The College of Optometrists advise that, on average, you will see a retinal detachment every 16 months.  Now, I’ve been practising for a grand total of 37 months (including my pre-reg) and I’ve seen 6 or 7 (I don’t know if I should count one of them because I didn’t actually see the detachment – but I’ll talk about that in a moment).

Here’s a brief rundown of the seven:

1) Towards the end of my pre-reg, late one evening, I saw a patient with a peripheral horseshoe tear.  The main symptom was a coloured circle in their peripheral vision and sudden onset floaters.  Schaeffer’s sign was absent.

2) The second was an aphakic patient who had been in a fight over Christmas.  That was eight months after the first one.  Again, no Schaeffer’s sign but the capsule of the lens was floating around in the anterior vitreous, like a wet tissue.  The detachment was peripheral.

3) A month later, I saw a completely asymptomatic detachment.  The patient’s main complaint was slightly reduced near vision.  The macula was off and the retina was a pale yellow.  Again, no tobacco dust.

4) This one looked like a stroke on visual fields as the macula was half on, leading to a very definite hemianopia.  On returning to me a couple of months ago, I found out that the outcome for that eye was poor and the patient has AMD in the other eye.

5) A young man with proliferative diabetic retinopathy.  He had recently undergone a vitrectomy and treatment for a detachment in his right eye (caused by a pre-retinal bleed) and had woken up that morning unable to see at all.  The left vitreous was so cloudy, I couldn’t see anything so I referred him straight into HES.  He lives a few minutes away from the practice and sometimes I see him on my way home, holding his white cane close to his chest.

6) A lady with a high minus prescription who had noticed a black spot at the side of her vision.  There was a small hole temporally and the retinal was raised between the hole and the optic nerve.  The detachment was lovely and pink.  Again, no tobacco dust but there was a 5mmHg difference in pressure between the eyes (with the affected eye having the lower pressure).

7) This happened yesterday.  Well, actually, it happened on Sunday but my patient (a lovely lady whom I tested 6 months ago) didn’t want to be a bother*.  She came in because she’d been experiencing a curtain across her vision, affecting her right eye (I was so happy to hear that as this lady only has one “good eye” – the left).  When she told me that, I knew immediately that it was a detachment so I popped in some tropicamide and did a thorough history and symptoms while it worked.

On Volk, there was a large area of peripheral degeneration (that I’d noted in March) which seemed to be where the problem had started.  The inferior retina had ballooned out and the macula was barely attached.  The retina was floating around making it very difficult to focus on any particular area.  I could see a black flap at the extreme periphery if I tilted the Volk and asked my patient to look as far up as she could.

I called HES and there was a bit of a discussion on what to do next.  As mentioned, the patient was densely amblyopic in the affected eye so she’d gone from counting fingers to hand movements.  In the end, the ophthalmologist decided to see her that day and I’ll hear on Monday how she got on.

 

* This is something I hear often from my older patients.

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