History

Specifically ask patients about the following risk factors that predispose to premature PVD:

Myopia
Prior intraocular surgery
Family history
RRD in the fellow eye

Photopsias

Photopsias refer to the perception of flashing lights by the patient. It probably arises from the mechanical stimulation of vitreoretinal traction on the retina. It may be induced by eye movements and appears to be more noticeable in dim illumination.

Visual field defect

Patients often describe a black curtain (visual field defect) once the subretinal fluid extends posterior to the equator.

Floaters

Floaters are opacities in the vitreous that cast variously sized and shaped dark shadows in the patient's visual field as they float in the vitreous cavity.

A ring-shaped floater is the Weiss ring or the remnant of the posterior hyaloid attachment to the edges of the optic disc.

Cobwebs are caused by condensation of the collagen fibers.

Small spots usually indicate fresh blood due to the rupture of a retinal vessel during an acute PVD.

Loss of central vision

When the macula becomes detached (ie, extension of subretinal fluid into the macula), the patient experiences a drop in visual acuity.

In other cases, a large bullous detachment may overhang and obstruct light from reaching the macula, causing decreased visual acuity even though the macula is not detached.

Physical

Cell and flare may be seen in the anterior chamber of eyes with a rhegmatogenous retinal detachment (RRD).

The intraocular pressure usually is lower in the eye with a RRD than in the fellow eye; this usually is reversed by retinal reattachment. In certain cases, the intraocular pressure may be higher than in the fellow eye.

Pigment in the anterior vitreous (tobacco dusting or a Shaffer sign) often is present.

Once the retina becomes detached, it assumes a slightly opaque color secondary to intraretinal edema. It has a convex configuration, has a corrugated appearance, and undulates freely with eye movements unless severe proliferative vitreoretinopathy (PVR) is present.

A retinal break in the shape of a horseshoe or flap often is present. Of all RRDs, 50% have more than 1 break. Of all breaks, 60% are located in the upper temporal quadrant, and 15% are located in the upper nasal quadrant. Another 15% are in the lower temporal quadrant, and 10% are in the lower nasal quadrant.

Chronic RRD may present with retinal thinning, intraretinal cysts, subretinal fibrosis, proliferative vitreoretinopathy (PVR), fixed folds, and demarcation lines. These lines usually are at the junction of attached and detached retina. Even though they represent areas of increased retinal adhesion to the RPE, it is not uncommon for subretinal fluid to spread beyond the lines.

Rhegmatogenous retinal detachment is shown in the images below.

Clinical picture of a rhegmatogenous retinal detachment involving the macula. Notice the folds just temporal to the fovea.

View Media Gallery

Clinical picture of a rhegmatogenous retinal detachment. Notice that the macula is involved and that the retina is corrugated and has a slightly opaque color.

View Media Gallery

Causes

The main cause of a rhegmatogenous retinal detachment (RRD) is a PVD that leads to retinal tear formation. The following are risk factors that commonly share the premature liquefaction of the vitreous gel leading to an increased rate of PVD.

Abnormal vitreoretinal adhesions are present in many eyes with RRD. Lattice degeneration of the retina is a common condition characterized by both retinal thinning and abnormal vitreoretinal adhesions, increasing the risk for 1 or more retinal tears.

Prior intraocular surgery, especially cataract extraction: It appears that an intact posterior capsule delays the onset of PVD. Other procedures, such as penetrating keratoplasty and pars plana vitrectomy (PPV), also may be complicated by a RRD.

Certain familial conditions, such as Stickler syndrome, Marfan syndrome, homocystinuria, and Ehlers-Danlos syndrome, are associated with RRD.

Inflammatory or infectious conditions, such as acute retinal necrosis syndrome, CMV retinitis in AIDS patients, ocular toxoplasmosis, pars planitis, and axial myopia may be noted.

Differential Diagnoses

Nielsen BR, Alberti M, Bjerrum SS, la Cour M. The incidence of rhegmatogenous retinal detachment is increasing. Acta Ophthalmol. 2020 Sep. 98 (6):603-606. [QxMD MEDLINE Link].
Park JY, Byun SJ, Woo SJ, Park KH, Park SJ. Increasing trend in rhegmatogenous retinal detachment in Korea from 2004 to 2015. BMC Ophthalmol. 2021 Nov 26. 21 (1):406. [QxMD MEDLINE Link].
van Leeuwen R, Haarman AEG, van de Put MAJ, Klaver CCW, Los LI, Dutch Rhegmatogenous Retinal Detachment Study Group. Association of Rhegmatogenous Retinal Detachment Incidence With Myopia Prevalence in the Netherlands. JAMA Ophthalmol. 2021 Jan 1. 139 (1):85-92. [QxMD MEDLINE Link].
Achour H, Thomseth VM, Kvaløy JT, Krohn J, Utheim TP, Forsaa VA. Substantial increase in the incidence of rhegmatogenous retinal detachment in Western Norway over 20 years. Acta Ophthalmol. 2022 Nov. 100 (7):763-768. [QxMD MEDLINE Link].
Haimann MH, Burton TC, Brown CK. Epidemiology of retinal detachment. Arch Ophthalmol. 1982 Feb. 100(2):289-92. [QxMD MEDLINE Link].
Wilkes SR, Beard CM, Kurland LT, Robertson DM, O'Fallon WM. The incidence of retinal detachment in Rochester, Minnesota, 1970-1978. Am J Ophthalmol. 1982 Nov. 94(5):670-3. [QxMD MEDLINE Link].
Laatikainen L, Tolppanen EM, Harju H. Epidemiology of rhegmatogenous retinal detachment in a Finnish population. Acta Ophthalmol (Copenh). 1985 Feb. 63(1):59-64. [QxMD MEDLINE Link].
Tornquist R, Stenkula S, Tornquist P. Retinal detachment. A study of a population-based patient material in Sweden 1971-1981. I. Epidemiology. Acta Ophthalmol (Copenh). 1987 Apr. 65(2):213-22. [QxMD MEDLINE Link].
Hajari JN, Bjerrum SS, Christensen U, Kiilgaard JF, Bek T, la Cour M. A nationwide study on the incidence of rhegmatogenous retinal detachment in Denmark, with emphasis on the risk of the fellow eye. Retina. 2014 Aug. 34 (8):1658-65. [QxMD MEDLINE Link].
Li JQ, Welchowski T, Schmid M, Holz FG, Finger RP. Incidence of Rhegmatogenous Retinal Detachment in Europe - A Systematic Review and Meta-Analysis. Ophthalmologica. 2019. 242 (2):81-86. [QxMD MEDLINE Link].
Van de Put MA, Hooymans JM, Los LI,. Dutch Rhegmatogenous Retinal Detachment Study Group. The incidence of rhegmatogenous retinal detachment in the Netherlands. Ophthalmology. 2013. 120:616-622.
Sasaki K, Ideta H, Yonemoto J, Tanaka S, Hirose A, Oka C. Epidemiologic characteristics of rhegmatogenous retinal detachment in Kumamoto, Japan. Graefes Arch Clin Exp Ophthalmol. 1995 Dec. 233(12):772-6. [QxMD MEDLINE Link].
Wong TY, Tielsch JM, Schein OD. Racial difference in the incidence of retinal detachment in Singapore. Arch Ophthalmol. 1999 Mar. 117(3):379-83. [QxMD MEDLINE Link].
Adelman RA, Parnes AJ, Michalewska Z, Ducournau D, European Vitreo-Retinal Society (EVRS) Retinal Detachment Study Group. Clinical variables associated with failure of retinal detachment repair: the European vitreo-retinal society retinal detachment study report number 4. Ophthalmology. 2014 Sep. 121 (9):1715-9. [QxMD MEDLINE Link].
Wolfensberger TJ, Gonvers M. Optical coherence tomography in the evaluation of incomplete visual acuity recovery after macula-off retinal detachments. Graefes Arch Clin Exp Ophthalmol. 2002 Feb. 240(2):85-9. [QxMD MEDLINE Link].
dell'Omo R, Viggiano D, Giorgio D, Filippelli M, Di Iorio R, Calo' R, et al. Restoration of foveal thickness and architecture after macula-off retinal detachment repair. Invest Ophthalmol Vis Sci. 2015 Jan 22. 56 (2):1040-50. [QxMD MEDLINE Link].
Seider MI, Nomides RE, Hahn P, Mruthyunjaya P, Mahmoud TH. Scleral Buckling with Chandelier Illumination. J Ophthalmic Vis Res. 2016 Jul-Sep. 11 (3):304-9. [QxMD MEDLINE Link].
Cruz-Pimentel M, Huang CY, Wu L. Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment. Clin Ophthalmol. 2022. 16:1971-1984. [QxMD MEDLINE Link].
Roca JA, Maia M, da Cruz NFS, Polizelli MU, Chhablani J, Gangakhedkar S, et al. Non-contact wide-angled visualization with chandelier-assisted scleral buckling for primary uncomplicated rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol. 2020 Sep. 258 (9):1857-1861. [QxMD MEDLINE Link].
Custodis E. Beobachtungen bei der diathermischen Behandlung der Netzhautablosung und ein Minweis zur Therapie der Amotio retinae. Ber Dtsch Ophthalmol Ges. 1952. 57:227.
Lincoff HA, Baras I, McLean JM. Modification to the Custodis procedure for retinal detachment. Arch Ophthalmol. 1965. 73:160-3.
Frisina R, Forlini M, Date P, Meduri A, Pinackatt JS, Sborgia L, et al. Microscope-Assisted ab externo Surgery for the Treatment of Primary Rhegmatogenous Retinal Detachment - New Tech Meets Old Art. Ophthalmic Res. 2019 Jul 26. 1-7. [QxMD MEDLINE Link].
Aras C, Ucar D, Koytak A, Yetik H. Scleral buckling with a non-contact wide-angle viewing system. Ophthalmologica. 2012. 227 (2):107-10. [QxMD MEDLINE Link].
Chalam KV, Shah VA. Optics of wide-angle panoramic viewing system-assisted vitreous surgery. Surv Ophthalmol. 2004 Jul-Aug. 49 (4):437-45. [QxMD MEDLINE Link].
Hu Y, Si S, Xu K, Chen H, Han L, Wang X, et al. Outcomes of scleral buckling using chandelier endoillumination. Acta Ophthalmol. 2017 Sep. 95 (6):591-594. [QxMD MEDLINE Link].
Kita M, Kusaka M, Yamada H, Hama S. Updated chandelier illumination-assisted scleral buckling using 3D visualization system. Clin Ophthalmol. 2019. 13:1743-1748. [QxMD MEDLINE Link].
Schepens CL, Okamura ID, Brockhurst RJ. The scleral buckling procedures. I. Surgical techniques and management. Arch Ophthalmol. 1957. 58:797.
Chignell AH. Retinal detachment surgery without drainage of subretinal fluid. Am J Ophthalmol. 1974 Jan. 77(1):1-5. [QxMD MEDLINE Link].
Lincoff H, Kreissig I. The treatment of retinal detachment without drainage of subretinal fluid. (Modifications of the Custodis procedure. VI). Trans Am Acad Ophthalmol Otolaryngol. 1972 Sep-Oct. 76(5):1121-33. [QxMD MEDLINE Link].
Weng CY, Gregori NZ, Moysidis SN, Shi W, Smiddy WE, Flynn HW Jr. Visual and anatomical outcomes of macular epiretinal membrane peeling after previous rhegmatogenous retinal detachment repair. Retina. 2015 Jan. 35 (1):125-35. [QxMD MEDLINE Link].
Wolfensberger TJ. Foveal reattachment after macula-off retinal detachment occurs faster after vitrectomy than after buckle surgery. Ophthalmology. 2004 Jul. 111(7):1340-3. [QxMD MEDLINE Link].
Itakura H, Kishi S. Intravitreal injection of 0.3 ml of SF6 gas for persistent subfoveal fluid after scleral buckling for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol. 2009 Aug. 247(8):1147-50. [QxMD MEDLINE Link].
Jackson TL, Kwan AS, Laidlaw AH, Aylward W. Identification of retinal breaks using subretinal trypan blue injection. Ophthalmology. 2007 Mar. 114(3):587-90. [QxMD MEDLINE Link].
Escoffery RF, Olk RJ, Grand MG, Boniuk I. Vitrectomy without scleral buckling for primary rhegmatogenous retinal detachment. Am J Ophthalmol. 1985 Mar 15. 99(3):275-81. [QxMD MEDLINE Link].
Gartry DS, Chignell AH, Franks WA, Wong D. Pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment uncomplicated by advanced proliferative vitreoretinopathy. Br J Ophthalmol. 1993 Apr. 77(4):199-203. [QxMD MEDLINE Link]. [Full Text].
Hakin KN, Lavin MJ, Leaver PK. Primary vitrectomy for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol. 1993 Jun. 231(6):344-6. [QxMD MEDLINE Link].
Oshima Y, Yamanishi S, Sawa M, Motokura M, Harino S, Emi K. Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula-off rhegmatogenous retinal detachment. Jpn J Ophthalmol. 2000 Sep-Oct. 44(5):538-49. [QxMD MEDLINE Link].
Arya AV, Emerson JW, Engelbert M, Hagedorn CL, Adelman RA. Surgical management of pseudophakic retinal detachments: a meta-analysis. Ophthalmology. 2006 Oct. 113(10):1724-33. [QxMD MEDLINE Link].
Kinori M, Moisseiev E, Shoshany N, Fabian ID, Skaat A, Barak A, et al. Comparison of pars plana vitrectomy with and without scleral buckle for the repair of primary rhegmatogenous retinal detachment. Am J Ophthalmol. 2011 Aug. 152(2):291-297.e2. [QxMD MEDLINE Link].
Fujii GY, De Juan E Jr, Humayun MS, Chang TS, Pieramici DJ, Barnes A. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002 Oct. 109(10):1814-20. [QxMD MEDLINE Link].
Fine HF, Iranmanesh R, Iturralde D, Spaide RF. Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease. Ophthalmology. 2007 Jun. 114(6):1197-200. [QxMD MEDLINE Link].
Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005 Feb-Mar. 25(2):208-11. [QxMD MEDLINE Link].
Heimann H. [Primary 25- and 23-gauge vitrectomy in the treatment of rhegmatogenous retinal detachment--advancement of surgical technique or erroneous trend?]. Klin Monbl Augenheilkd. 2008 Nov. 225(11):947-56. [QxMD MEDLINE Link].
Tsang CW, Cheung BT, Lam RF, Lee GK, Yuen CY, Lai TY. Primary 23-gauge transconjunctival sutureless vitrectomy for rhegmatogenous retinal detachment. Retina. 2008 Oct. 28(8):1075-81. [QxMD MEDLINE Link].
Miller DM, Riemann CD, Foster RE, Petersen MR. Primary repair of retinal detachment with 25-gauge pars plana vitrectomy. Retina. 2008 Jul-Aug. 28(7):931-6. [QxMD MEDLINE Link].
Von Fricken MA, Kunjukunju N, Weber C, Ko G. 25-Gauge sutureless vitrectomy versus 20-gauge vitrectomy for the repair of primary rhegmatogenous retinal detachment. Retina. 2009 Apr. 29(4):444-50. [QxMD MEDLINE Link].
Davis MJ, Mudvari SS, Shott S, Rezaei KA. Clinical characteristics affecting the outcome of pneumatic retinopexy. Arch Ophthalmol. 2011 Feb. 129(2):163-6. [QxMD MEDLINE Link].
Hilton GF, Tornambe PE. Pneumatic retinopexy. An analysis of intraoperative and postoperative complications. The Retinal Detachment Study Group. Retina. 1991. 11(3):285-94. [QxMD MEDLINE Link].
McAllister IL, Meyers SM, Zegarra H, Gutman FA, Zakov ZN, Beck GJ. Comparison of pneumatic retinopexy with alternative surgical techniques. Ophthalmology. 1988 Jul. 95(7):877-83. [QxMD MEDLINE Link].
Tornambe PE, Hilton GF. Pneumatic retinopexy. A multicenter randomized controlled clinical trial comparing pneumatic retinopexy with scleral buckling. The Retinal Detachment Study Group. Ophthalmology. 1989 Jun. 96(6):772-83; discussion 784. [QxMD MEDLINE Link].
Tornambe PE, Hilton GF, Brinton DA, et al. Pneumatic retinopexy. A two-year follow-up study of the multicenter clinical trial comparing pneumatic retinopexy with scleral buckling. Ophthalmology. 1991 Jul. 98(7):1115-23. [QxMD MEDLINE Link].
Vidne-Hay O, Abumanhal M, Elkader AA, Fogel M, Moisseiev J, Moisseiev E. OUTCOMES OF RHEGMATOGENOUS RETINAL DETACHMENT REPAIR AFTER FAILED PNEUMATIC RETINOPEXY. Retina. 2019 Mar 2. [QxMD MEDLINE Link].
Lincoff HA, Kreissig I, Hahn YS. A temporary balloon buckle for the treatment of small retinal detachments. Ophthalmology. 1979 Apr. 86(4):586-96. [QxMD MEDLINE Link].
Sun Q, Sun T, Xu Y, Yang XL, Xu X, Wang BS. Primary vitrectomy versus scleral buckling for the treatment of rhegmatogenous retinal detachment: a meta-analysis of randomized controlled clinical trials. Curr Eye Res. 2012 Jun. 37(6):492-9. [QxMD MEDLINE Link].
Soni C, Hainsworth DP, Almony A. Surgical Management of Rhegmatogenous Retinal Detachment: A Meta-Analysis of Randomized Controlled Trials. Ophthalmology. 2013 Mar 16. [QxMD MEDLINE Link].
Wilkinson C. Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database Syst Rev. 2005 Jan 25. CD003170. [QxMD MEDLINE Link].
Mitry D, Singh J, Yorston D, Siddiqui MA, Murphy AL, Wright AF. The fellow eye in retinal detachment: findings from the Scottish Retinal Detachment Study. Br J Ophthalmol. 2012 Jan. 96(1):110-3. [QxMD MEDLINE Link].
Ross WH, Stockl FA. Visual recovery after retinal detachment. Curr Opin Ophthalmol. 2000 Jun. 11(3):191-4. [QxMD MEDLINE Link].
Ricker LJ, Noordzij LJ, Goezinne F, Cals DW, Berendschot TT, Liem AT. Persistent subfoveal fluid and increased preoperative foveal thickness impair visual outcome after macula-off retinal detachment repair. Retina. 2011 Sep. 31(8):1505-12. [QxMD MEDLINE Link].
Henrich PB, Priglinger S, Klaessen D, Kono-Kono JO, Maier M, Schotzau A. Macula-off retinal detachment--a matter of time?. Klin Monbl Augenheilkd. 2009 Apr. 226(4):289-93. [QxMD MEDLINE Link].
Mowatt L, Tarin S, Nair RG, Menon J, Price NJ. Correlation of visual recovery with macular height in macula-off retinal detachments. Eye (Lond). 2010 Feb. 24(2):323-7. [QxMD MEDLINE Link].
Day S, Grossman DS, Mruthyunjaya P, Sloan FA, Lee PP. One-year outcomes after retinal detachment surgery among medicare beneficiaries. Am J Ophthalmol. 2010 Sep. 150(3):338-45. [QxMD MEDLINE Link]. [Full Text].
Gharbiya M, Grandinetti F, Scavella V, Cecere M, Esposito M, Segnalini A. Correlation between spectral-domain optical coherence tomography findings and visual outcome after primary rhegmatogenous retinal detachment repair. Retina. 2012 Jan. 32(1):43-53. [QxMD MEDLINE Link].
Amato JE, Akduman L. Incidence of complications in 25-gauge transconjunctival sutureless vitrectomy based on the surgical indications. Ophthalmic Surg Lasers Imaging. 2007 Mar-Apr. 38(2):100-2. [QxMD MEDLINE Link].
Azad RV, Chanana B, Sharma YR, Vohra R. Primary vitrectomy versus conventional retinal detachment surgery in phakic rhegmatogenous retinal detachment. Acta Ophthalmol Scand. 2007 Aug. 85(5):540-5. [QxMD MEDLINE Link].
Chen E. 25-Gauge transconjunctival sutureless vitrectomy. Curr Opin Ophthalmol. 2007 May. 18(3):188-93. [QxMD MEDLINE Link].
Chen SN, Hwang JF. Treatment of rhegmatogenous retinal detachment in teenagers by pneumatic retinopexy technique. Am J Ophthalmol. 2007 Feb. 143(2):217-221. [QxMD MEDLINE Link].
Christensen U, Sander B, Villumsen J. Retinal thickening after successful surgery for macula-off retinal detachment. Curr Eye Res. 2007 Jan. 32(1):65-9. [QxMD MEDLINE Link].
Diederen RM, La Heij EC, Kessels AG, Goezinne F, Liem AT, Hendrikse F. Scleral buckling surgery after macula-off retinal detachment: worse visual outcome after more than 6 days. Ophthalmology. 2007 Apr. 114(4):705-9. [QxMD MEDLINE Link].
Goldmann H. Zur Biomikroskopie des Glaskorpers. Ophthalmologica. 1954. 127:334.
Lincoff HA, Mclean JM, Nano H. CRYOSURGICAL TREATMENT OF RETINAL DETACHMENT. Trans Am Acad Ophthalmol Otolaryngol. 1964 May-Jun. 68:412-32. [QxMD MEDLINE Link].
Rizzo S, Genovesi-Ebert F, Murri S, et al. 25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study. Graefes Arch Clin Exp Ophthalmol. 2006 Apr. 244(4):472-9. [QxMD MEDLINE Link].
Saw SM, Gazzard G, Wagle AM, Lim J, Au Eong KG. An evidence-based analysis of surgical interventions for uncomplicated rhegmatogenous retinal detachment. Acta Ophthalmol Scand. 2006 Oct. 84(5):606-12. [QxMD MEDLINE Link].
Schepens CL, Marden D. Data on the natural history of retinal detachment. I. Age and sex relationships. Arch Ophthalmol. 1961. 66:631.
Schwartz SG, Flynn HW. Primary retinal detachment: scleral buckle or pars plana vitrectomy?. Curr Opin Ophthalmol. 2006 Jun. 17(3):245-50. [QxMD MEDLINE Link].
Gorovoy IR, Porco TC, Bhisitkul RB, de Juan E Jr, Schwartz DM, Stewart JM. Same-Day Versus Next-Day Repair of Fovea-Threatening Primary Rhegmatogenous Retinal Detachments. Semin Ophthalmol. 2015 Aug 21. 1-7. [QxMD MEDLINE Link].

Media Gallery

Clinical picture of a rhegmatogenous retinal detachment involving the macula. Notice the folds just temporal to the fovea.
Clinical picture of a rhegmatogenous retinal detachment. Notice that the macula is involved and that the retina is corrugated and has a slightly opaque color.
This patient had a vitreous hemorrhage that prevented visualization of the retina. A B-scan ultrasound reveals a retinal detachment.

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Author

Lihteh Wu, MD Ophthalmologist, Costa Rica Vitreo and Retina Macular Associates

Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Club Jules Gonin, Macula Society, Pan-American Association of Ophthalmology, Retina Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Bayer; Quantel Medical, Roche<br/>Received income in an amount equal to or greater than $250 from: Bayer Health; Quantel Medical, Roche.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Additional Contributors

V Al Pakalnis, MD, PhD Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, South Carolina Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Teodoro Evans, MD Consulting Surgeon, Vitreo-Retinal Section, Clinica de Ojos, Costa Rica

Disclosure: Nothing to disclose.