Laser treatment for retinal tears

Mei Tan

MB ChB BAO, PhD, FRCOphth, FRANZCO

The hollow space inside your eye is filled with a gel called vitreous. Normal aging changes in the gel cause it to liquefy with age, collapsing toward the centre of the eye. This process is referred to as a posterior vitreous detachment (PVD), and in most people it does not cause any damage. In some cases, the gel does not release cleanly from the retina, pulling the retina with it until the tissue tears. Some people are at higher risk of developing retinal tears, due to extreme nearsightedness or a history of trauma to the eye. A tear in the retina allows fluid into the space underneath it, pushing the retina away from the wall of the eye. This is referred to as a retinal detachment, and can cause permanent vision loss without prompt surgery. Applying laser treatment to retinal tears can preserve your vision by sealing off the defect and preventing retinal detachment. The procedure is referred to as laser retinopexy.

A healthy retina lines the inside wall of your eye, reacting to light and sending visual information to your brain. Light passes through the vitreous gel to reach the retina. As you age, the gel liquefies and collapses toward the middle of the eye. If the gel is very adherent to the retina, it can pull a flap of tissue free, creating a defect in the retina.

Some defects in the retina are not caused by traction, forming gradually due to progressive thinning of the retina. These atrophic holes may be discovered during a routine eye examination, prompting referral to a specialist. Small, round holes may not require any treatment if you have no symptoms. A retina specialist can give you advice about the risk profile of your specific case.

How does the laser work?

Small spots of laser energy are applied in a ring around the defect. Over approximately 2 weeks, these spots form a scar, sealing the retina to the layer underneath. Because of the adhesion at the scar, fluid can’t pass into the space under the retina, and the retina is prevented from detaching.

What are the risks of laser retinopexy?

All laser procedures carry the risk of applying laser energy to a part of the eye that is critical for vision. Fortunately, the area where retinal tears usually occur is far away from the centre of your vision. If you are relaxed and still, applying the laser safely is much easier. The doctor will adjust the machine for your comfort.

What should I expect during the procedure?

The treatment is applied sitting upright, with your head resting on a chinrest, and typically lasts 5–10 minutes. The surface of the eye is numbed with an anaesthetic drop, and a contact lens is used to direct the laser energy to the tear. The doctor may ask you to focus on a target light with your other eye. When the laser is active, you will see flashes of green light and hear beeping noises. If many laser spots are required, you may feel an aching sensation. This feeling goes away with a short break.

What happens after the procedure?

Your vision will remain blurry for several hours, due to the dilating drops, contact lens, and bright lights, so you will need someone to drive you home. The vision typically returns to normal the following day. A review appointment will be needed several weeks later, to ensure that the laser is holding. Most of the time, laser retinopexy is sufficient to prevent a retinal detachment, but if the laser does not hold, or new tears develop, additional procedures may be needed. If you have symptoms from your tear, like flashing lights or grey floaters, these will still be present after the treatment, but they usually improve with time. If the floaters persist and affect your quality of life, surgical treatment options can be considered.

What should prompt me to call my doctor?

If you have an increase in flashing lights or floaters, a drop in your vision, or a dark area at the edge of your vision, you will need to be examained again, to ensure the retina is not detaching.