The vitreous humor is a jelly mass that forms the contents of the eyeball and consists of 98% water. Normal vitreous humor contains strands and structures that you can observe in everyone. But in one person the vitreous contains hardly any irregularities, while in another it is full of strands and clouds that can vary greatly in size and shape. With age, changes occur in the vitreous. The jelly mass liquefies and shrinks, causing it to detach from the retina. This often happens around the age of 60, but it can also occur earlier or later. Posterior vitreous detachment usually proceeds without complications and in that case treatment is not necessary. Sometimes intervention is necessary. The prognosis of surgical intervention for vitreous and retinal detachment is very good for most people.
- The vitreous and the retina
- The eye
- Vitreous humour
- Posterior vitreous detachment
- What is it?
- Age-related
- Who is at risk?
- Posterior vitreous detachment causes
- Symptoms: floating spots, flashes of light and reduced vision
- Floating spots
- Flashes of light
- Reduced vision
- The process of vitreous detachment
- Examination and diagnosis
- Ophthalmological examination
- Fundoscopy
- Retinal scan
- Posterior vitreous detachment treatment
- No treatment
- Retinal detachment
- Operation for retinal detachment
- Complications
- Prognosis
The vitreous and the retina
The eye
The eye is a hollow ball filled with transparent structures and has a transparent front, which is called the cornea. The light enters through the cornea. Together with the aqueous humor, the lens and the vitreous humor, a clear image is projected onto the retina. The two images are converted into one image in the brain.
Vitreous humour
The vitreous humor, also called ‘vitreous humor’, is a jelly mass that fills most of the eye and consists of 98% water. It is located behind the eye lens and maintains the spherical shape of the eye. Vitreous humor normally allows light rays to pass through unhindered to the retina. However, many people notice moving clouds in their field of vision, which are not always noticeable. The spots are often visible against a light background. Opacities in the vitreous form a shadow on the retina, which can be seen in various forms through dots, circles and spider webs.
Posterior vitreous detachment
What is it?
The vitreous is attached to the retina and it remains attached until one day it detaches itself due to aging. This phenomenon is called ‘posterior vitreous detachment’ (AGVL) or ‘posterior vitreous detachment’ (PVD). When they develop, you may experience transient flashes of light at the edge of the field of vision and permanent floaters (see below), which can be quite annoying. These can vary greatly in number, size and shape. This is observed due to cloudiness in the vitreous. These clouds occur between the light source and the retina and cast a shadow on the retina in the form of a hair or cotton wool.
Age-related
This age-related posterior vitreous detachment starts around the macula lutea, an area at the back of the retina where many cones are located in the light-sensitive layer. It then slowly spreads to the optic nerve. This degeneration process can take many years. In the early stages there are often no complaints.
Who is at risk?
Posterior vitreous detachment is a common condition that usually affects people over the age of 50 and is very common after the age of 80. People who are nearsighted (myopia, minus glasses) also have an increased risk. A vitreous detachment develops in myopia about 6-10 years earlier than in other eyes. Those who have already experienced a posterior vitreous detachment in one eye are more likely to develop it in the other eye, usually within 6 months to 2 years.A trauma or accident in the form of a blow to the eye increases the risk of developing a posterior vitreous detachment. This does not have to occur immediately after an accident. In addition, certain eye conditions can increase the risk, such as internal eye infections. Furthermore, posterior vitreous detachment develops more quickly after cataract surgery. Finally, there are indications that posterior vitreous detachment occurs more often and earlier in women.
Posterior vitreous detachment causes
Posterior vitreous detachment occurs frequently with old age. This is a natural process. With old age, both eyes are often involved. However, it can also occur after:
- an eye infection;
- a hard blow to the eye; or
- after cataract treatment.
Symptoms: floating spots, flashes of light and reduced vision
Floating spots and seeing flashes of light are the hallmark symptoms of posterior vitreous detachment. You may also experience reduced vision.Mouches volantes / Source: Acdx, Wikimedia Commons (CC BY-SA-3.0)
Floating spots
In addition to the shrinking of the vitreous, aging also causes cloudiness in the vitreous, called mouches volantes (floaters). These floaters are observed as floating or dancing spots, thread-like strands, strings or a kind of spider. With a posterior vitreous detachment, these spots can increase in number and become more prominent. Eventually, a fairly large floating spot or haze may even develop.
Flashes of light
Flashes of light, especially at night or in a dark environment, can occur because the vitreous membrane pulls on the retina in places where it is more firmly attached to the retina. Often the flashes are visible as a short-lived lightning bolt on the side of the eye.
Reduced vision
A posterior vitreous detachment can lead to reduced vision, especially when the opacities are located in front of ‘the macula’. The opacities float and move in the vitreous space. As a result, visibility will vary.
The process of vitreous detachment
Age-related posterior vitreous detachment starts around the macula and slowly spreads to the optic nerve over the years. There are often no complaints at the beginning of this process.
| Stage | Characteristics |
| Stage 0 | No features. The vitreous is still completely attached to the retina. The vitreous in front of the macula or macula may liquefy. |
| Stage 1 | The vitreous gradually becomes loose in the macula region, around the fovea (in the middle of the yellow spot of the retina). |
| Stage 2 | The vitreous detaches in the entire area of the macula. |
| Stage 3 | There is extensive vitreous detachment, except at the edge of the optic nerve. |
| Stage 4 | Complete posterior vitreous detachment; the entire vitreous has been detached. |
Examination and diagnosis
Ophthalmological examination
An ophthalmological examination will take place in the hospital. The ophthalmologist (or optometrist) looks at the inside of your eye with a so-called slit lamp, where you place your head in a headrest. A slit-shaped beam of light is then directed into the eye from different angles. A number of structures at the front of the eye are examined with a special microscope.
Fundoscopy
The back of the eye is then examined. To this end, the pupil is dilated with pupil-dilating eye drops (mydriatics) in order to view the inner eye. Such an examination is called fundoscopy. It takes about 30 minutes for the eye drops to take effect. This may cause visual acuity to temporarily decrease. This can last for about 6 hours. That is why it is not wise to drive a car yourself after the examination. The drops allow the ophthalmologist to get a better look at the inside of your eye. This is done with an ophthalmoscope; there are different methods of ophthalmology.
Retinal scan
The process of detachment can be demonstrated with a retinal scan (OCT scan), a laser technique that creates an image of the eye structure. An OCT scan images the central part of the retina (the yellow spot or macula).
Posterior vitreous detachment treatment
No treatment
Treatment for a posterior vitreous detachment is not necessary. The floating spots usually do not disappear completely, but will often become less bothersome over time. When the vitreous no longer pulls on the retina, the flashes of light usually stop on their own. If no retinal problems are found after examination (see below), reduced vision will often slowly improve.
Retinal detachment
Posterior vitreous detachment can lead to retinal detachment or retinal ablation. This may be the result of a tear in the retina, which causes fluid to get under the retina and cause the retina to become loose. Therefore, in the event of posterior vitreous detachment, the retina must be examined by the ophthalmologist to rule out this risk. If no abnormalities are found in the retina, it will continue without any consequences.
Operation for retinal detachment
Retinal detachment requires surgery to prevent someone from losing their vision.
Complications
Posterior vitreous detachment can sometimes lead to complications, such as a retinal tear, retinal detachment and macular detachment.
Prognosis
Posterior vitreous detachment can occur in anyone. This often occurs without problems and treatment is not necessary. Sometimes complications can arise. Retinal detachment can lead to blindness if medical intervention is not taken in time.
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