Dr Richard Hart Dr Sonya Bennett Dr Clairton De Souza Ophthalmologist, Cataract Surgeon Consultant Ophthalmologist Senior Lecturer, Optometry Ophthalmic Plastic Surgeon Greenlane Clinical Centre Eye Clinic Clinical Senior Lecturer in Ophthalmology Auckland University of Auckland

8:30 - 9:25 WS #213: Glaucoma, Retinal Disease and the Watery Eye 9:35 - 10:30 WS #225: Glaucoma, Retinal Disease and the Watery Eye (Repeated) Retinal Detachment

Dr Clairton F. de Souza (Rhegmatogenous) Retinal Detachment

 Major retinal disorder requiring surgery

• Annual incidence of 11.8 cases per 100.000 in northern New Zealand (Polkinghorne and Craig 2004)

 Major cause of severe loss of vision  Success rate of primary surgical repair: 85%; (95% after 2-3 surgeries) Idiopathic Polypoidal Choroidal Vasculopathy Retinal Detachment – Macula-on

Vision: 6/24

Vision: 6/9 Dr. Didier Ducournau – Nantes, France Retinal Detachment

Attached Retina

Detached Retina

Fovea Loss of central vision Normal Vision: Vision in RRD: Vision after RRD repair: 6/6 Counting fingers 6/15 Retinal Cell Biology Lab – Institute of Neuroscience, Santa Barbara California Ocular trauma and retinal detachment Iridodialysi s

Lens subluxation Does Bungee jumping cause retinal detachment?

• No documented association between bungee jumping and retinal detachment

+100mmHg Valsalva Phenomenon Gravitational force (G-force) All papers report: Rapid - 3G deceleration Intravenous pressure: Ocular haemorrhages (conjunctival and retinal) Does Bungee jumping cause retinal detachment?

• No documented association between bungee jumping and retinal detachment

+100mmHg Valsalva Phenomenon Gravitational force (G-force) All papers report: Rapid - 3G deceleration Intravenous pressure: Ocular haemorrhages (conjunctival and retinal) Is it preferable for a high myope pregnant to give birth by C-section?

Is she at higher risk of retinal detachment after normal labour?

No.

High myopes and even women with history of retinal break treatment do not require C-section.

Valsalva manœuvres during labour do not increase risk of retinal detachment

Hormonal and Immunological changes during pregnancy do not increase risk of retinal tear/detachment in high myopic women. Importance of Awareness of retinal detachment symptoms Floaters – Ophthalmologist view Flashes (Photopsia) - Differential Diagnoses

Other Diagnosis Duration Colour Location Shape Stimulus Flickering symptoms

Seconds Temporal Crescentic Eye PVD White Floaters No or less Periphery vertical Movements Scotoma, 20-30 Arcuate, Migraine Not typical Paracentral Stress, food headache, Yes minutes zigzag nausea Neck Occipital Minutes Nil Central Petaloid movements, Yes ischaemia exertion Cystoid Macular Constant Variable Central Pinpricks Nil Poor vision Yes Oedema Outer retinal Blob, or RPE Minutes Blue/purple Paracentral Nil Scotoma No spirals abnormality

Comet Retinal Central/par Eye Visual field Seconds Golden oblique No detachment acentral Movements loss horizontal

Retinal detachment - Summary

• RD is a potentially blinding condition if untreated.

• Surgical success rates are above 80% with a single surgery for non-complex cases (95% with 2 or more surgeries).

• Patient awareness, fast recognition of suggestive symptoms and prompt referral are crucial for optimal visual prognosis. Flashes (Photopsia) - Differential Diagnoses

Other Diagnosis Duration Colour Location Shape Stimulus Flickering symptoms

Seconds Temporal Crescenti Eye PVD White Floaters No or less Periphery c vertical Movements Scotoma, 20-30 Arcuate, Migraine Not typical Paracentral Stress, food headache, Yes minutes zigzag nausea Neck Occipital Minutes Nil Central Petaloid movements, Yes ischaemia exertion Cystoid Macular Constant Variable Central Pinpricks Nil Poor vision Yes Oedema Outer retinal Blob, or RPE Minutes Blue/purple Paracentral Nil Scotoma No spirals abnormality

Comet Retinal Central/par Eye Visual field Seconds Golden oblique No detachment acentral Movements loss horizontal