Name: David Cartwright
Symptoms: Flashing lights, plus floaters, then restricted vision
Recovery: Half a day in hospital, then three weeks at home – two of them spent lying on his front with his head down
Other treatment/medication: Steroid drops for four weeks, and antibiotic drops for two weeks
Prevalence: About 7,300 people per year in the UK suffer from a detached retina
In mid-April last year, I was in a meeting at the hospital where I work when I noticed some flashing lights at the periphery of my vision. I remember thinking, ‘That’s strange’. But they only happened that once and although, as an optometrist, I was aware that flashes can be a sign of a detached retina (see below), I also knew that in most cases they are harmless. I had had cataract surgery a year before, but had no other risk factors for retinal detachment, so didn’t pay too much attention.
Two weeks later, I noticed what I now realise were floaters. But rather than the classic floaters that look like little lacy blobs or spidery webs, it was more like I had a bit of water in my eye. As we get older there are natural changes in the vitreous gel inside the eye that can cause an increase in floaters and flashes, so again I didn’t think too much of it.
However, after a couple of days, the symptoms became unmistakable. I couldn’t see my hand as I moved it up from the right, meaning that the lower right part of my visual field had become restricted. I knew for certain that it must be a retinal detachment – a condition that affects about one in 300 people with normal eyesight; one in 20 with short-sightedness – and that, without an operation to restore the retina to its proper place, I could lose the sight of my right eye.
The next day, by 8.15am, I was waiting in the Emergency Department of the Nottingham Eye Hospital, where the surgeon confirmed my suspicions. As a keen runner, cyclist, golfer and tennis player, I couldn’t bear the thought of losing my sight, even in one eye, as this would affect my perception of distances. An operation was essential – and it had to be immediate.
Thankfully I was admitted at once – I’d taken the precaution of not having anything to eat since the night before – and by 12.30pm was in the operating theatre undergoing a vitrectomy. This involves the surgeon making two tiny incisions in the white of the eye, sucking out the vitreous gel from the middle layer of the eye, and draining fluid away from beneath the retina. A small gas bubble is then injected into the space; it presses against the retina, restoring it to its proper position.
Did you know?
Sight loss affects more than 2 million people in the UK yet, according to the charity Fight for Sight (fightforsight.org.uk), eye research only receives 1% of overall public funding.
The whole procedure takes about 40 minutes and the incisions are made at an angle so the pressure of the gas causes the wounds to close without stitches. Over the next one to two weeks, the gas bubble is gradually absorbed and replaced with natural fluids produced inside the eye.
The operation can be done under a local anaesthetic, but I had a general, so the next thing I knew I was in the recovery room with a big pad over my eye. After a couple of hours, I went home. I returned next day for a post-operative check and had a first peek at my eye, which was incredibly red. The lids were swollen and my eye black, but it wasn’t at all painful. Now it was down to me.
1. A tear or break in the sensory layer, which allows fluid to seep underneath, causing the layers of the retina to separate. This is the most common type, which David had.
2. Strands of vitreous or scar tissue create traction on the retina, pulling it loose. The risk is higher in those with diabetes.
3. Fluid collects underneath the layers of the retina, causing it to separate from the back wall of the eye, usually as a result of another eye problem causing swelling or bleeding.
To keep the gas bubble in the right position to encourage the retina to stay attached, I had to lie on my front with my head down for 50 minutes out of every hour, day and night, for two weeks. You can hire a headrest to keep your head in the correct position.
Although uncomfortable and boring, the thought that it was essential for my vision kept me going – that and lots of books and films on my iPad. As the gas is gradually absorbed and fluid produced, a line appears that gradually moves down. Above the line everything is clear; below it is blurry. I remember a moment in the garden about two weeks after the operation when I realised I could see the plants and trees clearly. Things were going to be OK.
Three weeks later, I was back at work and by six weeks I was running, cycling, golfing and playing tennis. It took a while to regain my confidence, however, as I knew a detached retina can recur, and I did get one or two flashes as things settled down. I was not allowed to fly until the gas bubble was absorbed, so we had to cancel a holiday to Corfu.
A year later, however, I’m completely recovered. We still haven’t made it to Corfu, but we have been to New Zealand and Portugal. My message? If you get symptoms, seek medical help without delay. I didn’t and could have lost my sight.
David Cartwright is chair of Eye Health UK
What is a retinal detachment?
The retina, the thin, light-sensitive layer of tissue at the back of the eye responsible for seeing, lifts or is pulled away from the underlying layer of tissue.
Common risk factors?
Older age, short sight, previous eye surgery or injury, family history of retinal detachment.
What are the symptoms?
Light flashes, wavy or watery vision, a ‘veil’ or ‘curtain’ obstructing vision, a ‘shower’ of floaters resembling spots, insects or cobwebs, a sudden decrease in vision.
How is it diagnosed?
The pupil is dilated with special drops to enable the doctor to examine the retina with an opthalmoscope.
Find out more
This year’s National Eye Health Week (NEHW) runs from 24-30 September, promoting the importance of eye health and the need for regular sight tests for all. visionmatters.org.uk