The eye works like a camera. It has two parts, a lens and a film. The film layer lines the back wall of the eyes and is called the retina. There is a gel called the vitreous which is very firmly adherent to the retina. The vitreous separates from the back of the eye towards the front of the eye as a normal part of aging. The vitreous can pull firmly enough on the retina during the separation process that a small piece of retina is torn off, and remains attached to the gel.
The small piece of torn retina does not cause any visual changes. However, there is a small risk that an untreated retinal hole may lead to a retinal detachment. Therefore, your eye care specialist recommends a treatment to decrease the risk of developing a retinal detachment in the future.
The in-office laser procedure is called laser retinopexy. Laser is used to form scar tissue around the edges of the retinal hole. This decreases the risk of developing a retinal detachment in the future.
Laser Retinopexy is an in-office laser procedure which is typically performed with topical anesthesia (eye drops). The procedure is performed using a machine called a laser indirect ophthalmoscope which essentially looks like a mining helmet with a laser attached to it. Topical anesthesia (eye drops) are applied to the eye to decrease discomfort.
The ophthalmologist then examines the eye to determine where laser will be applied. It is important for patients to follow directions in regards to where their ophthalmologist asks them to look with the eye not being lasered. This helps the doctor apply laser therapy to the intended areas and avoid misplaced laser spots. It is also helpful for patients to avoid leaning, pulling back, or turning their head during the procedure. Keeping the eye open that is not being lasered also makes it much easier for the treating physician to apply laser therapy safely.
Patients perceive laser as bright flashes of light. Many patients experience no or very little discomfort. There are some patients who find laser therapy to be very uncomfortable; There are other anesthesia options for such patients.
A typical laser treatment may take anywhere between 5 and 10 minutes, but is patient dependent. Patients will notice that the vision is dark and they will often ask if their eye is open or closed. The vision returns to about 90% of normal within 30 minutes following the procedure. The rest of the vision typically will return by the next day.
The eye will usually feel sore after the procedure. Tylenol is typically all that is needed for pain. Some patients may experience sensitivity to light that lasts a few days and resolves on its own. No eye patch or eye shield is required. Patients may return to work and resume normal activities unless otherwise specified by your doctor.
The risks of performing this procedure is that it will cause a decrease in peripheral vision. In my experience, patients do not notice a change.