Blurry far vision, glasses and contact lenses – short-sighted Singaporeans are more than familiar with this myopia starter pack. But what can also potentially turn up like an unpopular Labubu in a blind box reveal is an eye condition that many myopes may not be aware of: retinal detachment.
That was what Mediacorp actor and myope Elvin Ng was diagnosed with on Feb 23 after consulting a doctor about “a dark circular shadow at the bottom corner of my right eye”, he wrote on an Instagram post.
The 45-year-old actor noted that “when I moved my eye around, the shadow didn't move” and “by the evening, the shadow had covered nearly half my eye and was near the centre”.
When interviewed by 8 Days and asked if he knew what the cause of the detachment was, the actor said, “it is most likely due to my myopia as retinal detachment can happen with those with high myopia”.
Ng was scheduled for an emergency eye operation on the very same day, and a gas bubble was inserted into his affected right eye to save his vision.
If you thought the treatment was unusual, wait till you read about his home-rest instructions – he had to lie face down for two weeks and could only take hourly breaks to clean his eye and take medication. “Even when I sleep, I can’t be on my back and need to face down,” he told 8 Days.
Just what is retinal detachment and can it happen to you if you have myopia? Would you also experience seeing “shadows” like Ng did if it happens to you? Find out from the experts.
The retina is a thin, light-sensitive layer of tissue found at the back of the eyeball, explained Associate Professor Andrew Tsai from Singapore National Eye Centre (SNEC). It functions like a camera film by converting light into nerve signals, which the brain processes as the images you see.
Those with myopia have stretched eyeballs or what the eye experts call an increase in axial length. Over time and especially with severe or high myopia of over -6.00 diopters or 600 degrees, the stretching can cause small, painless tears or holes in the retina.
Then, if the naturally occurring gel in the eyeball (aka the vitreous humour) gets behind these openings, the gel can push the retina away from the back of the eye. This form of retinal detachment, regarded as rhegmatogenous retinal detachment, is the most commonly seen in patients, said Assoc Prof Tsai.
Tractional retinal detachment: It is more commonly observed in diabetics, who have damaged blood vessels scarring their retinas. As the scars get bigger, they pull on the retina and detach it from the back of the eye.
Exudative retinal detachment: There aren’t any tears or breaks in the retina. But the vitreous humour (eye gel) gets trapped behind the retina, pops it away from the back of the eye, and cause it to detach.
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“Patients with severe myopia tend to have a higher risk of retinal detachment as they often have areas of thinner retina that are more susceptible to tears,” explained Dr Paul Zhao, the senior consultant ophthalmologist at Eagle Eye Centre, who treated Ng's retinal detachment.
The incidence of retinal detachment in Singapore is approximately 10 cases per 100,000 people every year, according to Dr George Thomas, a consultant with National University Hospital’s (NUH) Department of Ophthalmology.
SNEC handles several hundreds of retinal detachment cases annually, while NUH manages several new retinal detachment cases each week. Private clinics such as Dr Zhao's see an average of about two or three patients a week.
Retinal detachment most commonly occurs in people over the age of 50, with the highest risk between ages 40 and 70. “Men are at a slightly higher risk of retinal detachment than women," shared Dr Thomas. “Local research has also shown differences in incidence among racial groups, with Chinese patients having a higher reported risk, followed by Malays and Indians.”
Severe myopia increases your risk of retinal detachment by five to six times compared to someone who has low myopia. (Photos: iStock/MTStock Studio)
As for the causes, severe myopia tops the list. In fact, those with high myopia run a five-to-six times higher risk of developing it than those with low myopia.
But why don’t more people suffer from retinal detachment since Singapore is regarded as the myopia capital of the world? “Although myopia is a known risk factor, most Singaporeans have low to moderate myopia, which carries a much lower risk than pathological or very high myopia,” explained Dr Thomas.
There have been cases where retinal detachment can also be a sign of permanent age-related vision loss known as glaucoma. Glaucoma and retinal detachment coexist as they share risk factors such as severe myopia, eyeball structural changes and age.
Speaking of age, said Dr Thomas, the years are certainly not kind on the eyes. The vitreous humour naturally liquefies and may separate from the retina in a process known as posterior vitreous detachment, he explained. “If the vitreous humour pulls strongly on the retina, it can create a tear, which may then lead to retinal detachment.”
Other contributing causes include eye trauma, previous eye surgery, a history of retinal detachment in the other eye, and a family history of the condition, he said.
And sometimes, even innocuous actions such as “frequent eye rubbing could cause retinal tears, which if not treated promptly, will progress to a retinal detachment requiring major surgery”, cautioned Dr Zhao.
Innocuous actions such as frequent eye rubbing could lead to retina tears. (Photos: iStock/Chainarong Prasertthai)
Dr Zhao explained that when there is a tear in the retina, fine blood vessels release red blood cells and pigment into the cavity of the eye. When that happens, what your eye sees is “a sudden onset of floaters, cloud-like dust or shadow moving across your vision”, he said.
“Other warning signs not to ignore would be seeing flashes of light, sudden blurriness or distorted vision,” continued Dr Zhao. “Experiencing any of these symptoms should prompt an urgent eye assessment because early treatment can prevent permanent vision loss.”
But you can't tell if someone has a retinal detachment just by looking at him, said Assoc Prof Tsai. "In general, there are no external physical changes to the eye."
Retinal detachment can cause permanent blindness if it's not treated immediately. According to Assoc Prof Tsai, if the macula (an area that serves central vision) is still attached, surgery should ideally be performed within 24 to 72 hours to preserve vision.
Retinal detachment can cause permanent blindness if it is not treated immediately. (Photos: iStock/Toa55)
Surgery needs to be done before the detachment reaches the macula, emphasised Dr Zhao. He also mentioned that “detachments in the upper half of the retina tend to progress more quickly as gravity pulls the eye gel under the retina down towards the centre".
Even if the macula is already detached, "surgery should still be performed as early as possible", said Assoc Prof Tsai. "Visual recovery depends on how long the macula has been detached; earlier repair gives better outcomes."
There are a few surgical options available to reattach the retina. Pneumatic retinopexy involves injecting a bubble of self-dissolving gas into the eye, so that the bubble holds the tear up against the back of the eye, and allows it to reattach and heal. Usually, laser treatment will be needed to seal the area around the retinal tear.
Lying face down (sometimes, on one side for some patients) after pneumatic retinopexy surgery is critical as the posture allows the gas bubble to float up and press on the retina at the back of the eye, said Dr Zhao. Depending on the type of gas used, the required facedown duration can range from two to eight weeks. "It also prevents the gas bubble from touching the lens in front of the eye, which can lead to a cataract,” he said.
Other treatment options include scleral buckling and vitrectomy. In the former, a silicone band known as the scleral buckle encircles the eyeball externally like a belt to reattach the retina.
In vitrectomy, keyhole surgery is used to remove the vitreous humour that has gotten behind the retina. Then, the eye is filled with a gas bubble that acts like an internal bandage to flatten the retina against the wall of the eye. “Laser is then applied around the edges to seal and reinforce the edges,” said Dr Zhao.
General anaesthesia is used if it suits the patient’s risk profile, or if the patient is young or restless, said Dr Zhao in his practice.
"In most cases, surgery is performed under local anaesthesia," said Assoc Prof Tsai, who added that topical antibiotics, steroids, cycloplegic agents and/or medications to lower intraocular pressure may be prescribed as well.
Yes, it can in 5 per cent to 15 per cent of the time, said Assoc Prof Tsai. Dr Thomas explained that recurrence could be "due to incomplete positioning after surgery, new retinal tears, persistent traction or scar tissue formation inside the eye.”
It’s back to the operating suite for these recurring cases. Combining procedures such as vitrectomy and scleral buckling is often done to ensure the retinal tear firmly reattaches the second time around, said Dr Thomas.
According to Assoc Prof Tsai, the treatment will depend on the complexity of the recurrence but will generally involve a repeat vitrectomy. "Instead of a gas bubble, we sometimes inject silicone oil at the end of surgery."
Your best bet against retinal detachment, said Dr Zhao, is to recognise the warning signs of a retinal tear and seek immediate medical help. Getting regular eye checks is also crucial to spot any retinal tear or detachment.
Continue reading...
That was what Mediacorp actor and myope Elvin Ng was diagnosed with on Feb 23 after consulting a doctor about “a dark circular shadow at the bottom corner of my right eye”, he wrote on an Instagram post.
The 45-year-old actor noted that “when I moved my eye around, the shadow didn't move” and “by the evening, the shadow had covered nearly half my eye and was near the centre”.
When interviewed by 8 Days and asked if he knew what the cause of the detachment was, the actor said, “it is most likely due to my myopia as retinal detachment can happen with those with high myopia”.
Ng was scheduled for an emergency eye operation on the very same day, and a gas bubble was inserted into his affected right eye to save his vision.
If you thought the treatment was unusual, wait till you read about his home-rest instructions – he had to lie face down for two weeks and could only take hourly breaks to clean his eye and take medication. “Even when I sleep, I can’t be on my back and need to face down,” he told 8 Days.
Just what is retinal detachment and can it happen to you if you have myopia? Would you also experience seeing “shadows” like Ng did if it happens to you? Find out from the experts.
WHY DOES MYOPIA LEAD TO RETINAL DETACHMENT?
The retina is a thin, light-sensitive layer of tissue found at the back of the eyeball, explained Associate Professor Andrew Tsai from Singapore National Eye Centre (SNEC). It functions like a camera film by converting light into nerve signals, which the brain processes as the images you see.
Those with myopia have stretched eyeballs or what the eye experts call an increase in axial length. Over time and especially with severe or high myopia of over -6.00 diopters or 600 degrees, the stretching can cause small, painless tears or holes in the retina.
Then, if the naturally occurring gel in the eyeball (aka the vitreous humour) gets behind these openings, the gel can push the retina away from the back of the eye. This form of retinal detachment, regarded as rhegmatogenous retinal detachment, is the most commonly seen in patients, said Assoc Prof Tsai.
TWO OTHER TYPES OF RETINAL DETACHMENTS
Tractional retinal detachment: It is more commonly observed in diabetics, who have damaged blood vessels scarring their retinas. As the scars get bigger, they pull on the retina and detach it from the back of the eye.
Exudative retinal detachment: There aren’t any tears or breaks in the retina. But the vitreous humour (eye gel) gets trapped behind the retina, pops it away from the back of the eye, and cause it to detach.
Collapse Expand
“Patients with severe myopia tend to have a higher risk of retinal detachment as they often have areas of thinner retina that are more susceptible to tears,” explained Dr Paul Zhao, the senior consultant ophthalmologist at Eagle Eye Centre, who treated Ng's retinal detachment.
HOW COMMON IS RETINAL DETACHMENT? WHAT ARE THE CAUSES?
The incidence of retinal detachment in Singapore is approximately 10 cases per 100,000 people every year, according to Dr George Thomas, a consultant with National University Hospital’s (NUH) Department of Ophthalmology.
SNEC handles several hundreds of retinal detachment cases annually, while NUH manages several new retinal detachment cases each week. Private clinics such as Dr Zhao's see an average of about two or three patients a week.
Retinal detachment most commonly occurs in people over the age of 50, with the highest risk between ages 40 and 70. “Men are at a slightly higher risk of retinal detachment than women," shared Dr Thomas. “Local research has also shown differences in incidence among racial groups, with Chinese patients having a higher reported risk, followed by Malays and Indians.”
Severe myopia increases your risk of retinal detachment by five to six times compared to someone who has low myopia. (Photos: iStock/MTStock Studio)
As for the causes, severe myopia tops the list. In fact, those with high myopia run a five-to-six times higher risk of developing it than those with low myopia.
But why don’t more people suffer from retinal detachment since Singapore is regarded as the myopia capital of the world? “Although myopia is a known risk factor, most Singaporeans have low to moderate myopia, which carries a much lower risk than pathological or very high myopia,” explained Dr Thomas.
There have been cases where retinal detachment can also be a sign of permanent age-related vision loss known as glaucoma. Glaucoma and retinal detachment coexist as they share risk factors such as severe myopia, eyeball structural changes and age.
Speaking of age, said Dr Thomas, the years are certainly not kind on the eyes. The vitreous humour naturally liquefies and may separate from the retina in a process known as posterior vitreous detachment, he explained. “If the vitreous humour pulls strongly on the retina, it can create a tear, which may then lead to retinal detachment.”
Other contributing causes include eye trauma, previous eye surgery, a history of retinal detachment in the other eye, and a family history of the condition, he said.
And sometimes, even innocuous actions such as “frequent eye rubbing could cause retinal tears, which if not treated promptly, will progress to a retinal detachment requiring major surgery”, cautioned Dr Zhao.
Innocuous actions such as frequent eye rubbing could lead to retina tears. (Photos: iStock/Chainarong Prasertthai)
IS SEEING “SHADOWS” OR FLOATERS A COMMON SYMPTOM?
Dr Zhao explained that when there is a tear in the retina, fine blood vessels release red blood cells and pigment into the cavity of the eye. When that happens, what your eye sees is “a sudden onset of floaters, cloud-like dust or shadow moving across your vision”, he said.
“Other warning signs not to ignore would be seeing flashes of light, sudden blurriness or distorted vision,” continued Dr Zhao. “Experiencing any of these symptoms should prompt an urgent eye assessment because early treatment can prevent permanent vision loss.”
But you can't tell if someone has a retinal detachment just by looking at him, said Assoc Prof Tsai. "In general, there are no external physical changes to the eye."
WHY IS IT AN EMERGENCY?
Retinal detachment can cause permanent blindness if it's not treated immediately. According to Assoc Prof Tsai, if the macula (an area that serves central vision) is still attached, surgery should ideally be performed within 24 to 72 hours to preserve vision.
Retinal detachment can cause permanent blindness if it is not treated immediately. (Photos: iStock/Toa55)
Surgery needs to be done before the detachment reaches the macula, emphasised Dr Zhao. He also mentioned that “detachments in the upper half of the retina tend to progress more quickly as gravity pulls the eye gel under the retina down towards the centre".
Even if the macula is already detached, "surgery should still be performed as early as possible", said Assoc Prof Tsai. "Visual recovery depends on how long the macula has been detached; earlier repair gives better outcomes."
WHY ARE GAS BUBBLES USED TO TREAT RETINAL DETACHMENT?
There are a few surgical options available to reattach the retina. Pneumatic retinopexy involves injecting a bubble of self-dissolving gas into the eye, so that the bubble holds the tear up against the back of the eye, and allows it to reattach and heal. Usually, laser treatment will be needed to seal the area around the retinal tear.
Lying face down (sometimes, on one side for some patients) after pneumatic retinopexy surgery is critical as the posture allows the gas bubble to float up and press on the retina at the back of the eye, said Dr Zhao. Depending on the type of gas used, the required facedown duration can range from two to eight weeks. "It also prevents the gas bubble from touching the lens in front of the eye, which can lead to a cataract,” he said.
Other treatment options include scleral buckling and vitrectomy. In the former, a silicone band known as the scleral buckle encircles the eyeball externally like a belt to reattach the retina.
In vitrectomy, keyhole surgery is used to remove the vitreous humour that has gotten behind the retina. Then, the eye is filled with a gas bubble that acts like an internal bandage to flatten the retina against the wall of the eye. “Laser is then applied around the edges to seal and reinforce the edges,” said Dr Zhao.
General anaesthesia is used if it suits the patient’s risk profile, or if the patient is young or restless, said Dr Zhao in his practice.
"In most cases, surgery is performed under local anaesthesia," said Assoc Prof Tsai, who added that topical antibiotics, steroids, cycloplegic agents and/or medications to lower intraocular pressure may be prescribed as well.
CAN THE DETACHMENT RECUR?
Yes, it can in 5 per cent to 15 per cent of the time, said Assoc Prof Tsai. Dr Thomas explained that recurrence could be "due to incomplete positioning after surgery, new retinal tears, persistent traction or scar tissue formation inside the eye.”
It’s back to the operating suite for these recurring cases. Combining procedures such as vitrectomy and scleral buckling is often done to ensure the retinal tear firmly reattaches the second time around, said Dr Thomas.
According to Assoc Prof Tsai, the treatment will depend on the complexity of the recurrence but will generally involve a repeat vitrectomy. "Instead of a gas bubble, we sometimes inject silicone oil at the end of surgery."
Your best bet against retinal detachment, said Dr Zhao, is to recognise the warning signs of a retinal tear and seek immediate medical help. Getting regular eye checks is also crucial to spot any retinal tear or detachment.
Continue reading...