A posterior vitreous detachment (PVD) occurs when the collagen fibers which make up the vitreous cavity condense, causing the gel to “pull forward.” This is a normal age-related phenomenon, but in some patients, it can be associated with a retinal tear or detachment.
A simple explanation is that age-related changes in the vitreous cause the vitreous gel to collapse and pull forward. A small hole develops in posterior cortical vitreous and the liquefied vitreous passes through the hole into the space between the vitreous and the retina. This causes the collagen fibers to come forward and condense. The fibers will always stay attached just behind the iris to an area called the vitreous base.
In some patients, the gel will not break away “cleanly” and may cause a retinal tear. If the gel continues to pull on the flap of the tear, the fluid in the vitreous can go through the tear and cause the retina to detach.
A floater is any type of object in the vitreous gel which generally moves with eye or head movement. Floaters may cause a wide range of visual problems and symptoms. Patients may describe these as spots, clouds, webs, or clumps. In many patients, they are only a nuisance, but in some patients, they may significantly interfere with activities of daily living such as reading, driving, or watching TV.
- Seeing floaters
- Seeing flashes of light
- Observation and management
- YAG Laser Therapy
Based on our experience, a repeat evaluation in approximately 2 months allows for detection of most retinal tears. By then, most patients’ symptoms have improved dramatically.
The most important thing is to monitor your vision daily. Cover each eye and test yourself to see if there are any changes in your central or peripheral vision. Call us for any of the following:
- Multiple new floaters
- Multiple flashes
- Changes in peripheral vision
A YAG laser may be used to break down floaters in select cases. Patients with significant opacities located behind the lens or lens implant may benefit from this procedure.
If a patient’s floaters do not improve after a couple of months of observation, and they interfere with activities of daily living, we do believe it is appropriate to consider a vitrectomy. This is where the vitreous gel is removed and replaced with clear saline solution.
There are risks associated with any procedure, but if a patient has enough visual disability, the benefits of the procedure generally outweigh the risks. We have found that in carefully selected patients, vitrectomy eliminates the patient’s symptoms and is a highly successful procedure.