By Marti Webb Slay
Ophthalmologist Robert Morris, MD, founding physician of Retina Specialists of Alabama and president of the Birmingham-based Helen Keller Foundation for Research and Education, has documented a non-invasive laser treatment that can reliably prevent most retinal detachments in eyes known to be at high-risk.
Since retinal detachment is the leading cause of sudden sight loss in the aging eye, Morris wants fellow physicians to be aware of the procedure for their patients who have a history of retinal detachment.
The procedure entails using a laser to weld the peripheral retina to the eye wall, effectively preventing tears that can cause blinding retinal detachments. “This encircling laser treatment has been around for quite a while,” Morris said. “But nobody has defined exactly how to do it, and we have.”
Knowing how to best do the procedure is only the first step, however. Knowing when to do it is also important. Most adult patients with retinal detachment get their macular vision back, but many don’t. For those patients, the insurance of this procedure on their remaining good eye is an important consideration.
Others are at risk for retinal detachment as well. “There are a lot of risk factors for people getting a detachment,” Morris said. “One is if you have had a cataract extraction. (You should not avoid a cataract extraction, however, because the risk is still low.) Also, people who are highly nearsighted, and people who have a family history of retinal detachment. But if you look at all those risk factors together, it’s still hard to quantify how high a risk each patient faces.
“We’ve shown that if a patient and their doctor decide they are at an unacceptably high risk after evaluating all these factors, then there is a treatment that is not invasive which can reliably prevent detached retina. We’re not telling doctors who should get it. That’s ultimately a decision the patient has to make when they are fully informed. That’s something a doctor and a patient may discuss over many visits.”
Because it can be difficult to assess who is at risk for retinal detachment, proving this procedure could prevent it was elusive, until Morris was visited in 2012 by a father and son with Stickler Syndrome. Stickler Syndrome is a rare, inherited disease affecting children and teenagers. “Retinal detachment is caused by vitreous gel moving in the eye,” Morris said. “When you are 20, the gel is solid and clear. But as you age, the gel starts to turn liquid and move around. That movement can cause a tear, resulting in retinal detachment.
“In Stickler children, vitreous gel never forms completely, so they have a partial gel floating around just like older folks, from birth onward.” As a result, Stickler patients have a 65 percent lifetime risk of retinal detachment.
When the two family members with Stickler Syndrome came to see Morris, they had both lost vision in one eye, and they were looking to protect the vision in their good eyes. They had been told there was nothing they could do. Morris performed the encircling laser bonding.
“We found a back door proof that encircling laser treatment provided reliable prevention for detachment, even in older people. We connected the dots showing that what works in a kid with Stickler Syndrome should also prevent the more common retinal detachments in older folks, because they have the same pathogenesis of peripheral retinal tears,” he said.
Morris has performed the procedure for other Stickler patients in the ensuing years, and the Helen Keller Foundation released the results in January. “It reduced Stickler Syndrome retinal detachment 10-fold on average from all reports,” according to the release. “Our conclusions are subject to continuing medical peer review, starting with this publication, but the ultimate judgment will be made by each informed patient who faces a high risk of retinal detachment and chooses preventive laser treatment or continued observation.”