The agony of Retinal Detachment Patients in Ghana

Ghanaians who are diagnosed of having Retinal Detachment of the eye are physically and psychologically traumatized. The diagnosis is usually very late and to add insult to injury, there is no single hospital in Ghana with facilities to help manage Retinal detachment adequately. The few financially endowed Ghanaians travel abroad for services when already the eye may be irreparable because of late diagnosis. The poor ones are left to their faith.

What is Retinal Detachment?
Retinal detachment is a disorder of the eye in which the Retina peels away from its underlying layer of support tissue leading to Vision loss and Blindness. It is a Medical_emergency.

The retina is a thin layer of light-sensitive tissue on the back wall of the eye. The optical system of the eye focuses light on the retina much like light is focused on the film in a camera. The retina translates the focused image into Neural impulses and sends them to the brain via the Optic_nerve. Occasionally, injury or trauma to the eye or head may cause a small tear in the retina. The tear allows vitreous fluid under the retina, and peels it away like a bubble in wallpaper.

A retinal detachment may also occur due to inflammation, injury or vascular abnormalities from Diabetes Mellitus, Hypertension, Sickle cell Disease etc. that results in fluid accumulating underneath the retina without the presence of a hole, tear, or break.

A substantial number of retinal detachments result from trauma, including blunt blows to the orbit, penetrating trauma, and concussions to the head. A retrospective Indian study of more than 500 cases of retinal detachments found that 11% were due to trauma, and that gradual onset was the norm, with over 50% presenting more than one month after the inciting injury. A recent study in Nigeria revealed that Retinal detachment is a significant cause of blindness in Africa.

The risk of retinal detachment in otherwise normal eyes is around 5 in 100,000 per year. Detachment is more frequent in the middle-aged or elderly population with rates of around 20 in 100,000 per year. The lifetime risk in normal eyes is about 1 in 300.

Short-Sightedness (Myopia) is associated with 67% of retinal detachment cases. Patients suffering from a detachment related to myopia tend to be younger than non-myopic detachment patients. Retinal detachment can occur more frequently after surgery for Cataracts

Although retinal detachment usually occurs in one eye, there is a 15% chance of developing it in the other eye, and this risk increases to 25-30% in patients who have had cataracts extracted from both eye.

The symptoms of Retinal detachment are flashes of light, a slight feeling of heaviness in the eye, the impression that a veil or curtain was drawn over the field of vision, and also the sensation that straight lines suddenly appear curved, and finally blindness

Any time delayed in diagnosis and treatment may affect outcome of management. Results of Surgery are usually good if done early. Eighty-five percent (85%) of cases will be successfully treated with one operation with the remaining 15 percent requiring 2 or more operations. After treatment patients gradually regain their vision over a period of a few weeks, although the Visual_acuity may not be as good as it was prior to the detachment, particularly if the Macula was involved in the area of the detachment. However, if left untreated, total Blindness could occur in a matter of days.

Retinal detachment can sometimes be prevented. The most effective means is by educating people to seek ophthalmic medical attention early and from ophthalmologists in public and private hospitals and not from wayside opticians. Early examination allows detection of retinal tears which can be treated with laser or cryotherapy.

Individuals prone to retinal detachment due to a high level of myopia are encouraged to avoid activities where there is a risk of shock to the head or eyes.

Because retinal detachment requires emergency care, it is appropriate to have retinal surgeons in Ghana to manage the cases early. The government of Ghana could save a lot of hard foreign currencies since the cases will be managed home rather than what pertains now where retinal detachment patients are routinely referred to Tanzania in East Africa for retinal surgery.

In conclusions, to be able to manage retinal diseases adequately in Ghana, I recommend that very attractive training fellowships could be awarded to young ophthalmologists to super-specialize in retinal surgery and also equipping eye departments in hospitals like Komfo Anokye Teaching Hospital, Korle Bu Teaching Hospital, Tamale Teaching Hospital, 37 Military Hospital etc. with state –of-the- art facilities to manage retinal diseases.

Lastly, a retinal detachment foundation is advocated for regular health education and soliciting of financial assistance to sufferers of the condition. Retinal Detachment patients especially the very educated ones who were in Tanzania for retinal surgery could take it up.

Credit: Dr. Habib Ahmed
(Ghanaian student in Tanzania)
Email: isam26gh@yahoo.com

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