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Ears, Nose, Throat and Health

Loss of sight , temporarily

A Drug That Made Me A Hero With My Mother

By Dr. W. Gifford Jones

August 5, 1995

How a few moments can change our lives! One minute we have perfect eyesight. The next instant a shadow clouds all or a large part of our vision. Retinal detachment often occurs suddenly with no warning. Now a new technique using perfluorocarbon liquids (PCL's) has revolutionized retinal detachment surgery. Eyesight that was permanently lost a few years ago can now be restored.

  The retina at the back of the eyeball acts like the film in a camera, carrying images to the brain. If it becomes detached from its supports part or all vision is lost.

It's estimated that about one in 10,000 people experience retinal detachment every year. Patients often complain of seeing flashes of light or stars followed by the sensation of a curtain moving across the eye. How much loss occurs depends on the location of the detachment.

  Patients with a high degree of short-sightedness are more susceptible to detachment. It also occurs in about one per cent of cases following cataract surgery.

  Retinal detachments are closely related to aging. As years pass the normal jelly-like vitreous chamber at the back part of the eye becomes less homogeneous. Fibrous bands form which tug on the retina. This may cause a small hole to occur and fluid seeps behind the retina. The combination of pressure from both the bands and the fluid causes the detachment.

  Retinal detachment is an emergency and ideally should be repaired as soon as possible. But the degree of emergency depends largely on the status of the macula, that part of the retina responsible for central vision and our ability to read.

  The retina receives it's blood supply from the underlying choroid. The longer the retina is detached the longer the sensitive photoreceptors are without an adequate blood supply and the greater the damage.

  How to repair retinal detachment has always taxed the ingenuity of ophthalmologists. For many years surgeons have used what's called a "buckling procedure".

  During this operation a band is placed around the eyeball which brings the detached retina close to it's former point of attachment. Doctors then use a laser beam to weld the retina to the choroid. But this operation has limitations in repairing difficult detachments.

This is where perfluorocarbons open a new dimension to retinal surgery. And for patients whose buckling operations have failed.

  Dr. Stanley Chan, a New York ophthalmologist, pioneered the work on PCL's which were originally developed as blood substitutes. This liquid is injected into the back vitreous chamber of the eye and removed at the conclusion of the operation.

  PCL'S are heavier than water so when patients are lying on their backs the liquid drops to the bottom of the eye. This creates a "steamroller effect" which flattens the detached retina.

  PCL's are of great advantage to retinal surgeons in other ways. For instance, prior to the use of PCL's surgeons injected air into the eye in an attempt to push back the detached retina.

  But when air in injected into the vitreous chamber it's hard for surgeons using optical instruments to see through the air. The last thing eye surgeons want is cloudy vision while trying to repair detachments. Particularly when they're working at the extreme periphery of the eyeball where most detachments occur. In contrast PCL's provide excellent visualization.

PCL's also have a very high boiling point. This enables surgeons to cauterize the retina while PCL's are still in the eye. There are a few do's and don'ts" after retinal detachment surgery. Infection is a major worry so it's important to stay away from swimming pools for several weeks. And it's unwise to engage in strenuous physical activity where the eye could be injured by trauma.

  Some retinal detachment operations require the injection of air or gas into the eye. While this gas is still present flying is hazardous as it causes a severe increase in intraocular pressure.

  Parents and school boards should take note of this fact. Retinal detachment and other eye injuries also result from sporting accidents. Dr Robert G Devenyi, Director of Retinal Services at the University of Toronto deplores the number of eye injuries he sees due to sport accidents.

  Devenyi says, "You can never protect the eyes against pickup games on the street. But it should never happen in schools during floor hockey games. People forget it's just as easy to injure the eye with a floor hockey stick as an ice hockey stick".

  Dr. Devenyi claims there are no regulations about wearing facial protection. And that he's written to school boards and never even received a response! Is it asking school boards too much to reply to Dr. Devenyi noting his concern?


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod