Rhegmatogenous retinal detachment: Recognition of warning symptoms, time to surgery, and visual outcomes

Rhegmatogenous retinal detachment (RRD) threatens sight through separation of the neurosensory retina from the retinal pigment epithelium after a full-thickness retinal break. The opportunity to preserve central vision depends on events occurring before and after diagnosis: recognition of warning symptoms, access to a dilated retinal examination, identification of foveal involvement, and appropriate surgical scheduling. This critical narrative review examines how these linked intervals relate to functional outcomes. Literature published through 2026 was examined using PubMed/MEDLINE, relevant ophthalmology society guidance, and original reports and evidence syntheses addressing acute flashes and floaters, patient delay, macula-on and macula-off RRD, and postoperative vision. New-onset photopsias, floaters, and a progressive visual-field shadow warrant urgent retinal assessment, although their individual diagnostic specificity is limited. Symptom awareness is associated with earlier treatment and more frequent preservation of an attached fovea. Observational syntheses favor prompt repair of fovea-on detachments at risk of progression and earlier surgery, particularly within the first few days, after foveal detachment. Nevertheless, baseline visual acuity, detachment configuration, photoreceptor integrity, and surgical technique also shape recovery. A clinically useful approach prioritizes rapid recognition and referral, documents the onset of central vision loss separately from initial symptoms, and individualizes operative urgency without interpreting observational timing thresholds as absolute guarantees.