Lattice degeneration is the most common peripheral retinal abnormality associated with retinal detachment.
Lattice degeneration is a peripheral retinal abnormality. Since lattice degeneration affects the peripheral retina, it does not affect the central vision. Lattice degeneration gets its name from the white appearance of retinal vessels criss crossing the lesions that can look like a lattice ( see accompanying photograph). Lattice degeneration is common, affecting about 10 percent of the population in the United States. About 50 percent of people with lattice degeneration in one eye also have it in their fellow eye.
Lattice degeneration is associated with retinal detachments. One third of retinal detachments are caused by lattice degeneration. There are three reasons for this association. First, the retina is thin within areas of lattice degeneration. This retinal thinning is visible in the accompanying photograph which shows the eye indented with scleral depgression in an area of lattice degeneration. When viewing the lattice degeneration from the side, you can see that the retina is thin within the area of lattice. Second, the vitreous is usually firmly attached at the edge of lattice degeneration lesions. Because of this firm attachment, some patients with lattice degeneration develop retinal tears at the edge of their lattice degeneration when the vitreous in their eye contracts or shifts. Finally, because of the retinal thinning, atrophic holes often develop within lattice degeneration lesions. These retinal holes will sometimes allow fluid to pass from inside the eye into the subretinal space causing a retinal detachment.
About 25 percent of lattice degeneration lesions contain atrophic retinal holes as seen in the accompanying image. These are not tractional retinal holes and therefore the risk of these holes causing a retinal detachment is low. The lifetime risk of someone with lattice degeneration developing a retinal detachment is less than one percent. In someone with lattice degeneration and atrophic holes, the lifetime risk of retinal detachment is less than two percent.
Lattice degeneration is very common and the risk of someone with lattice degeneration developing a retinal detachment is low: about one or two percent. Therefore, laser surgery for asymptomatic lattice degeneration is rarely done. In the past, when retinal detachment surgery was less successful and the risk of lattice degeneration causing a retinal detachment was less well understood, laser therapy of lattice degeneration was commonly performed. At this time, laser for lattice degeneration is sometimes reocmmended. First, at the time of retinal detachment repair, as in the accompanying image, all areas of lattice degeneration are treated with laser. Second, in a patient who has had a retinal detachment in one eye, the risk of retinal detachment in the fellow eye is fairly high: about 10 percent. For this reason, some retina specialist recommend laser treatment for lattice degneeration lesions in the fellow eye of a patient who has had a retinal detachment.