The interior of your eye contains a gel-like substance called vitreous. It’s composed of 99 percent water, with collagen and hyaluronic acid filling the other one percent. These substances give the vitreous its gel-like consistency. The vitreous helps your eye maintain its round shape.
Inside the vitreous are millions of intertwined fibers that are hooked to the surface of the retina. The retina acts like film in your eye, capturing the images and light that enter through your iris. Aging causes changes in your eyes, and one of these changes is the shrinking of the vitreous. When the vitreous shrinks, the fibers pull your retina.
The fibers eventually break and shrink away from the retina. When this happens, it’s called a vitreous detachment. It can also be called a posterior vitreous detachment because when the vitreous begins to shrink, it creates pockets that leave space at the back of your eye near the optic nerve. Most of the time, a vitreous detachment poses no risk to your vision and doesn’t need treatment.
When You Are at Risk
Vitreous detachment is common and usually affects those over the age of 50. It’s extremely common for people over 80. If you are extremely nearsighted, you may also be at risk for a vitreous detachment.
If you’ve had a detachment in one eye, it’s quite likely that you’ll have one in the other eye at some point, but not necessarily in the near future. They can happen many years apart. There’s no way to predict when a detachment may occur, so regular eye exams are very important as you age.
In the vast majority of cases, you won’t notice any symptoms at all. There are two main symptoms, floaters and photopsia. If you experience either symptom, it’s important to have your eyes checked as soon as possible, preferably by an ophthalmologist, because there is an increased risk of retinal detachment. Vitreous detachment and the retinal detachment often occur simultaneously.
Most of the time, you won’t even notice that a vitreous detachment has taken place, except for the annoyance of an increase in floaters. The only way that a vitreous detachment can be detected is with a thorough exam by your ophthalmologist. If the vitreous detachment has created a macular hole or a detached retina, catching the condition early can help prevent vision loss. There is no way to predict if a vitreous detachment will lead to complications, but sometimes they do happen. More often, when symptoms are present, complications may be apparent as well.
When the vitreous shrinks, it can become stringy. The gel that makes up the vitreous tends to become clumpy and full of debris. The loose pieces then create tiny shadows on your retina. With a regular eye exam, your ophthalmologist can see these floaters on the surface of your retina.
Floaters can appear in a variety of shapes and sizes. As they float across your visual field, they can be perceived as:
Floaters may be more obvious in bright light. Sometimes, the floaters appear to be in motion; other times, they are stationary. When you try to look directly at them, however, they float toward the edge of your field of vision. Floaters cause no problems, and they can be present without posterior vitreous detachment. They appear in the eyes as you age even if you have no other obvious eye problems.
Photopsia (Flashing Lights)
Photopsia appears in your eyes as quick golden yellow or white streaks at the edges of your vision. They can be brought on by moving your eyes quickly and are more obvious in the dark. Flashing lights appear due to the photoreceptors in your eyes being stimulated by the vitreous pulling away.
When this happens, the photoreceptors convey a number of impulses to your brain that are perceived as short flashes of light. When the vitreous is completely separated from the retina, the flashes should dissipate because it isn’t pulling on the retina any longer. It’s common for you to continue seeing flashes of light occasionally after the separation takes place, but it’s usually no cause for concern.
Complications That Often Arise
Even though vitreous detachment does not directly lead to a loss of vision, occasionally the fibers pulling on your retina can lead to a retinal detachment or a macular hole. If this happens, treatment is needed immediately to prevent permanent damage.
If you experience a sudden increase in floaters or flashes of light in your peripheral vision, you should have a professional do an exam as soon as possible. Major complications occur in about 10 percent of cases, such as:
- Vitreous hemorrhage: Bleeding into the cavity is due to the detachment of the vitreous.
- Retinal Tear: The action of the vitreous detaching tears the retina.
- Retinal detachment: The retina moves out of position as the pulling of the vitreous becomes stronger.
- Macular Hole: The pulling of the vitreous fibers then leads to a hole being torn in the macula.
When complications do occur and your ophthalmologist recommends treatment, there are a number of options available, including:
- Laser or cryosurgery: This can be done in the office with no anesthesia. Your doctor repairs the holes or tears in your retina, which prevents further progression of the condition.
- Scleral buckle: This involves placing a band around the outside of the eye to counterbalance the force of the vitreous pulling on the retina. Fluid is then drained from behind your retina, allowing it to return to its proper position. This is usually done as outpatient surgery.
- Pneumatic retinopexy: This surgery is sometimes done in the office. Your doctor injects a gas bubble into the vitreous behind your eye. The bubble pushes the tear against the back wall of the eye and closes it. Then your doctor uses laser or cryosurgery to secure the retina where it belongs. After surgery, you may need to keep your head in a certain position for a few days. The gas bubble dissipates over time.
When surgery is needed, your doctor decides which type of procedure is best for your situation. In many cases, treatment can be performed in the office, and no anesthesia is needed. For more severe cases, an operating room and local or general anesthesia may be required. In any case, your doctor takes into account your general health and the health of your eyes when making the decision about a course of treatment.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult eye doctor about your specific condition. Only a trained, experienced board certified eye doctor can determine an accurate diagnosis and proper treatment.
Do you have any questions about Vitreous Detachment, Degeneration treatment in NYC? Would like to schedule an appointment with the top Ophthalmologist in New York CIty, Optometrist Dr. Saba Khodadadian of Manhattan Eye Specialists, please contact our office for consultation with New York eye doctor.
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