The vitreous is the gel-like fluid that fills the eyes. It is full of minuscule fibers that attach to the retina. As people age, the vitreous fibers separate from the retina. As this happens, a person may notice symptoms affecting their vision.
In this article, we look at what vitreous detachment is in more detail, as well as its symptoms, potential complications, causes and risk factors, and treatment.
We also look at the outlook for those with vitreous detachment and compare the condition with retinal detachment.
Doctors also refer to vitreous detachment as posterior vitreous detachment (PVD). It occurs as part of a natural change during adulthood and usually begins after age
As people age, the gel-like fluid that fills the middle of the eye, called the vitreous, becomes less solid and more like a liquid in consistency.
While the vitreous cavity remains the same size, the volume of the vitreous no longer fills the space. This change in volume causes the vitreous to pull back from the retina.
The cavity attaches to the retina through millions of tiny fibers. As the fluid pulls away and the fibers break, the vitreous becomes separated from the retina.
Some people with PVD may not notice any symptoms.
Other people may have mild symptoms if the condition progresses gradually. However, the process can tear the retina or a blood vessel if the separation is forceful.
Others may experience the following:
- specks that move around in a person’s field of vision, called floaters
- flashes of light in the peripheral vision
- in rare cases, a dark shadow moving across the field of vision or decreased vision
Dark shadows moving across the field of vision or decreased vision are more likely to be a sign of retinal detachment. If these symptoms are present, a person should contact a doctor as soon as possible for an eye examination.
Around 85% of people who experience vitreous detachment do not develop complications and typically stop experiencing floaters and flashes of light in their peripheral vision within a few months.
Though uncommon, complications of vitreous detachment can
- Epiretinal membrane: Doctors also refer to this as “macular pucker.” It occurs when the vitreous pulls back from the retina, causing a thin, clear membrane — called an epiretinal membrane — to form on the retina. This condition can lead to retina wrinkling, which can distort and blur vision. If this occurs, a person may require corrective surgery.
- Macular hole: PVD can tear a hole in the part of the retina that controls central vision, called the macula. This complication can occur during the early or later stages of vitreous detachment.
- Retinal tear: As the fibers in the vitreous pull away from the retina, they can tear a hole in the retina. A retinal tear requires treatment via laser or cryotherapy as soon as possible. Without urgent treatment, it can lead to a detached retina.
- Retinal detachment: In fewer than 1 in 10 people, the vitreous may pull away from the retina hard enough to completely tear the retina. This tear can cause retinal detachment, which can cause loss of vision or a black shadow over the field of vision. This condition requires urgent surgical treatment.
The vitreous gel that fills the eye shrinks and becomes more liquid in consistency over time due to expected “wear and tear” as people age. Eventually, the volume of vitreous gel cannot fill the vitreous cavity anymore, so the gel separates from the retina.
Between 1 and 3 months after this process begins, the vitreous gel shrinks away from the retina further until even the sides of the gel separate from the retina, and vitreous detachment is complete. By then, the vitreous gel only attaches to the retina at the vitreous base.
The clear vitreous fluid then fills the spaces between the vitreous gel and the retina.
The risk of PVD is
- are over age 50 years — it is rare in people under 40 years old
- have myopia or nearsightedness
- experience vitreous detachment in one eye, as they will likely experience it in the other eye within 1 year
Other risk factors for PVD include eye trauma and eye surgeries such as cataract surgery.
An eye doctor can diagnose PVD as part of a dilated eye exam.
A dilated eye exam is typically painless but may be uncomfortable if the doctor presses on the eyelids to check for tears in the retina.
There is no specific treatment for PVD since most cases do not involve complications, and the process is not a threat to sight.
Symptoms such as floaters generally disappear within a few months, and the condition does not cause pain or serious damage.
If a person develops complications from PVD, they may require urgent treatment. Treatment for complications such as a retinal tear may
Retinal detachment is a possible complication of PVD. While vitreous detachment is an expected part of aging and is not a risk to a person’s sight, retinal detachment is a serious problem that requires urgent medical attention.
The retina does not function if it detaches, which can cause vision to blur. Retinal detachments cause immediate vision loss, but doctors can sometimes correct it with surgery if treated promptly and with good follow-up care.
Symptoms of retinal detachment can be similar to those of PVD. A person should contact an eye doctor if they have symptoms of either condition. Symptoms include:
- the appearance of many new floaters in the field of vision
- sudden flashing lights, which may look similar to “seeing stars” after being hit in the eye
- a gray curtain over the field of vision
- a shadow in the peripheral vision
As the vitreous gel moves and shrinks away from the retina, it can adhere to the retina and pull it hard enough to cause a tear. Fluid can then leak through the tear and lift the retina, which can cause it to detach.
While people generally do not require treatment for PVD, a doctor will recommend surgery to repair a detached retina. Types of surgery include:
- Vitrectomy: This surgery will remove the vitreous, which pulls on the retina. Doctors will replace the vitreous with an air, oil, or gas bubble to push the retina back into place to allow it to heal.
- Pneumatic retinopexy: An ophthalmologist inserts a gas bubble into the eye, pushing the retina into the correct position to allow it to heal.
- Scleral buckle: To perform this surgery, a retina specialist — an ophthalmologist — will sew a soft plastic or rubber band to the outside of the eyeball, which gently presses the eyeball inwards. This surgery pushes the detached retina against the eye wall and helps it to heal.
PVD is a natural part of the aging process. As people age, the vitreous gel, which fills the cavity in the middle of the eye, shrinks and changes to a more liquid consistency. As this happens, the gel pulls away from the retina, and the small fibers in the gel separate from the retina.
PVD requires no treatment and is usually harmless.
However, in some cases, PVD can lead to complications. For this reason, anyone with new symptoms such as flashes, floaters, a shadow over their field of vision, or loss of vision should consult a doctor. An eye care professional will evaluate a person’s eyes to rule out any complications.