Dr. Eng shares findings and insight from his study, the first to examine the impact of the COVID-19 pandemic on patients with retinal detachments, recently published in the Canadian Journal of Ophthalmology.

Are patients delaying seeking treatment due to the pandemic?

Dr. Eng: Throughout the pandemic, individuals have been presenting late or delayed going to see their doctors with serious eye conditions.

In the early months of the pandemic, there was a drop in the number of patients coming in with retinal detachments. We learned through the study that this was due to the uncertainty around the coronavirus. Fear and anxiety around hospital visits led some patients to hold off on the medical treatment they needed.

The hospital is safe and has remained open to patients throughout the pandemic. In recent months more patients have been returning for routine examinations. If people have pre-existing conditions and they’re having difficulty, it’s best to reach out to their physician in the earliest stage and not put off receiving treatment.

Is a retinal detachment painful?

Dr. Eng: Typically with a retinal detachment, patients do not feel any pain. There aren’t visible signs, for example, redness around the eye.

Often what happens before it detaches, is that patients will see flashes of light in one or both eyes, or “floaters” which are tiny dark spots or specks that seem to float away when individuals try to look right at them.

It is important that patients contact their ophthalmologist when they notice new “flashing” or “floaters.” Their physician can determine if there is a tear or hole in the retina and help treat it before it leads to a full retinal detachment.

What can happen when treatment is delayed for retinal detachments?

Dr. Eng: Retinal detachment can lead to permanent vision loss if not treated in time.

When patients experience a detachment, they may feel like there’s a shadow or curtain or veil over their vision and it becomes more difficult to see things. Sometimes it grows over a few hours or over the course of several days, and it progresses until that shadow covers your central vision. When that happens, it can be an indicator that the central retina has detached.

Individuals can progress from being able to read and recognize faces to seeing next to nothing. Sometimes they’ll only see fingers in front of their face or movement at the sides, or even perhaps only light.

In general, the longer patients wait to seek treatment, the less they can recover.

Patients that come to us with a retinal detachment after many weeks or many months may never regain very useful vision in that eye.

The eye is not very forgiving. When you have a retinal detachment and that part is injured or damaged, it never recovers function like it used to. The retina can be reattached months or years later, but by then the damage is done.

What signs or symptoms should patients watch out for?

Dr. Eng: Patients will often see warning signs before a retinal detachment actually occurs.

Patients should pay close attention to the “flashes” and “floaters” mentioned earlier, blurred vision, or feeling like there is a curtain or shadow affecting your vision.

Delaying treatment for a retinal detachment can have serious implications in terms of how much vision you can recover, so it is best to reach out to your ophthalmologist at the onset of symptoms.

Read the full study: Impact of the COVID-19 pandemic on characteristics of retinal detachments: the Canadian experience

Learn more about Ophthalmology & Vision Sciences at Sunnybrook

The post Don’t delay eye care for retinal detachments: Q&A with ophthalmologist Dr. Kenneth Eng appeared first on Your Health Matters.

“Before the pandemic, I was in the gym almost every day,” says the 21-year-old. “It became the best part of my day.”

When Richard’s local gym closed due to the COVID-19 pandemic, he started working out at home using a resistance band, a large band made of synthetic rubber that can be used for strength training or rehabilitation. The bands provide resistance so muscles are working against its force to help build strength.

The band that Richard used was weighted to 50 pounds, almost 23 kilograms, which means using it was like working out with a 50-pound hand weight.

“After a couple of pulls, the band snapped out of nowhere,” says Richard. “One end hit my left eye and I couldn’t see anything for about 10 minutes. After awhile, my vision started coming back, but was a little blurry. At first, I thought it was just a little injury and wasn’t a big deal.”

Richard says the initial force on his eye caused some pain, but it eventually subsided.

“My eye just looked really bloodshot and red,” he says.

Later in the day, he noticed some changes to his vision.

“I would look left to right and started noticing darker spots, and that’s when I started thinking it might be more serious.”

Impact of retinal detachment

After seeing his optometrist who suspected Richard had suffered a detached retina, he was referred to Sunnybrook where it was determined there was more damage than first thought.

“Richard had an unusual retinal detachment. His retina was damaged in three separate areas,” explains Dr. Kenneth Eng, chief of ophthalmology and vision sciences in the Hurvitz Brain Science Program at Sunnybrook. “There was a large tear in his retina as well as extensive bleeding and bruising. The retina had detached in two places, and there was also a hole in his macula, which is the central part of the retina. He lost a lot of vision. Enough to be considered legally blind in that eye.”

The operation was extensive. Dr. Eng and his team used special surgical tools to do precision work on the fine membrane inside the eye, measuring only one micron thick (or 1/1000^th of a millimetre). The surgery also involved laser treatment to help repair the retinal tears. The team also applied a special silicone solution to help the holes in Richard’s eye heal.

After a few weeks, the bleeding and bruising subsided. After another surgery to remove the silicone, the holes eventually closed and his retina remained attached with improvement in his vision.

Unique case study

The case was so unusual that a photo essay case study was recently published in The Canadian Journal of Ophthalmology.

Dr. Eng says within a couple of weeks of Richard’s eye injury, another patient experienced a similar injury after working out with a resistance band at home during COVID. Dr. Eng says while these exercise band injuries seem to be rare, there is the possibility for more cases as more people are exercising at home over the course of the pandemic. Dr. Eng says safety during physical activity is imperative.

“It’s important to exercise with caution and not be cavalier with any workout equipment that is used,” recommends Dr. Eng. “Accidents can happen that could impact vision or lead to serious complications.”

Recovering after retinal detachment

“The first time I had surgery I thought, ‘I won’t be able to see anymore,’” says Richard. “But Dr. Eng had put his whole effort to helping me and the best I could do was move forward and just recover one day at a time with the help of people around me. Throughout my recovery, my family has been there to support me.”

Dr. Eng says about 80 per cent of Richard’s vision has returned over a couple of months.

“Richard has come a long way,” adds Dr. Eng. “Time will tell how much of his vision will return, but he has made some positive progress after his ocular trauma.”

“Before this injury, I had 20/20 vision and I saw everything crystal clear,” says Richard. “But now, if I read with my left eye, I am not able to read small-font books, so I rely on my right eye. I might not get all my vision back, but I just have to get used to it and I am adapting.”

“While exercise is important to maintaining mental health and physical conditioning during the pandemic, care and attention is needed whenever new activities or equipment are being used. Individuals should familiarize themselves with the use and warnings of all equipment being used. Some equipment, like exercise bands, can store significant amounts of energy,” emphasizes Dr. Eng, “so ensuring that they are installed properly and securely is of the utmost importance to help avoid serious accidents.”

In the meantime, Richard says he is remaining positive and when using the bands in the future, he plans to wear protective glasses. “It may look strange to be wearing safety glasses, but I’m not taking any chances. This injury won’t prevent me from going to the gym in the future. I’m going to be more careful and am looking forward to going back when it is safe to do so.”

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How does spending time on screens affect our eyes?

We know that doing prolonged near work, where you are sitting close to a screen, can promote the development of myopia (nearsightedness) in the growing eyes of young children. This is also true of books or other activities that require close-up work.

Prolonged screen use can also lead to tired or dry eyes. This is because when we concentrate on something, we tend to not blink enough. Blinking is important because it spreads tears evenly over our eyes, and it should happen on average 15 times per minute.

What symptoms indicate there may be reason for concern?

There is nothing inherently dangerous about looking at screens, but if you are noticing changes in your vision, reach out to your doctor. Any loss of vision or significant visual symptoms should be investigated.

Generally, for tired or dry eyes, rest and lubricating eye drops can offer some relief. Using a humidifier in the space where you do most of your online work can also be helpful.

Does the type or size of screen matter?

No. Just make sure the font size is at a comfortable setting to read without straining.

Are there recommendations for the amount of time children or adults should be online every day?

In terms of your eye health, there are no formal recommendations. You may have heard of the 20-20-20 rule, which will definitely help give your eyes a rest: every 20 minutes, look at something that is at least 20 feet away for 20 seconds. If you are spending significant amounts of time online, you might find that frequent breaks will help give your eyes, and body, a good rest and stretch.

Are certain screen settings better than others?

Some people prefer cutting the glare on their screens by using a filter or choosing settings like night mode, which eliminates blue light. There is no specific setting I recommend to my patients as this is really all about personal preference.

Any other tips?

For everyone, including children as they grow and develop, remember that regular eye exams are important. They are an opportunity to discuss any concerns or changes and to examine the eye for more serious problems.

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Flashes or arcs of light

“Flashes or arcs of light get us worried,” said Dr. Peter Kertes, chief of ophthalmology at Sunnybrook. “It might mean that the vitreous – the gel-like substance that makes up the bulk of the volume of the eye – is pulling on the retina.” If you move your eye quickly and there’s a flash briefly, see an eye doctor. Over time the vitreous gets pockets of fluid in it. The fluid comes together and the gel collapses forwards and can pull on the retina and tear the retina. This can lead to retinal detachment and other issues.

Floaters

“Floaters” happens when the vitreous becomes liquefied. “People report seeing spiderwebs or a seeing a bug that’s not there,” Dr. Kertes said. What you are actually seeing is the shadow of coalesced material in the vitreous. These floaters can be a normal part of aging, and for some, are just a nuisance. But, they can be a sign of other issues and can lead to complications, so best to get it checked out.

Aura Light from Migraines

Aura light from migraines can be disturbing and difficult to see through. “These are usually accompanied by a headache and last a few minutes,” Dr. Kertes said. “In the elderly in particular, these can be visual migraines.” But these differ from flashes and arcs of light in that they aren’t just when you move your eye as mentioned above. If you suffer from migraines, speak to your family doctor who can help with treatment.

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Quit smoking.

The most common cause of vision loss is macular degeneration.

According to the Centre for Disease Control and Prevention in the US, people who smoke are twice as likely to develop macular degeneration compared with a non-smoker. While there are a number of risk factors for macular degeneration like family history and age, there is one risk factor that you can do something about – and that is smoking. If you need help to quit, visit sunnybrook.ca/quitsmoking

Wear safety glasses.

“We see some pretty bad eye injuries from sports as well as from people tinkering around at home on DIY projects,” Dr. Kertes said. “People doing renovations can have things fly into their eyes because they aren’t wearing eye protection.”

Protect your eyes by wearing approved safety glasses during sports and while doing work with power tools, sawing, cutting or working with metals. Most sunglasses or eyeglasses don’t count as safety goggles (and in fact, cheap sunglasses could make matters worse if they shatter near your eyes.)

Care for your contact lenses.

If you wear contact lenses, it’s important to care for them properly. Clean your hands before touching your lenses. Sterilize your lens case and wash your lenses carefully if you use re-usable lenses.

“If you have any irritations in your eyes, don’t leave it,” Dr. Kertes said. “Make an appointment with your eye doctor.”

Never sleep in your contact lenses.

All of your organs and tissues get their blood supply of oxygen-rich blood to keep them working. Your corneas don’t have blood vessels, and so rely on ambient air for oxygen.

“So, now imagine that you have a plastic cover over your eye. It can’t let enough oxygen into your cornea.” If you wear your contact lenses in the day and take them out and clean them at night, your corneas should get enough oxygen.

“But, imagine that plastic cover over your eye, and your eyes closed as they are when you sleep — your corneas become starved of oxygen,” Dr. Kertes said. “This can lead to infection or even blood vessels growing into your cornea, which can cause hazy vision.”

Even if you wear lenses that are sold as “suitable for around the clock wear” don’t be fooled: Your eyes need a break from contacts lenses so they can get the oxygen they need.

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