend having an Optomap performed during every eye exam for all age groups.