Retinal detachment

Considerations

Retinal detachment most frequently is a posterior detachment and follows collapse of the vitreous gel. The symptoms are a sudden shower of floaters (caused by vitreous haemorrhage or pigment release) and flashing lights, due to vitreous traction on the retina. Urgent referral to an ophthalmologist is mandatory to exclude the presence of a retinal tear.

This may occur at any age although it is commoner in the elderly. High myopes are at increased risk. For this reason advice on the long-term prospect of an aviation career should be given to those with high myopic refractive errors.

If the retina is torn, but not yet detached, laser treatment may be used to seal the retinal tear before fluid from the vitreous cavity passes through it and detach the retina. Once the retina begins to detach, prompt surgery is necessary. If surgery can be undertaken before the retina detaches from the macula, the prognosis for maintained vision is excellent. Once the macula has been detached for more than a few hours, visual recovery is only partial.

In the young, retinal dialysis is the commonest type of detachment. It may occur after a blunt injury which causes a tear in the most periphery of the retina.

During retinal detachment surgery intraocular gases are often injected into the vitreous cavity. The most commonly used gases are air, Sulphur Hexafluoride (SF6) and Perfluoropropane (C3F8). While air takes three or four days to be reabsorbed, SF6 persists for up to two weeks and C3F8 for up to six weeks. Air travel should be avoided until the gas bubble completely reabsorbs as it will expand during ascend, leading to a possibly dangerous rise in intraocular pressure.

Information to be provided

An applicant who first applies with a history of retinal detachment should provide:

• A special eye report;
• A visual fields determination report;
• A copy of all reports by the treating ophthalmologist.

Disposition

An applicant with a history of retinal detachment may be considered as having a condition that is not of aeromedical significance if:

• A special eye report indicates that the applicant meets the visual standards; and
• An automated visual fields determination indicates absence of any visual fields defect; and
• An ophthalmologist opinion indicates unequivocally that the condition has been effectively treated, is stable and is unlikely to recur; and
• In case of a recent event, any gas bubble has resolved.

If uncertain or in the absence of those reports, the condition should be considered of as being of aeromedical significance and considered via the flexibility pathway.