The big vision
It is impossible to overstate the worth of our eyesight. Yet many of us don’t make a concerted effort to take care of it, and more than one in 10 adults have never had an eye test. What’s even more worrying is that the majority of those who have had a test only undergo a standard vision exam. While these are hugely important, they do not test for a whole host of other serious conditions, such as damage to the retina.
To paint a more detailed picture of overall eye health a retinal check is also required. The exam, which is sometimes called ophthalmoscopy or fundoscopy, allows a physician or optometrist to evaluate the condition of the back of the eye. This includes the retina, optic disk and choroid blood vessels. It can be performed independently or along with a standard eye test, and typically it looks for any signs of damage such as ruptured blood vessels or tears to the actual retina.
Spotting these tears early is paramount as they can lead to retinal detachment. If left untreated, a retinal detachment almost always causes some degree of blindness, as without their blood supply the nerve cells of the retina die. That’s why prompt testing and regular eye care are of paramount importance.
Unfortunately, people often write off the common signs of early retinal damage — such as flashes of light, blurred vision, ‘floaters’, a cobweb effect of black dots in the field of vision — thinking they are relatively normal.
While retinal detachment is more common in those over 40 it can affect those of all ages. So with that in mind, here are some key risk factors. Myopia, also known as short-sightedness, drastically increases the chances of developing retinal detachment. Ageing is also a problem because as we grow older the collagen fibres within the vitreous can shrink. This causes it to pull forward in the retina until the vitreous pulls away completely. According to the Eye Institute of West Florida, around 90 percent of people over the age of 60 will have vitreous detachment in at least one eye.
Head injuries increase this risk. As the vitreous is rocked within the eyeball it can move forward at such force that it detaches from the retina, causing a tear. Even if the initial impact of the injury does not prompt the retina to detach, damage to blood vessels can develop into scar tissue, which can then displace the retina.
Eye diseases and disorders such as retinoschisis (splitting of the retina’s neurosensory layers), uveitis (inflammation of the layer between the retina and the cornea), and lattice degeneration (which causes the peripheral retina to atrophy) are also common among those with detached retinas.
And finally, diabetes is another risk factor. Diabetic retinopathy occurs when prolonged high blood sugar damages the blood vessels in the eye, leading to a build-up of scar tissue which pulls the retina out of its position.
All these factors should be enough to convince you of the need to book a retina exam. Most physicians will perform one as part of a full eye exam, which will screen for a number of other disorders. Don’t wait until you notice problems. Many sufferers only know of an issue when what is often described as a shadow appears across their vision. Unfortunately, in most cases, by the time this happens it’s usually too late. While it is of course important to recognize warning signs, pre-screening by way of a retinal exam is by far the most efficient form of diagnosis.
As I have already touched on, almost all cases of untreated retinal detachment result in some degree of loss of sight. When treated, however, success rates are often between 80-95 percent. What’s more, in 85 percent of cases all that is required is one straightforward surgery, performed under local anaesthetic.
So in the end, there really is no exaggeration when I say that routine retinal exams can save your eyesight.
Dr. Mark Janowski (MD, USA) is a fully licensed internal medicine specialist at Intelligent Health a preventive medical centre located in Jumeirah, Dubai.