An immediate surgical response is required to overcome retinal detachment, writes Iva Pocock
As an occupational therapist, Ann Murphy is used to patients' selective hearing - filtering medical advice is a common strategy for avoiding unwelcome news.
When faced with some bad news in January 2003 - vision in her right eye had suddenly become blurry and she called into Dublin's Eye and Ear Hospital as she happened to be close by - she acted no differently.
The registrar told her she had a retinal detachment and needed immediate surgery. "I said: 'I'm too busy, it doesn't suit and I've only put an hour in the car meter."
When the doctor reiterated the urgency of her condition, Ann came up with yet another excuse.
"It was only when the doctor said by way of comforting me: 'Look, you don't need to consider a new career as yet' that I really listened," recalls Ann.
Within 48 hours she was under general aesthetic to save her sight. "If I'd gone home instead of going to the hospital when I did, I probably wouldn't have vision in that eye."
Ann's symptoms were typical of a retinal detachment - she had no pain and her loss of vision happened quite suddenly.
For a while before surgery she also had floaters "like little tadpoles across your vision".
Flashing lights and a persistent shadow on the edge of one's vision are other symptoms of retinal detachment, says consultant eye surgeon Dara Kilmartin at the hospital.
He says they are dangerous symptoms and warns that prompt action must be taken when they develop.
"There is a time factor," he says. "There's no hard and fast rule but if the retina has been detached for anything longer than four to six weeks..., the risk of getting a poor outcome is very high."
First described by Swiss ophthalmologist Jules Gonin in 1904, retinal detachments are "not rare but not the commonest eye disorder", says Kilmartin. "They occur in one in 10,000 of the population."
In children they are very rare and among adults are most likely among two age groups - those between 25-40 years-of-age and 55-70 years-of-age.
People who are very short-sighted, with prescription glasses of minus six or worse, are also more predisposed to developing retinal detachments, as are those with a family history of the disorder, explains the eye surgeon. He advises such people to have their retina examined, even if they don't have symptoms.
Anyone who experiences a blunt or penetrating trauma to the eye, or even indirect trauma to the head and neck, risks a retinal detachment, he says. "Those that play high risk activities, such as squash, hurling or ice hockey, should wear eye-protection."
Retinal detachments can be put right by two types of surgery. The first "conventional" technique hasn't changed since the 1950s. Considered the "gold standard", it still benefits a high proportion of patients, says Kilmartin.
The second type of operation, a vitrectomy, which requires complex equipment and expert medical staff, is "probably more common now".
The latter removes the vitreous gel which fills the chamber of the eye behind the lens and replaces it with either silicon oil or an inert gas.
Surgery is typically performed under general aesthetic and is an emergency procedure.
Dublin's Eye and Ear Royal Victoria Hospital has an emergency room that attends 365 days of the year, 24 hours a day, and two "fully dedicated retinal theatres", with a "a specific retinal surgeon on call every week". There are 10 retinal surgeons dotted throughout the Republic, based in six hospitals.
"Although people often think nowadays that with the advances in technology we can fix absolutely everything, we can't," caution Kilmartin.
"One out of 10 retinal detachments will do badly, no matter what we do." Some 80 per cent can be fixed with just one operation, and 10 per cent will require further surgery, he adds.
Post-surgery requires that patients retain a set posture to aid the healing process, only moving for 10 minutes in every hour.
"I had to lie face down for three weeks until the gas bubble was dissolved," says Ann Murphy.
While she had no pain in her eye she suffered discomfort from having to stay motionless for three weeks.
"People find it devastating because it's not as if they are given a warning," explains Kilmartin. "It also has consequences for their family as patients are usually out of action for a month following surgery."
For Ann Murphy, it meant two months off work. It was only with hindsight that she realised her retinal detachment was most likely due to a car crash she had had a couple of months earlier and that her retinal detachment symptoms were masked by whiplash. Her message to all other likely sufferers: "Don't delay in going to hospital."