Probability of retinal tear leading to retinal detachment (feat. retinal tear laser treatment)

“Sir, what is the probability that I will have another “retinal tear” ?”

“I had laser treatment… It will not progress to retinal detachment, will it?”

Hello, your ophthalmologist, Dr. Song (Easy-Eye).

I talked about the dangers of retinal detachment on my blog or YouTube. ( Click if you haven’t seen it)

  1. It can happen to anyone, even at a relatively young age.
  2. The high risk of retinal detachment, especially in high myopia, is
  3. once it occurs, emergency surgery is required.
  4. If you don’t get surgery, you could go blind.

Early detection and early treatment have been emphasized several times.

So, in the end, it is very important to detect a retinal tear and laser treatment,

which is the pre-stage of retinal detachment.

Therefore, people who have received laser treatment for retinal tears, and those who suffer from floater and photopsia, which are typical symptoms of retinal tears, are very concerned…

From the patient’s point of view, it is impossible to know the condition of the eye; It will be worried about when a retinal detachment might occur .

However, it is also true that there are many things that are difficult to tell even from a doctor’s point of view.

It’s hard to tell you the exact part because the probability is different for each person and each situation.

(There is a proverb that says not to trust a confident doctor)

Nevertheless, there were many people asking questions, so I searched several papers, but the number of studies was small and the reliability was not high.

This is because it is difficult to design a study . (Perhaps we can’t just leave the retinal tear untreated…?)

In spite of this limitation, I brought one paper worth reading. (Almost unique…)

Probability of retinal tear leading to retinal detachment (feat. retinal tear laser treatment)

This is a review paper published in Acta Ophthalmologica in 2015. (As of 2021, impact factor 3.7)

The title is Prophylactic treatment of retinal breaks a systemic review.

  1. Probability of retinal tear after posterior vitreous detachment

  2. Probability of retinal tears (including asymptomatic) leading to retinal detachment

  3. How much prophylatic lasers prevent retinal detachment.

2,933 papers were organized and analyzed, and 13 papers were finally organized and published .

(I will explain one more time at the end, but there are bound to be many limitations of the study. Please do not dwell too much on the probabilistic parts and numbers that will be explained in the future.)


What is retinal tear and detachment?

First, you need to know what a retinal tear and detachment are? (+ Posterior vitreous detachment)

This part is too long to explain, so I’ll attach a link to my previous post.

Retinal tear (aka retinal hole) that can lead to blindness if left untreated

According to one study

Retinal tears are reported to occur in 2 to 9% of the population (autopsy study results).


Posterior vitreous detachment

Retinal tear and detachment, is ultimately closely related to posterior vitreous detachment (as discussed in previous articles).

Probability of retinal tear leading to retinal detachment (feat. retinal tear laser treatment)
Posterior vitreous detachment

When the vitreous that fills the eye (with age) falls off from the retina, it is called posterior vitreous detachment.

Probability of retinal tear leading to retinal detachment (feat. retinal tear laser treatment)
Retinal tear and subsequent detachment, a complication of posterior vitreous detachment

Rarely, as in the image above , retinal tears (holes) and retinal detachment may occur as complications during this process.

Now, is retinal detachment unconditionally related to posterior vitreous detachment? It is not.

About 87% of patients with retinal detachment were associated with posterior vitreous detachment .


retinal tear
(…maybe doctor haven’t seen it?)

The typical symptoms of posterior vitreous detachment are photopsia and floater .

So, when you come to the hospital for photopsia and floater, a retinal examination is performed to check for retinal tears, a risk factor for retinal detachment .

retinal examination
Retinal examination methods (left: indirect ophthalmoscopy, right: 90D lens slit lamp microscopy)

A drug that enlarges the pupil (mydriatic) is put in, and the doctor directly examines the retina in the way as in the picture above.

retinal detachment, retinal tear
Left: wide-angle fundus camera (Optos), right: retinal detachment (white arrow) and tear (yellow arrow) seen in the wide-angle fundus photograph

These days, as shown in the figure above , wide-angle fundus cameras that can see the periphery of the retina are widely available, and the objectivity and convenience of retinal examination have improved significantly.

(Nevertheless, I prefer to see the retina directly for first-time patients.)

If there is no problem with the retina after the examination, most of you will hear like below.

“Right now, the retina is fine~ But there may be a damage in the future, so if the symptoms worsen or persist, visit us again~”

So… what are the odds of having a tear? Maybe there are some undiscovered tear ?

As a result of analyzing the patients who visited for floater and photopsia, the probability of later finding a tear that was not seen in the first retinal examination was about 1.5 to 4%. .

if you look only here

You might say “Even if the retina is normal, should I have to undergo a re-examination?”

Most of the cases in which delayed retinal tears were when the first examination was not performed properly .

It was a case where a detailed retinal examination was difficult for other reasons such as retinal hemorrhage.

In other words, it is the conclusion that “if the first retinal examination went well, there is no need for a re-examination without a specific reason” .

It is thought that this is also affected by the fact that there are many cases abroad where access to hospitals is difficult.

Another large study found that

The probability of developing a delayed retinal tear is about 10%, and even though the first examination was perfect, the probability of developing a delayed retinal tear was about 1.7% .


Asymptomatic retinal tear

I mentioned earlier that the typical symptoms of a retinal tear are floater and photopsia.

However, having a tear does not necessarily mean that you have symptoms. That is, there are asymptomatic retinal tears .

In this case , it is discovered incidentally during retinal examinations such as regular examinations.

When I tell patients that a tear was found and that laser treatment is necessary, they respond in two main ways.

  1. Retinal detachment is real disaster. I’m glad to find early…

  2. I have no symptoms, do I need laser treatment? I’m a little wary of the laser on my eyes… Shall I go to another hospital?

Yes, in fact , it is not always possible to retinal detachment just because there is a tear

As mentioned at the beginning of the article, as a result of autopsy studies, retinal tears are found in 2 to 9% of cases, right?

The fact is that there are a lot of people who do not even know they have a retinal teartheir entire life.

Well, let’s mention it in the paper

In the case of asymptomatic retinal tear, the number of cases leading to retinal detachment varied from 0 %~14% (at 6 months observation).

It may feel less than you think, but considering that the observation period is 6 months, I don’t think it’s a small probability.

In addition, the probability was high in the case of cataract surgery, high myopia, a family history of retinal detachment, and a history of treatment for retinal detachment or tear in the contralateral eye.

In short

Although asymptomatic retinal tears do not necessarily require laser treatment, it is recommended if there is a history of ophthalmic surgery, high myopia, a family history of retinal detachment, or contralateral detachment or tear .


Symptomatic retinal tear

So, what about retinal tears accompanied by symptoms such as floater and photopsia?

As mentioned in the paper,

In the case of symptomatic retinal tear, the probability of retinal detachment was up to 35-47%.

Are you sure you need laser treatment?


The effectiveness of prophylactic lasers

Treatment for retinal tears (without detachment) is laser .

How effective is laser treatment?

Probability of retinal tear leading to retinal detachment (feat. retinal tear laser treatment)
Probability of retinal detachment after prophylactic laser

Combining the results of several studies as shown in the table above,

Even after prophylactic laser treatment for retinal tears, the probability of occurrence retinal detachment was 2.1 to 8.8%.

Therefore , it is concluded that prophylactic laser treatment is necessary if there is a retinal tear .

(The problem is that the above studies did not classify asymptomatic or symptomatic retinal tears, so there is no basis for treatment for asymptomatic retinal tears.)

also,

During the observation period, the probability of developing a new retinal tear in an area other than the prophylactic laser-treated area was 7.3 to 14%.

Therefore , it is emphasized that periodic follow-up is very important even if laser treatment was perfect for retinal tears .


organize

Shall we summarize the contents of the thesis?

In the case of a simple posterior vitreous detachment without retinal abnormalities in a patient with symptoms such as floater, photopsia, etc.

1. If the examination was fully done at the first visit, there is no need for a second visit.

2. However, if the retinal examination was limited at the first visit, a second visit is absolutely necessary.


If a retinal tear is found

1. If there are symptoms such as floater, photopsia, etc., the probability of progression to retinal detachment is 35-47%

2. In the case of a tear discovered incidentally without symptoms, the probability of progression to retinal detachment is about 0 to 13.8%.


For eyes with a high risk of retinal detachment, prophylactic laser treatment is recommended if retinal tears are found regardless of the presence or absence of symptoms.

Thank you for reading this long post so far.

(Although mentioned in the papers, the analyzed papers are papers with many limitations, so please do not dwell too much on probability figures)

Please use the community for questions.

Next time, we will learn about “degenerative myopia or pathological myopia”.


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