Increased risk of rhegmatogenous pathology in fellow eyes of rhegmatogenous retinal detachment patients

This study published in January in the British Journal of Ophthalmology examines the predisposing pathology and clinical features of fellow eyes of patients in the large prospective Scottish Retinal Detachment Study. The results confirm that fellow eyes of eyes with primary rhegmatogenous retinal detachment (RRD) have a high incidence of asymptomatic full-thickness retinal breaks and lattice degeneration. There was also a high likelihood of diagnosis of bilateral, consecutive detachments prior to macular involvement, which occurred in 60 percent of cases. These findings reinforce my pattern of immediately sending any RRD patient to a retinal specialist for further evaluation and treatment.

The Scottish Retinal Detachment Study was designed to include all incident cases of primary RRD that occurred during a two-year period in Scotland. Detailed data on the clinical features of fellow eyes with RRD were available for 1,130 cases (94 percent).

Among fellow eyes, full-thickness retinal breaks were found in 8.4 percent (95/1,130) on presentation and lattice degeneration in 14.5 percent (164/1,130). Seven percent (88/1,202) of cases had RRD in both eyes, with 1.5 percent presenting with simultaneous bilateral RRD.

Thirteen percent (148/1,130) of fellow eyes had BCVA of 6/18 or worse, with RRD in the fellow eye accounting for reduced visual acuity in 20.9 percent (31/148), highlighting the importance of rhegmatogenous pathology as a cause of fellow-eye visual loss. The authors say it is notable that approximately 3 percent of fellow eyes had visual acuity of less than 6/60, highlighting the potential for blindness secondary to RRD.

They conclude that fellow-eye detachments are more common in pseudophakic individuals and individuals with a more myopic refractive error. They also note that despite early identification and prophylactic treatment of retinal breaks or peripheral retinal degeneration, 5.8 percent of treated cases still developed RRD in the treated eye. Fellow-eye RRD has a greater likelihood of prompt presentation with a smaller area of detachment and an intact macula compared to unilateral RRD.