Senile retinoschisis is a condition that primarily affects older individuals and involves the splitting or separation of the layers of the retina, the light-sensitive tissue at the back of the eye. The lesions are typically in the peripheral retina and do not affect central vision. Unlike the juvenile form, which occurs in childhood or adolescence and is associated with a genetic mutation, senile retinoschisis is related to age-related changes in the eye. This condition typically develops in elderly individuals and may be more common in those over the age of 60. Diagnosis involves a comprehensive eye examination, including imaging tests such as optical coherence tomography (OCT). Retinoschisis rarely needs to be treated.
Senile retinoschisis is important for several reasons. Firstly, it can mimic retinal detachment, making it crucial to distinguish between the two conditions. Retinal detachment is a serious and sight-threatening condition where the retina detaches from the underlying tissue, leading to a sudden onset of symptoms such as floaters, flashes of light, and a curtain-like shadow across the visual field. Senile retinoschisis, on the other hand, involves the splitting of retinal layers, and its symptoms may overlap with those of retinal detachment. Proper diagnosis is essential, as the management and prognosis of retinoschisis differ from that of retinal detachment.
Secondly, senile retinoschisis predisposes patients to a higher risk of developing retinal detachment. Although senile retinoschisis itself may not always lead to retinal detachment, it creates a vulnerability in the retina that can increase the likelihood of detachment occurring. The splitting of retinal layers in retinoschisis can weaken the structural integrity of the retina, making it more susceptible to complications such as breaks or tears. Consequently, individuals with senile retinoschisis may require close monitoring by eye care professionals to detect any potential signs of retinal detachment and take preventive measures.
The natural history is that retinoschisis rarely progresses from where it’s first observed, so treatment is never necessary. Most cases of posterior retinoschisis will not progress beyond 3 disc diameters from the macula (central vision) and only a handful of cases of degenerative retinoschisis involving the macula have been reported. Additionally, no treatment, including laser, has been shown to halt the progression of retinoschisis.
Although approximately three-quarters of lesions will have their most posterior extent past the equator of the eye, only about three percent will progress posteriorly, so most still should observed. Neither cataract surgery nor posterior vitreous detachment have any adverse effect on retinoschisis because pathology is within the retina and not at the vitreoretinal interface.
There are several ways to distinguish retinoschisis without a retinal detachment from retinoschisis with a retinal detachment. The primary method is by looking for a pigment change at the edge of the lesion. Since retinoschisis is a partial thickness retinal defect, it never causes a pigment irregularity. The presence of fluid and a pigment irregularity almost always means there is a retinal detachment present. If the lesion is posterior, OCT imaging can also be used to distinguish retinoschisis from retinal detachment.
Most retinoschisis retinal detachments are not progressive and can be watched.