Vitreous Detachment

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Vitreous Detachment

Posterior Vitreous Detachment (PVD) is a natural change that occurs during adulthood, when the vitreous gel that fills the eye separates from the retina, the light-sensing nerve layer at the back of the eye.

About Vitreous Detachment

Vitreous detachments will happen to most of us during our lives. They’re usually a harmless event, but present the risk of serious vision threatening complications. These complications are very treatable by a retina specialist, generally with excellent visual outcomes.

The vitreous is a clear gel that fills the interior space of the eye. When we’re young, it’s quite firm and adherent to the retina, which lines the back of the eye. As we age it naturally softens and weakens its attachment to the retina. A vitreous detachment occurs when it comes loose from the retina and then floats more freely in the central chamber of the eye.

Symptoms & Risk Factors

The symptoms of a vitreous detachment are variable. Some people may not even notice the detachment occurs. Most common symptoms include floaters, which are mobile blurry shadows that obscure the vision, and flashes which appear as brief streaks of light, usually at in your peripheral side vision in the eye. Floaters and flashes are distracting, but typically fade over the next several weeks.

Vitreous detachments are primarily age related and usually occur after age 40. If a vitreous detachment is detected at a young age, it is often related to myopia (nearsightedness) or trauma to the eye. Typically patients who experience PVD in one eye will develop the same symptoms in their other eye within one year.

Testing & Diagnosis

Posterior vitreous detachment is usually diagnosed with a dilated eye examination. However, if the vitreous gel is very clear, it may be hard to see the PVD without additional testing, such as optical coherence tomography (OCT) or an ocular ultrasound.

In general, the sooner a Colorado Retina surgeon is able to diagnose PVD and repair a torn or detached retina, the more vision we can save for the patient. Our physicians always encourage people with floaters, flashes or rapid vision loss symptoms to contact their primary eye doctor for an immediate referral to a Colorado Retina physician to perform the above testing.

Treatment

Vitreous detachments are simply observed to assure that no complications arise, which usually occurs in the first few months. The symptoms are not very helpful in determining if there is a complication, so a thorough dilated retinal exam is required. Obstructive floaters can potentially be removed with a procedure called vitrectomy (link to this), but this is reserved for cases where the floaters significantly interfere with daily activities or quality of life.

A vitreous hemorrhage may or may not require treatment. If it is mild to moderate, and the view into the eye is adequate, then it may just be observed and will resolve spontaneously within about three months or less. In severe cases, surgery is required to remove the blood and treat any possible source of the bleeding.

Retinal tears can be treated without surgery and stop it from causing any permanent damage. Retinal tears occur at the far edge of the retina and can be sealed off with a non-invasive laser procedure in clinic. Retinal tears themselves are not a cause of significant vision loss, but may rapidly lead to detachment of the retina from the inner wall of the eye.

Retinal detachments can cause serious permanent damage and require urgent intervention to repair. There are several ways to reattach the retina, and the optimal approach is individually tailored. Minor detachments can sometimes be repaired with a minimally invasive procedure in clinic. Most commonly surgery is required to repair the detached retina, often on an urgent basis. The visual results from retinal detachments repair depend primarily on how extensive it is and how long it’s been detached. In general, the sooner we're able to repair a detached retina, the more vision we can save for the patient. We always encourage people with floaters, flashes or rapid vision loss to contact their eye doctor immediately for a thorough dilated eye exam or referral to a retinal specialist.

Complications

The trouble with a vitreous detachment comes from the vitreous pulling on the retina as it comes loose. Complications potentially include bleeding, retinal tears, or retinal detachment. These can be a visual emergency and may require surgery to repair the retina right away. If the retina bleeds into the central space of the eye, the vision is much cloudier, with dense floaters.

Retinal tears may be asymptomatic, or result in somewhat worse floaters. A retinal detachment causes progressive loss of vision, commonly described as “a curtain coming over my vision.” Untreated, this may result in blindness of the eye and may occur rapidly.