What is posterior vitreous detachment?
A posterior vitreous detachment (PVD) occurs when the vitreous gel inside the eye condenses and pulls away from the retina. The vitreous is a thick, clear gel with invisible fibers that fills the inside of the eye. From birth the vitreous gel is attached to the retina and helps to support it. The retina is a thin layer of tissue that lines the inside of the eye like film in a camera. Just like film, the retina serves to “take the picture” of objects you look at. The primary cause of PVD is a degeneration of the vitreous, in which the tiny fibers clump together causing the vitreous to pull away from the retina.
What symptoms does posterior vitreous detachment cause?
The most common symptoms of PVD are floaters and flashes. Floaters are specks, fibers, or veils that appear to move in front of your eye. Floaters are actually tiny clumps of gel or cellular debris within the vitreous. PVD sometimes causes bleeding inside the eye. Blood in the vitreous appears as floaters described as hair-like strands or tiny round dots. Over time floaters may appear like a cloud or veil that moves across the vision. Flashes are brief streaks of light that are usually seen off to the side, especially at night, when you turn your head or eyes. Flashes are caused by vitreous gel tugging on the retina with eye movement. Although the sudden onset of new floaters is reported by almost everyone with PVD, flashes are only seen by half of all people with PVD.
Why is it important to be seen for these symptoms?
Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters, with or without flashes, is an important symptom to report to your eye doctor. In about 10-20% of people with these symptoms, the vitreous pulls on and tears the retina. A retinal tear by itself causes no pain or visual problems. However, if a retinal tear is not detected and treated, it may go on to cause blindness from retinal detachment. A retinal detachment is when the retina stops functioning because it is pulled away from the inner eye wall and floats freely inside the eye. A retinal detachment causes a progressive loss of vision appearing like a curtain or shadow that slowly moves across the vision from the side.
What causes posterior vitreous detachment?
PVD is usually due to degeneration of the vitreous gel from aging. Over time, the thick vitreous gel tends to become liquefied and the microscopic fibers in the gel tend to condense together becoming visible and causing traction on the retina. The following conditions tend to accelerate the degeneration and cause PVD to occur earlier in life: trauma, inflammation, diabetes, and myopia (near-sightedness).
How is posterior vitreous detachment managed?
The most important step is to have a thorough, dilated eye examination. The eye doctor will check for the presence of a tear in the retina. If a tear is found, laser or cryopexy is usually recommended to decrease the chances of blindness from retinal detachment. If a retinal detachment is found, more extensive surgery is required in an attempt to repair it. If there is no retinal tear or retinal detachment found at the initial exam, another exam several weeks later may be performed to be certain that a delayed tear has not occurred. Generally, there are no restrictions to your activities.
What happens to the floaters and flashes?
There is no treatment to make the floaters and flashes go away even though they may be quite annoying. The flashes gradually subside and disappear over days to weeks without treatment. However, the floaters rarely completely disappear. They will gradually fade and become less obvious over weeks to many months. For the first few days or weeks, many people find that the floaters are less annoying if they wear sunglasses when out of doors and turn the lights down when indoors.
What to be on the lookout for?
After examination or treatment, any new floaters or loss of side vision should be reported to the doctor without delay. Sometimes, new tears or a retinal detachment can occur after the eye examination. In fact, 7% of eyes with PVD will develop a retinal break sometime after the initial eye exam; about half occur more than one year after PVD. This is more likely to occur in near-sighted eyes and eyes with lattice degeneration.
PVD may stimulate the formation of macular pucker, which may cause symptoms of distortion of vision. Treatment of a retinal tear does not prevent macular pucker.
When one eye develops a PVD, the fellow eye will usually do so at a future date. Whether the floaters and flashes are more or less severe in the second eye, they should be promptly reported to the eye doctor. If the first eye develops a torn retina, the second eye runs about a 20% chance of developing a tear as well. But even if the first eye does not have a torn retina, the second eye may still develop a tear when a PVD occurs.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.
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