Age-related (senile) retinoschisis (SR) is an acquired condition characterized by splitting of the retina into 2 separate layers.
Not clearly defined.
• Ranges from 1.65–7% among persons older than 40 years (1)
• Generally equal in male and females
• Preexisting peripheral retinal cystoid degeneration
• Vision is not significantly affected when the schisis cavity remains in the periphery
• Visual loss occurs predominantly in 2 circumstances:
– The area of retinoschisis extends posteriorly toward, or into, the macula (occurs in 3% of cases).
– An associated rhegmatogenous retinal detachment (RRD) develops.
• Generally develops as a consolidation of intraretinal cysts in an area of peripheral cystoid degeneration
– Begins anterior at the ora serrata and extends posteriorly
– The splitting most often occurs in the outer plexiform layer
COMMONLY ASSOCIATED CONDITIONS
• An RRD may develop secondarily.
• Age-related retinoschisis is usually asymptomatic and is detected on routine examination.
• Some patients may have peripheral visual field loss, flashes and floaters, and central vision loss.
• Dilated funduscopic examination shows:
– A smooth dome-like elevation of the retina that remains fixed in position and does not undulate.
– Often bilateral (one-fifth to half of the cases) but can be asymmetric.
– Most commonly located inferotemporally
– Peripheral cystoid degeneration is seen anterior to the schisis cavity.
– Inner and/or outer retinal holes may be present.
– Fine, irregular white dots may be seen on the retinal surface.
– Sclerotic retinal vessels in the area of schisis
– The inner layer does not collapse on scleral depression.
DIAGNOSTIC TESTS & INTERPRETATION
Photographs to document posterior extent of the area of retinoschisis may be useful for comparison on follow up.
Follow-up & special considerations
Asymptomatic and peripheral age-related retinoschisis can be followed every 2–3 years.
Visual field testing reveals an absolute scotoma in the areas of schisis.
• There are 2 main types of acquired retinoschisis:
– Typical degenerative retinoschisis
– The more common subtype in which the splitting occurs in the outer plexiform layer
– Reticular degenerative retinoschisis is characterized by cystoid spaces and splitting within the nerve fiber layer
Breaks in the outer retina occur in 11–24% of cases, and may lead to rhegmatogenous retinal detachment.
• Rhegmatogenous retinal detachment. This is the most important condition to differentiate from age-related retinoschisis. Chronic rhegmatogenous retinal detachments also may appear smooth and domed. The presence of pigment in the vitreous, or a pigmented demarcation line suggests rhegmatogenous detachment.
– In some cases, differentiating these 2 conditions can be difficult. Two other ways to diagnose them are: 1) Laser retinopexy to the cavity will cause a burn in retinoschisis, but not in a retinal detachment, and 2) Optical coherence tomography (OCT) at the edge of the schisis cavity will show a complete neurosensory retinal detachment in a rhegmatogenous detachment, and a splitting of the neurosensory retina with apposition of the photoreceptors and retinal pigment epithelium in cases of retinoschisis.
• The majority of cases only need observation as they progress slowly, if at all (1).
• For SR that extends into the posterior pole, demarcation with cryotherapy or laser retinopexy can be considered (2). However, most of these may be observed as rarely does age-related retinoschisis reach the macula, and cryotherapy may increase formation of retinal detachment.
• Dilated fundus examination every 1–3 years for uncomplicated SR without holes
• Patients with multiple retinal breaks or significant posterior extension should be followed more closely.
– Should a retinal detachment develop or should there be a question of an associated retinal detachment, prompt referral to a retinal specialist is advised.
Patients should be counseled to return to the ophthalmologist if any changes in vision occur.
• Vision is typically unaffected or only minimally affected if the area of retinoschisis remains peripheral.
• The prognosis is significantly worse should a retinal detachment develop.
• Posterior extension of the retinoschisis