RC: Lasers may cause photochemical and photothermal reactions in tissue. JB: As I understand it, lasers work by heating the torn area, which causes scar tissue to form a "patch." Can you describe how this works? Before lasers, people tried rest, bandaging, cautery, freezing, tacks, among other techniques. RC: Lasers have actually been used for approximately 50 years for ophthalmic purposes, and some of the first treatments were performed at Columbia. How was this managed before the advent of lasers? JB: Lasers are now the standard method for repairing tears in the retina. Of course, vitreoretinal surgeons are trained to fix retinal detachments, and we are very good at attaching retinas, but it’s definitely better to avoid getting a detached retina in the first place. If a partial retinal detachment is left untreated, the entire retina may detach, resulting in permanent visual loss. RC: The worst-case scenario is total blindness. JB: What is the worst case scenario? Can people permanently lose sight in the injured eye? Because there is a relatively real chance of a big problem associated with these symptoms, we recommend that everyone who experiences new changes such as these should be evaluated as soon as possible. Every eye is different, and not every tear leads to a retinal detachment, but we do know that when people experience symptoms of flashing lights or new floaters, and we see a new retinal tear on exam, there is up to a 50% chance that the tear will lead to a retinal detachment if not treated. This results in permanent damage to the vision cells of the eye. Basically, fluid from the vitreous can sneak underneath the retina through the new break and then cause a separation of the retina from the underlying layer. In turn, retinal tears may lead to retinal detachment and vision loss. RC: People with acute symptoms of new flashes and new floaters need to have a careful dilated exam as soon as possible because about 10% of the time, these symptoms may be caused by vitreous traction leading to a retinal tear. Why is this? Approximately how much time do patients have to seek treatment before the injury gets worse? JB: It is very important to seek treatment for torn or detaching retinas as quickly as possible. In most cases, tears in the retina occur spontaneously, but other factors, such as trauma, may directly cause tears as well When the vitreous tugs hard enough on susceptible retina, a tear may develop. At some point in time for most people, the vitreous will gradually separate from the back of the eye and result in something called a posterior vitreous detachment, or PVD. The next question is, “what is the vitreous?” And the answer is that the vitreous is a clear gel composed mostly of water, but also of collagen and other proteins. RC: Most retinal tears occur spontaneously and are associated with traction from the vitreous humor upon the retina. Can you give us a brief primer about retinal injuries? Why do they occur? What will a person who has a retinal injury experience? I was struck by the ease, lack of invasiveness, and minimal discomfort of the procedure, and I think that our readers would be interested in knowing what can be accomplished by using a laser. Chen, thanks very much for taking the time to speak with me about how lasers are used for repair of damaged retinas. Many of you will be very surprised by the power of lasers in correcting torn retinas and preventing blindness. Chen has graciously offered to do the following interview. Royce Chen, MD, is the Helen and Martin Kimmel Assistant Professor of Ophthalmology at Columbia University Medical Center and Attending Ophthalmologist at the New York-Presbyterian Hospital.
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