Posterior Vitreous Detachment

The eye is hollow like a basketball, with the center being occupied by a jelly-like substance called the vitreous.  The vitreous is much like jello in that it consists primarily of water (99%) and protein.  As people get older, the protein portion of the vitreous changes slowly so that large pockets of fluid form in the otherwise jello-like substance.  In the 7th and 8th decades of life (60's and 70's), the vitreous loses its gel-like consistency and becomes so "liquidy" that it separates from the back potion of the eye (the retina).  This is called posterior vitreous Detachment and occurs in about 80% of people by the age of 80. 

Posterior vitreous detachment by itself is not harmful.  It can, however, be complicated by bleeding into the central cavity of the eye (vitreous hemorrhage) about 5 % of the time.  Usually the bleeding is not severe.  Approximately 10-15% of the time, posterior vitreous detachment is associated with retinal tears.  Because retinal tears can lead to retinal detachment (with significant loss of vision), this is a very important point. 

In most cases, if a retinal tear is going to occur, it will do so in the first few weeks after posterior vitreous detachment.  The symptoms of retinal detachment and posterior vitreous detachment are very similar - flashes of light and floating dots in your field of vision.  Only with very careful retinal examination can an ophthalmologist rule out a retinal tear or detachment.  For this reason, we perform dilated retinal exams on all patients with these symptoms.  We do this at least twice: when we see the patient initially, and 2-3 weeks later. 

If any high-risk retinal holes are seen, it is likely that we will recommend treatment of these with laser or with a similar treatment called cryopexy.  This decreases the risk of frank retinal detachment.  The laser or cryopexy causes a scar to from around the treated retinal hole which helps to prevent retinal detachment (this is not a guaranteed, because unfortunately, untreated areas can go on to form holes which can then lead to detachment). 

If after treatment or during the 2-3 week follow-up period after posterior vitreous detachment occurs your vision worsens, symptoms of flashes or floaters increase, or a curtain or cloudy area appears in your field of vision, then you should call us immediately at 656-4520 or 1-800-358-1144, as this could be a symptom of progressive retinal detachment.