Most Asymptomatic Retinal Detachments Do Not Require Surgery

Observation without surgery may be a viable initial management strategy for most patients with asymptomatic retinal detachment (RD), according to a report published in Ophthalmology Retina.

This retrospective, nonconsecutive case series reviewed 20 eyes from 18 patients at the Bascom Palmer Eye Institute between 2010 and 2021. All participants had asymptomatic RD — defined as the absence of photopsias and subjective visual field deficits — and were evaluated for interventions and outcomes.

Patients had a mean age of 45 (range, 19-88) years, 50% were men, 33% were White, 33% were Hispanic, and 28% were Black. The most common risk factors for RD were myopia (95%) and lattice retinal degeneration (60%). No cases were associated with trauma or inherited vitreoretinopathy.

At examination, 90% of eyes had at least 20/40 visual acuity at baseline, 80% had inferotemporal RD, 80% had posterior to equator RD, and 90% had no macular involvement.

A total of 10% of eyes progressed and required vitreoretinal surgery. 

A single patient had RD due to a giant retinal tear and was repeatedly offered surgery. The patient opted to undergo scleral buckling and external drainage and the retina was successfully reattached. Another 2 patients underwent surgical intervention for symptomatic RD in the fellow eye, and 3 patients had lattice degeneration of the fellow eye. Two eyes had myopic degeneration with an active choroidal neovascular membrane requiring intravitreal injections, and 1 patient received intravitreal injection due to age-related macular degeneration.

This study may have been limited by including 5 eyes that had previously underwent laser demarcation.

“Asymptomatic retinal detachments may be diagnosed incidentally on routine examination or when a patient presents with an unrelated complaint. Currently, limited natural history studies are available to guide the management of asymptomatic retinal detachments and practice patterns vary greatly. Treatment decisions are based on detailed clinical examination to identify signs of progression and with the patient’s preferences and overall health and cognitive status in mind,” the authors report. They “recommend management by observation in select patients able to maintain regular follow-up examinations and understand the potential serious nature of this diagnosis.”