Retinal detachment

All RDs are accompanied by some loss of visual function but this will vary depending upon the type of detachment, its size, and retinal location, making it difficult to ascribe one set of symptoms to the condition (Box 71.3). Diagnosing RD is complex with many qualifications. Abnormal vision is the only reliable symptom of RD. But the types of abnormal vision are large and varied: light flashes, floaters, changes in the peripheral visual field, decreased acuity, defective color vision, distorted vision (metamorphopsia), or even unilateral double vision (diplopia). Patients often remain unaware of large peripheral detachments until they approach the macula and begin to produce a visual field defect. Many times they are discovered during an ocular examination. Foveal detachment always involves loss of central visual acuity. Indeed, the duration of a foveal rhegmatogenous RD is based upon the time of patient-observed decrease in visual acuity. A macular rhegmatogenous RD will generally produce visual acuity loss that cannot be corrected, while blurred vision produced by a centrally located serous detachment (central serous retinopathy, or CSR) can often be corrected by shifting the focal plane of the image to a more forward location. The book series Retina includes much information relevant to diagnosing detachments.