Celebrated Edinburgh eye surgeon explains what a detached retina is - and how future plans will be a nightmare
We have all heard about a detached retina but most of us would struggle to say what actually happens.
The easiest way to visualise it is to think of the inside of the eye as a brandy glass on its side and the retina as clingfilm lining it, attached at the rim and attached at the stem. The glass is filled with a substance not unlike uncooked egg white and the whole unit sealed by the lens – that’s the bit that becomes a cataract.
In health, that arrangement survives intact. But things can go wrong.
If a hole develops in the lining and the egg white becomes less viscous, the resultant liquid will trickle between the glass and the clingfilm which thus separates from its natural bed. That is precisely what happens when a retina detaches and there are certain consequences.
The retina is brain tissue and does not survive long separation from its blood supply.
And there is a very special bit of that tissue just beside the “stem” – the Macula.
We use that area of retina to see detail, to read, to see number plates. If it is in the section of retina that detaches, detailed vision will never be the same again.
If the retinal hole should be positioned above the Macula, gravity will bring it off more quickly – hence the urgency and the need for informed advice on how to prevent that before surgery.
So what happens to patients unfortunate enough to suffer this frightening condition?
During office hours, they would most likely go to an optometrist who would refer them to the Eye Pavilion where surgery and post operative care would be carried out in the same building.
But what if there were no Eye Pavilion and their symptoms struck outside office hours? Their terror of total blindness, already acute, could only increase with the delay and the uncertainty of what was going to happen to them.
The dispersed model of care in the recent proposals, would start them off on a long, slow and certainly bumpy journey.
The first step would be [email protected] at Little France. Selection of patients with priority could well make that quite a long step.
Then the A&E doctor would diagnose something wrong with the eye. Then - delay.
An ophthalmic surgeon would eventually come along, find a retinal detachment and, with luck, declare it to be simple. The result - more delay.
Now St. John’s is not nearby so there would follow a search for an ambulance, not immediately successful. Even more delay.
And the searches would continue - an available theatre at St. John’s, specialist nursing staff, a retinal surgeon, an anaesthetist. None of these would be instantly available. Delay now increasing exponentially.
Then the pièce de résistance, the journey by ambulance up the M8 during which the Macula detaches. And after all that, the theatre is not immediately available – perhaps occupied by someone with a burst appendix.
Then fate twists further – a simple detachment is one that is not yet complicated and such a discovery is generally made on the operating table. The essential Vitrectomy apparatus proves to be beyond the skill of the nursing staff.
And to cap it all, post operative management would be a bed - somewhere.
Such an outcome today in a capital city would be the subject of litigation and an inquiry. To plan for such an outcome would require a whitewash.
Dr Hector Chawla is a consultant ophthalmic surgeon (retired), an acknowledged expert in retinal surgery and former director of the Princess Alexandra Eye Pavilion.