Posterior Vitreous Detachment: Symptoms and When to Seek Help

Overview

Symptoms such as flashing lights or floaters in your vision can be worrying, particularly if you have never experienced them before. There are many reasons why these can occur, but one of the most common is called a posterior vitreous detachment (PVD). This is a natural process that occurs inside the eye as we get older and in most cases is not harmful. It can, however, cause tears in the retina or retinal detachment, which are serious problems that can be sight threatening. This article aims to increase your knowledge about PVD and explain when you seek expert advice.

What Is Posterior Vitreous Detachment?

When we are born, the vitreous gel inside our eyeball is firmly attached to the wall of the eye, known as the retina. In most people, at some point in their life, the vitreous gel detaches away from the retina in a process which is known as posterior vitreous detachment.

What Causes Posterior Vitreous Detachment?

The most common cause of posterior vitreous detachment (PVD) is ageing. Like many tissues of the body, the eye changes as we get older. The vitreous gel mainly consists of water, hyaluronic acid and collagens. It begins as a gel-like substance but once we get into our 50s/60s/70s, the vitreous gel goes through a liquefaction process which results in it becoming less sticky and it then usually detaching from the retina. This is a PVD and it is very common, particularly as people get older. 

There are certain scenarios which mean the process can happen earlier in life. The most common risk factor for earlier PVD is myopia (being short sighted). There are other risk factors for PVD development such as trauma to the eye or having eye operations such as cataract surgery.

Is Posterior Vitreous Detachment Serious?

In the majority of cases, a posterior vitreous detachment (PVD) does not cause any long term serious problems. Many people who develop a PVD can notice floaters which might be troublesome. These floaters usually become less noticeable with time, but if they remain annoying, surgery can be considered to remove them, with a retinal specialist such as Mr Neffendorf.

A PVD can however be serious and threaten sight. This is because it can sometimes pull a tear in the retina when it is detaching. This can be considered like pulling blutack off a wall and a flake of paint coming away. It occurs in less than 5% of PVD events. However, the symptoms of a PVD and a PVD complicated by a retinal tear can be very similar, meaning assessment by an experienced optician or ophthalmologist is recommended. Retinal tear is a significant risk factor for a retinal detachment, which is a sight threatening emergency. Most retinal tears can be treated if they are caught early, further supporting the need for specialist assessment if you develop new floaters or flashes of light.

Symptoms of Posterior Vitreous Detachment to Watch For

What Symptoms Can Posterior Vitreous Detachment Cause?

The classic symptoms of a posterior vitreous detachment (PVD) are flashes of light and floaters. Typically, patients report the flashes of light usually occur in the early evening or at night. They also characteristically mention the position of the flash being in an arc on the outside of the vision. However, symptoms can vary and some people report different characteristics to the flashes. It is also common for one large central floater to be present, but other floaters may be present.

As mentioned earlier, sometimes PVD can cause a retinal tear. This also classically results in flashes of light and floaters. We often hear that the floaters are more numerous if a retinal tear has occurred, but this is not a reliable sign. Ultimately, the signs and symptoms of a PVD versus a retinal tear are very similar and the only way to truly differentiate between the two is to see an experienced optician or ophthalmologist such as Mr Neffendorf for a dilated eye examination.

What Is the Difference Between Posterior Vitreous Detachment and Retinal Detachment?

This is an important distinction because posterior vitreous detachment (PVD) rarely affects the vision whereas an untreated retinal detachment has a high risk for irreversible loss of vision. Simply put, a PVD is when the vitreous gel detaches from the retina. In contrast, a retinal detachment is when the retina detaches from the wall of the eye. 

Retinal detachment is an ophthalmic emergency which usually requires urgent surgery with a retinal surgeon such as Mr Neffendorf.

When to Seek Help for Posterior Vitreous Detachment

When Should I Seek Help for Posterior Vitreous Detachment?

Anyone who develops a sudden increase in floaters and/or flashing lights is highly recommended to see an experienced optician or ophthalmologist for a dilated eye examination. This is best done urgently, and ideally within 48 hours of the symptoms starting. This is because earlier recognition of a problem such as a retinal tear means more prompt treatment and better long term outcomes for vision.

How Is Posterior Vitreous Detachment Diagnosed?

A PVD is diagnosed by an experienced optician or ophthalmologist. This is done by dilating the pupil of the eye with eye drops in order to allow a careful examination of the vitreous gel and retina using a slit lamp microscope and lens. Signs can be subtle and scans such as an OCT can be helpful in supporting the diagnosis. Dilating drops blur your vision and therefore you cannot drive for 4-6 hours after this examination, until the dilating drops have worn off. It is a non-invasive examination.

What Happens After a Posterior Vitreous Detachment Diagnosis?

When a posterior vitreous detachment (PVD) is diagnosed, the clinician will explain the condition to you, often also showing you the findings of any scans done (such as an OCT). They will explain that this is a common process, and that the high likelihood is that there will be no long term consequences for your vision. Flashing lights tend to reduce in frequency over time and then stop completely. Floaters usually become less noticeable over time, although can remain visible when looking at a blue sky or white wall. The vast majority of people do not find floaters troublesome, and no intervention is needed. However, a small group of people find floaters very awkward and if this is the case for you, there are options which can be performed by retina surgeons such as Mr Neffendorf.

There is considerable debate about whether a PVD requires follow-up. If you have never had any eye problems before, and your optician or ophthalmologist is confident that you have a simple PVD with low risk for developing a problem such as a retinal detachment, then often you will be discharged. You should be informed that any new symptoms such as worsening floaters, new flashes, reduced vision or a shadow in the vision should prompt you seeking an urgent appointment with an experienced optician or ophthalmologist.

Despite this, many people with a ‘simple PVD’ often like to be followed up for reassurance, and Mr Neffendorf frequently sees such patients.

In addition, if you have risk factors for a retinal tear or retinal detachment, such as a history of myopia (short sightedness), blunt trauma, inflammation in the eye or previous eye surgery, then it is highly advisable to have a follow-up appointment after a PVD diagnosis is made. This is because sometimes problems like a retinal tear can occur slightly later than at initial presentation and repeat examination is prudent to check for any signs of a problem. 

The key take home message is that if you notice new symptoms after being diagnosed with a PVD, such as worsening floaters, flashing lights, reduced vision or a shadow in your vision that you seek urgent review by an experienced optician or ophthalmologist such as Mr Neffendorf for a dilated eye examination.

FAQs

Can Posterior Vitreous Detachment Cause Permanent Vision Loss?

No, it is highly unlikely that a PVD, on its own, would cause permanent vision loss. However, complications of a PVD such as a retinal detachment have a high risk for permanent vision loss if diagnosed late or left untreated.

Can Posterior Vitreous Detachment Happen in One Eye Only?

Usually a PVD occurs in one eye and then the other eye goes through the same process within a couple of years. 

How Long Does Posterior Vitreous Detachment Last/How Long Does It Take to Adapt to Symptoms?

This is quite variable depending on the person. In many people, the symptoms of PVD are mild and settle quickly. In others, flashing lights can persist for a few months months and floaters can persist long-term. In the vast majority of people, symptoms such as floaters become non-concerning after a few months.

What Is the Average Age for Posterior Vitreous Detachment?

The average age for a PVD is 60-70.