(September 10, 2009 - Insidermedicine) In this video, Dr. Pravin Dugel, MD, discusses what he would do if he had flashing lights and floaters in his vision. Dr. Dugel is an Ophthalmologist with the Retinal Consultants of Arizona.
What is the significance of flashing lights?
Dr. Dugel: Flashing lights can indicate a number of things, and perhaps what’s most important here is to talk about what would potentially be the most dangerous and also the most common. Flashing lights could indicate a separation and a condensation of the vitreous. In order to discuss that, perhaps we should start talking a little bit about the anatomy of the eye.
In the back of the eye, there is a layer of nerve fiber cells called the retina (it’s a very complicated layer) and stuck to this retina is a jelly-like substance called the vitreous, and as we age, that vitreous gets more and more liquid just like jello would if it were standing for a very very long time. As it becomes more liquid, the interfaces look like floaters and it also contracts and it pulls away from the retina. As it pulls away from the retina it stimulates the retina and these nerve fiber cells flash away, and as they flash, you can sense flashes and often times floaters associated with that as well.
How urgent is referral if I see flashes?
Dr. Dugel: You can get a tear in the retina because as that jelly separates it can pool in some weak areas of the retina and cause a tear. That can be dangerous because fluid can now go in the tear and cause a retinal detachment. This is relatively easily treated when you have a retinal tear so that the retinal detachment can be prevented but there is no way for you as the patient to know the difference between having a retinal tear and not having a retinal tear so this is why it is very important to be seen by a very good general ophthalmologist or a retina specialist within the next business day, so hopefully within 24 to 48 hours.
How will an eye doctor determine if I have a retinal tear?
Dr. Dugel: The ophthalmologist or retina specialist will have to do a dilated exam, and when one does a dilated exam one looks around the peripheral retina or the outer part of the retina very very carefully and often times this has to include a scleral depression and what that means is that the doctor will dilate your eye with drops, and will usually lie you down and use an indirect ophthalmoscope which is a light on the doctor’s headband to shine right into your eye and an instrument to press around the eye so that the entire retina can be very carefully studied to make sure that there is no tear present.
How is a retinal tear treated?
Dr. Dugel: A retinal tear means that when that jelly separated, it pulled on the retina and caused a little tear but no fluid has gone in yet. As soon as fluid goes in, we call that a retinal detachment and the treatment changes entirely. That is why it is very important to catch this early if a retinal tear is present, before it becomes a retinal detachment. A retinal tear is treated one of two ways. One can either laser around it to seal it up, or one can freeze it to seal it up. Either way, the tear is sealed up entirely so that fluid can’t go in and create a retinal detachment. That has to be done before fluid goes in because if fluid has already gone in, then no longer is it a tear, but a retinal detachment, and now we’re talking about other, more invasive forms of treatment.
How is a retinal detachment treated?
Dr. Dugel: Now what has happened is that fluid has gone into the retinal tear and fluid has separated the retina and the retina is starting to fall off like wallpaper coming off the wall. at this point, just doing a laser alone or doing a freezing treatment alone is not sufficient because fluid has already gone in.
Retinal detachments can be treated one of three ways:
One can do a pneumatic retinopexy, which is usually done in the office where either an air bubble or more frequently a gas bubble is injected and that gas bubble from the inside of the eye presses on the retina to flatten it, thereby pushing the fluid out so that the doctor can then go ahead and laser that tear to seal it up now, because the fluid is gone, or freeze it. This is one way of doing it.
The other way of treating a retinal detachment is to do something called a scleral buckle procedure where the patient is taken to the operating room and a band, much like a belt that goes around your waist, is placed around the retina and the tear is frozen at the same time and sometimes the fluid is also drained.
A third way is to do something called a vitrectomy where, using an automated device, the vitreous jelly is removed and often times either an air or gas bubble is placed and the retinal tear is either frozen, as before, or treated with laser photocoagulation.
The shape of the retinal detachment, the location, whether there is blood or not, and the surgeon’s preference will determine which of these three different methods he chooses.
If I had a retinal tear...
Dr. Dugel: If I suddenly saw flashes and floaters in my eye, what I would do is to make sure that I got the first available appointment to my ophthalmologist or my retinal specialist so that I can have a complete dilated examination. I wouldn’t wait very much longer than the first business day because I have no way of knowing whether there is a tear or not, or indeed whether there is a retinal detachment or not. Once that examination was done, I could be treated if I had a retinal tear as I have described before. If I had a retinal detachment, what I would see is not just flashes and floaters, but often times I would also see a black curtain either coming from the side of coming from the top or from the bottom. That curtain would approach my visual field like a black curtain being drawn across or pulled down or up, and if that happened I would definitely would not wait at all as that would be considered an emergency. I would call my ophthalmologist or I would call my retina specialist immediately to get in and be seen.