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Vision loss from retinal tears can be prevented


San Jose Mercury News (CA)

06-17-13

June 14--A flash of light startled Anne Collins as she stood at her kitchen counter chopping onions. She figured the blast of brightness came from sunshine bouncing through a skylight. Then a horde of black specks surged across her sightline.

Something was wrong.

But friends were coming for dinner and Collins was looking forward to the evening, so she didn't get her eyes checked right away. That decision could have cost the San Bruno resident her sight.

Sudden flashes of light and streams of floaters can be signs of a tear in the retina, the light-sensitive surface at the back of the eye, said Dr. Rahul Khurana, a Bay Area retinal specialist. Although the occasional splotch of debris drifting across an eye is

common -- and retinal tears are not -- ignoring these symptoms could lead to retinal detachment and permanent vision loss, he said.

"I discounted the signs," said Collins, who was 71 when the odd intruders affected her vision. "Now, every time I go out for coffee, I'm telling everyone to pay attention to their eyes."

Although she went to an emergency room two days later, Collins said she was told the haziness would eventually clear, and she drove home. She looked up her symptoms on the Internet and discovered it could be a serious problem. That's when she made an appointment to see her eye doctor.

A five-minute office procedure can fix a tear if it's caught in time, said Khurana, who rotates through six offices between

Monterey and San Mateo. Patients need only eye drops for anesthesia and then are carefully positioned to allow the edges of the sensitive eye tissue to be laser-sealed against the back of the eye.

"I've always had floaters that are perfectly harmless," said Holly Angeloty, a 53-year-old San Jose resident who said she also has always had poor eyesight. "Then one day I woke up with streams of black junk surging across my eye."

Angeloty chalked it up to being Monday-morning tired coupled with weariness from recent travels. Luckily, she had an appointment with an optometrist the following week, which led to an immediate referral to Khurana. "If I'd known, I would have been in there right away," she said.

"I hear that story all the time," said Dr. Robert Bhisitkul, a professor of clinical ophthalmology at UC San Francisco. But people can't feel the subtle changes that take place inside an eye before the retina rips, he said.

Every eye has a clear gel, called the vitreous, that fills and gives shape to the back part of the eyeball. As people hit their 50s and 60s, the vitreous becomes less like Jell-O and more like sticky fluid, Bhisitkul said. Sometimes, the changing fluid moves and sticks to the eye, dragging pieces of the retina with it.

When the sticky fluid tugs on the eye tissue, the retina fires off a flurry of electrical signals to the brain. Those signals are interpreted as light, causing the flashes. The floaters are bits of debris and red blood cells that slip into the liquefying vitreous when the retina peels off the back of the eye. If the gel contracts or folds, people describe seeing curtains or the appearance of objects.

It's delaying the checkup than can be so damaging, as Dean Bagley discovered. The 74-year-old San Mateo accountant worked through a week of cloudy vision in his left eye before he called his ophthalmologist. Bagley got an immediate referral to Khurana, who found three torn spots and retinal detachment.

"Now, I'm walking around with pretty good vision," Bagley said. But it took two procedures and days of immobility before his retina was reattached and sight was restored.

These days, he checks his vision daily for cloudy spots or obstructions. "I'm watching out for my own best interests," he said.

Although age is one risk factor for retinal tears, so is a history of cataract surgery, Bhisitkul said. Severe nearsightedness also increases the chances of tears because the eye is elongated and that can stretch the retina, he said.

Trauma can cause retinal tears or detachment at any age. But there's no evidence that playing high-impact sports makes this problem more likely, Bhisitkul noted.

"I wanted to know what I could have done differently to prevent this," said Mark Hutchinson, a former San Jose resident who watched a cobweb pattern billow through his eye while driving home one day.

It's not considered a hereditary condition, and there's no genetic test that can predict who is at risk for retinal tears. Unlike some other age-related eye diseases, vitamins and supplements won't stop the vitreous from changing with age.

As Khurana said: "Awareness is the main thing."

___

(c)2013 the San Jose Mercury News (San Jose, Calif.)

Visit the San Jose Mercury News (San Jose, Calif.) at www.mercurynews.com

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Copyright San Jose Mercury News (CA) 2013

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