Posterior Vitreous Detachment (PVD)

What is a Posterior Vitreous Detachment?

Posterior Vitreous Detachment is a common eye condition where the gel-like substance called the vitreous, that fills the space inside the eye, comes away from the eye’s retina. Posterior Vitreous Detachment is also referred to as PVD. 

Normally this Posterior Vitreous Detachment is harmless, but if the vitreous that detaches from the Retina pulls too hard from the back of the eye and takes a piece of the underlying retinal tissue with it, the condition is serious. This condition is called a Retinal Tear. It can lead to a Retinal Detachment, which can cause permanent loss of vision.

Who is Affected by Posterior Vitreous Detachment?

This occurrence of PVD typically increases with age. 75% of people over the age of 60 develop PVD. It is not necessarily a sign of eye disease. 

Patients at greater risk for PVD include people who: 

• Are nearsighted 
• Are diabetic 
• Have had cataract surgery or
• Have had eye trauma 

What Causes Posterior Vitreous Detachment?

Posterior Vitreous Detachment is caused by natural changes to the vitreous gel. As people age, the eye’s vitreous gel becomes more watery and can shrink in size. This can also cause the vitreous gel to move away from the retina at the back of the eye towards the centre of the eye. This makes it harder for the eye to maintain a normal shape.

Symptoms of Posterior Vitreous Detachment

Posterior Vitreous Detachment does not cause pain but has symptoms including:

• Flashes of light: bright and rapid flashes, caused by the vitreous gel pulling on the retina.
• New Floaters or a sudden increase in Floaters. These may be tiny dots, floating ‘insects’ or larger clouds or cobwebs which move across the vision.

What is the Impact of Posterior Vitreous Detachment?

PVD does not normally harm the eye or cause permanent loss of vision, and these symptoms do not always mean a Retinal Detachment is present. However, you should see your ophthalmologist as soon as possible.

A PVD will cause problems when the vitreous detaches from the Retina. This Retinal Tear can lead to a Retinal Detachment, which can cause permanent loss of vision. 

How is Posterior Vitreous Detachment Diagnosed?

Diagnosis of Posterior Vitreous Detachment is done during an Eye Health Examination. General Eye Examinations are recommended annually after 60 years of age, even if you don't have symptoms or wear glasses or contact lenses. 

Early detection of PVD can help protect your vision.

How is Posterior Vitreous Detachment Treated?

Where Floaters persist or return, your doctor may give you the option to 

• use a laser to reduce the Floaters, or 
• have surgery to take out the Vitreous Gel and clear the floaters.

If you have a Retinal Tear, 

• Laser Surgery or 
• Retinal Cryotherapy, which freezes the tear, can repair it.

What is a Retinal Tear?

A Retinal Tear can form when a part of the Retina separates from the outer layers of the eye. 

If a Retinal Tear is not treated early, retinal tears can lead to a more serious condition called Retinal Detachment, which may lead to partial or complete loss of vision.

Who Does Retinal Tear Affect?

A Retinal Tear can be affected by a patient's

• Age
• The degree of Myopia (nearsightedness)
• Associated lattice degeneration (thin patches in the retina)
• Trauma
• A family history of retinal tears or detachment
• Prior eye surgery

Causes of Retinal Tear

Retinal Tears occur when the gel-like vitreous in the eye becomes more liquid and exerts an abnormal pull on the retina.

At birth, this gel is attached to the retina, but as we age, the gel separates from the retina creating a Posterior Vitreous Detachment (PVD). In most cases, this happens without any issue. But sometimes, the gel builds up so much and pulls so hard that it tears the retina.

Symptoms of a Retinal Tear

• Patients with acute Retinal Tear may experience:
• Sudden onset of black spots or floaters in the affected eye
• Flashes of light (Photopsia) 

Additional symptoms can include 

• blurred vision or 
• closing in on your peripheral vision,

If associated:

• Vitreous Haemorrhage (bleeding in the clear cavity of the eye) or 
• Retinal Detachment,

However, in some cases, a retinal tear may not manifest any noticeable symptoms.

Retinal Tear Diagnosis

Retinal Tears are diagnosed as part of a General Eye Examination, further diagnostics tests typically include:

• A retinal examination - The doctor may use an instrument with a bright light and a special lens (ophthalmoscope) to examine the back of your eye, including the retina. 
• Ocular Ultrasound Imaging - Your doctor may use Ocular Ultrasound Imaging if bleeding has occurred in the eye, making it difficult to see your retina.

How is a Retinal Tear Treated?

If a Retinal Tear is addressed early enough it can be protected from causing vision loss. 

Retinal Tears require treatment using either:

• Laser Surgery - is often performed using a lens placed on the eye. 
• Retinal Cryotherapy (freezing), which seals the retina to the back wall of the eye. 

What if a Retinal Tear is Untreated?

Untreated Retinal Tears usually result in 

• Permanent, severe vision loss or 
• Blindness