Retinal pigment epithelial detachment Pigment epithelial detachment (PED) DESCRIPTION reveal a deficit: Visual field testing Retinal pigment epithelium (RPE) with an 18Hz flickering stimulus can detachment appears to result from disor- enhance the detection of the visual ders that disrupt the normal junction defect in RPE detachment. Delayed between the basement membrane of the retinal recovery time with the photo- RPE and the inner collagenous Bruch’s stress test may be present. membrane. This disruption may be associated with: Review and advice ● Thickening of Bruch’s membrane, Review and monitoring may be all that with associated increased resistance to is needed for RPE detachment without fluid flow from the retina, causing serous evidence of other retinal or choroidal fluid accumulation under the RPE disease. Review interval is dictated by the ● Choroidal circulation abnormalities level of symptoms and visual compro- leading to accumulation of serous fluid mise. Patients may be advised to conduct from the choriocapillaris in the sub-RPE Large chronic RPE detachment monocular checks (alternate covering of space each eye) and weekly home-monitoring ● Choroidal neovascularisation (CNV) DIFFereNTIal DIAGNOSIS with an Amsler grid. leading to haemorrhagic or fibrovascular Retinal detachment – exudative, Central RPE detachment. serous chorio-retinopathy, Choroidal Laser surgery detachment, Melanoma of the choroid Photodynamic therapy is rarely indicated ASSOCIATED CONDITIONS (malignant melanoma), Choroidal for chronic non-resolving idiopathic The most common condition associated metastasis, Best’s disease RPE detachment, or that associated with RPE detachment is age-related with CNV, with the aim of decreasing macular degeneration. Other possible SEE alSO leakage from the possibly anomalous associated ocular conditions are listed Age-related macular degeneration, underlying choriocapillaris circulation below. Uncomplicated idiopathic serous Choroidal neovascularisation, angioid or neovascular membrane. Risks with detachments of the RPE often resolve streaks, myopic degeneration, hereditary surgery include the risk of RPE rip. spontaneously, however, haemorrhage, choroidal degenerations; for example, CNV, and disciform scarring may affect Gyrate atrophy and Choroideraemia, Prognosis those detachments associated with other Ocular histoplasmosis. The prognosis for RPE detachment choroidal pathology. is related to the patient’s age and the MANAGEMENT presence of choroidal neovascularisa- SYMPTOMS tion. One study showed final vision of Patients may be asymptomatic, or if the Additional Investigations 20/30 or better in all eyes of patients macula is affected RPE detachment may ●Fluorescein angiography will show under 50 years of age with avascular cause blurred vision, metamorphopsia or early hyperfluorescence of the entire lesions, whereas 74 per cent of older positive scotomas. RPE detachment, persisting through- patients with vascular lesions had out the angiogram and demonstrating 20/200 or less. SIGNS late pooling. A concurrent serous retinal Typically, an RPE detachment is seen detachment may be present if there is as one or more focal, dome-shaped, evidence of leakage into the sensory elevation(s) of the retina and RPE. A retina serous detachment will often have a paler ● Ocular coherence tomography is colour than the surrounding fundus, useful in distinguishing types of RPE The full series of these articles is available in the book being a yellow to orange rounded lesion. detachments: Posterior Eye Disease and Glaucoma A-Z by Bruce AS, There may be overlying or marginal – Serous RPE detachment shows a O’Day J, McKay D and Swann P. £39.99. For further pigmentary changes. The extent of the focal elevation of the RPE band information click on the Bookstore at opticianonline.net lesion may be anything from a fraction over a non-reflective clear space. The of a disc diameter, to multiple disc detached RPE is slightly more reflec- ● Adrian Bruce is a Chief Optometrist at the Victorian diameters in size. Haemorrhage or lipid tive than normal, and the underlying College of Optometry and a Senior Fellow, Department deposition will indicate a fibrovascular choroid is shadowed of Optometry and Vision Sciences, The University of RPE detachment. – Haemorrhagic RPE detachments Melbourne. show a moderately reflective area ● Justin O’Day is an Associate Professor in the PREVALENCE corresponding to blood directly Department of Ophthalmology, The University of The condition is uncommon (approxi- beneath the detached RPE Melbourne and Head Of Neuro-Ophthalmology Clinic, mately 1/1,000) to rare (1/10,000) – Fibrovascular RPE detachment Royal Victorian Eye and Ear Hospital. is characterised by less reflective ● Daniel McKay is a Medical Officer at the Royal SIGNIFICANCE material throughout the entire sub- Victorian Eye & Ear Hospital. RPE detachment in patients over 55 RPE space down to the level of the ● Peter Swann is Associate Professor in the School of years of age is often secondary to choroi- choroid Optometry, Queensland University of Technology. dal neovascularisation. – Visual function testing will often opticianonline.net 16.05.08 | Optician | 51.