Detached Retina: Vision Problems After a Car Accident

Not long after a head-on car crash in early 2015, Ernestine’s vision started to change.

“I began to see sudden flashes of bright, clear light, similar to lightning, in the corner of my right eye,” she says. “They were intermittent, but they occurred especially frequently in the evening, when there was no other bright light. I also began to see a black floater, also intermittent, in the center of my eye, and my eyelid would flutter. My right eye’s vision seemed to be weaker.”

Eye trauma from the crash may have contributed to her difficulties, but Ernestine, 71, who asked to withhold her last name, also has a family medical history that included eye problems that can be hereditary. Her father had a detached retina, her mother had macular degeneration and a brother had glaucoma. Retinal detachment is more likely among people with high myopia or a family history of retinal detachment.

A former high school Spanish teacher who lives in a New Haven suburb, Ernestine decided to see a nearby optometrist. She was given a thorough eye exam and told to come back in a week. At that next visit, the optometrist asked her to look at an eye chart

“What do you see with your right eye?” he asked.

Over the next two months, Ernestine continued to have trouble seeing with her right eye. One day she felt "out of sorts." She tried to read but could not concentrate, so she took a shower. When she stepped out of the tub, all she could see from her right eye were colored waves of light. "I knew it was a retinal detachment," she says.

Ernestine’s husband drove her to the emergency room at a local hospital, where she waited several hours to be seen. At 1:30 a.m., a doctor diagnosed a detached retina and immediately called Yale Medicine’s Department of Ophthalmology to schedule a next-day appointment with Ron Adelman, MD, MHP, a professor of ophthalmology and visual science and director of its retina and vitreous section. The next morning, Dr. Adelman and his assistants did tests to confirm that Ernestine’s retina had detached. They would have to perform surgery.

“I was pretty numb about the operation,” Ernestine says. “I really didn’t think I’d get back any vision at all.”

“Floaters” are specks or clouds that appear in a person’s field of vision and look like small insects or cobwebs moving in the eye. “Flashes” appear as bursts of light or streaks of lightning. Both are caused by changes in the vitreous and the retina. The vitreous is a clear gel that fills the space between the lens and the retina. The retina is made of 10 layers of cells that line the back of the eye and sense light, enabling sight. Trauma to the eye (such as Ernestine’s car accident) and natural aging can cause the vitreous to shrink and wrinkle. That leads to floaters, which are actually shadows of those wrinkles cast on the retina. The gel pulls away from the retina, a process called posterior vitreous detachment that stimulates the retina, which the patient interprets as a bolt of light or a flash.

People who are nearsighted, who have undergone cataract or laser eye surgery, who have swelling in the eye, who have diabetes or who have sustained an eye injury are more likely to experience posterior vitreous detachment. To treat a tear, laser surgery is often used. For detachment, traditional surgery is necessary.

There are three main types of surgery to fix a retinal detachment:

• A vitrectomy removes the vitreous gel in the eye and replaces it with gas or silicon oil. This helps to push the retina back in place. Laser surgery is required to secure the retina. 
• A scleral buckle is a synthetic band that is attached to the outside of the eye. Its purpose is to push the wall of the eye against the retina.
• Pneumatic retinopexy is an office procedure that often utilizes cryotherapy (freezing) and gas injection.

Because Ernestine's eye had significant trauma and scar tissue, Yale Medicine doctors used a procedure that combined vitrectomy and scleral buckle.

Ernestine’s surgery went well, though the recovery was not simple. For several days she needed to keep her head down to allow her retina to become more secure in its restored position. “It was very tough,” she says. “I was bedridden for the first couple of days.”

But her post-operative visits with Dr. Adelman were encouraging, and her vision has slowly improved since the surgery. “The doctors were magnificent in keeping track of my progress and discomfort,” she says. “I feel a bit better each month.”

Dr. Adelman and a colleague, David Ketner, MD, discovered that Ernestine also had cataracts and glaucoma in both eyes. These diagnoses were made using a slit lamp, a tool that is helpful in detecting cataracts and discovering the increased eye pressure that is sometimes associated with glaucoma.

Ernestine has had one cataract removed; the other will be done when it is more fully developed. For treatment of her glaucoma, she also now sees Christopher Teng, MD, a glaucoma expert at Yale Medicine. Dr. Teng prescribed special eye drops that maintain the correct pressure in Ernestine’s eye. Without them, she could go blind.

“I feel so fortunate to have had this team at Yale Medicine,” she says. “No one else would have found this. No one else would have given me the attention and care that they did. I feel totally blessed that I found my way to Yale.”

Yale Medicine is at the forefront of the advances in ophthalmology and visual science. “We have participated in many clinical trials involving eye diseases and extensively published our advances,” he says. “One discovery of Yale Medicine is finding the gene for macular degeneration, which is damage to the center of the retina that can cause loss of vision. We’ve developed new glaucoma medications and new treatments for macular and retinal diseases.”

For Ernestine, Yale Medicine doctors provided “very specialized care,” Dr. Adelman says.

“She needed retinal treatment through advanced surgical techniques and using the best equipment, plus very involved care of glaucoma,” he says. “We were able to utilize a medical team of all our specialists to take care of her issues.”

Yale Medicine has about 20 physicians who practice ophthalmology. The Department of Ophthalmology has specialists available 24/7 to treat patients who need emergency eye care. A retina specialist is also on call at all hours, including weekends.

Ernestine could hardly be happier about the care she has received from Dr. Adelman and his team.

“They’re miracle workers,” she says. “They saved my life!”

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