Posterior vitreous detachment or PVD is a condition whereby the gel in the posterior chamber of the eye separates from the retinal layer of the eye. With PVD, patients come to the Best Eye Specialist in Lahore with complaints of flashes of light and floaters. While these symptoms fade over time, they still warrant review by an expert ophthalmologist. Read on to know more about PVD, its symptoms, complications, diagnosis and management:

What is posterior vitreous detachment?

With aging, the gel or vitreous located in the posterior chamber of the eye changes. This vitreous is normally attached to the neurosensory layer of the eye called retina. As the vitreous becomes less solid and more viscous due to age-related changes, it shrinks and pulls away from the retinal layer. When enough of the vitreous pulls away from the retina, posterior vitreous detachment occurs.

Posterior vitreous detachment is a common age-related occurrence and rarely leads to visual loss. In most cases, treatment is not recommended, as many people don’t even have any symptoms.

What are the symptoms of posterior vitreous detachment?

The symptoms of PVD are mild and with the passage of time become less noticeable as the brain learns to ignore them. Posterior vitreous detachment presents with:

• Flashes of light in the side vision particularly as one sees in the dark
• Tiny specks called floaters in the field of vision. These floaters can look like cobwebs or specks of dust.
• In rare cases a dark curtain can move across the field of vision

What are the complications of posterior vitreous detachment?

Posterior vitreous detachment is not painful and commonly doesn’t lead to visual loss. However, complications can occur in about 15 percent of cases in people with posterior vitreous detachment, which can impact vision. These include:

• Macular pucker or scar tissue
• Macular hole in the center of the retina
• Retinal tear
• Retinal detachment

What are the risk factors for posterior vitreous detachment?

The risk of PVD increases with age, and is therefore common in the age group of 40 to 60 years. Thus, the odds of getting PVD rise as one gets older, and if one already has a history of PVD in one eye. Other factors that predispose to PVD include:

• Eye injury or trauma to the eye
• Diabetes
• History of eye surgery such as cataract
• High myopia

How is posterior vitreous detachment diagnosed?

The diagnosis of posterior vitreous detachment is made on thorough history and physical examination. The confirmation of posterior vitreous detachment is made on dilated eye examination after instillation of topical mydriatic drops. These drops dilate the pupil and allow fundal view through a special lens and biomicroscope. The healthcare provider can then examine your retina, optic nerve head and the macula. The mydriatic agent can take a few hours to wear off. During this time, a pair of sunglasses can help to lessen discomfort of bright lights.

In addition to the slit lamp examination, other investigation that help with posterior vitreous detachment include:

• Optical Coherence Tomography (OCT): an OCT can diagnose the condition of posterior vitreous detachment.
• B-scan ultrasound: high frequency ultrasound waves are used to create an image of the vitreous cavity and picture of the eyes.   

How is posterior vitreous detachment treated?

The treatment of posterior vitreous detachment is only mandated if it causes retinal tear or detachment. In other cases, posterior vitreous detachment does not need treatment. Complete vitreous detachment takes about three months during which the patient can continue to see floaters.

Treatment can be needed if:

• Vitrectomy procedure for continued floaters: in case there are a lot of floaters in the eye or there is difficulty seeing clearly vitrectomy procedure may be indicated. This procedure involves removal of the vitreous gel from inside the eye.
• Macular holes: if macular holes appear secondary to PVDs, there can be distorted vision with metamorphopsia. While some macular holes heal on their own, sometimes surgery is necessary to repair them.
• Retinal tears: if the vitreous pulls too hard on the retina, it can cause retinal tears under which fluid can enter. Without management, this can cause retinal detachment. Retinal tears need to be treated at Ali Medical Centre.