You have always been an enthusiastic runner. It has been your passion for many years now. With your daily running sessions, you are having the best time of your life and feeling healthy and vital.
But one day you wake to find something is different about your eyes. You can see everything perfectly but there are small, squiggly lines everywhere. You wash your eyes with water with the hope to flush out an offending contaminant, but nothing happens.
"It's not that bad. They are not really hurting me anyway," you say to yourself and head out for work.
But with every passing day, the squiggly lines keep getting worse until you are forced make an appointment with your doctor. You are then told by your doctor that you suffer from something called a vitreous detachment.
What? You have never heard of this strange disease before. And to be honest, it does sound a bit scary.
So what is vitreous detachment, anyway? What causes this eye problem and is there a way to treat it? Keep reading the article to learn more.
Vitreous Detachment: The Basics
Before understanding what vitreous detachment is, it is important to have some basic understanding of different parts of the human eye.
The human eye comprises several parts. These include:
- The cornea, which is the outermost layer of your eye
- The lens is a transparent structure present just behind the iris
- The retina is a tissue that lines the back of your eyes and is sensitive to light
- The vitreous body, a clear substance present in the space between the retina and the lens
As mentioned above, the vitreous fluid is a clear fluid with a gel-like consistency that fills your eye. It consists of small fibers that extend toward the retina and attach to it.
With increasing age, these little fibers in the vitreous start pulling away from the retina slowly, a process known as vitreous detachment or posterior vitreous attachment. This normally happens in middle to older age, mostly after a person hits their 50's. However, it may also strike younger people as well. (1,2)
In most people vitreous detachment produces a number of symptoms; however, it can also be completely asymptomatic in some.
What Triggers Vitreous Detachment?
Age is the commonest cause of vitreous detachment. In fact, it is so common in older people that some experts consider it as a normal part of aging. As you age, it gets difficult for the vitreous body to maintain its shape. It eventually starts shrinking, begins losing its gel-like consistency, and gets more liquid-like. Despite the changes in the consistency of vitreous fluid, the space between the retina and lens remains the same and that's where problems begin to arise.
The more the vitreous fluid shrinks, the more it detaches its fibers from the retina.
Vitreous detachment commonly hits people after the age of 60 but can happen earlier than that as well. It is relatively uncommon in people below 40 years. (3)
Recognizing Vitreous Detachment
A vitreous detachment can present itself in the form of three different visual disturbances. These disturbances are described below. (4, 5)
Flashes
People with vitreous detachment compare flashes to seeing stars after hitting their heads against hard surfaces. These flashes may last for a few seconds to even minutes. As the disease progresses, the frequency of these flashes starts reducing and they may even completely stop once the vitreous gel is completely separated from the retina.
Floaters
Floaters appear in your field of vision in the form of small dots, dust, specks, or even shadows resembling a cobweb. They are more common during the first few weeks of this disease and become more prominent when you are looking at the sky, a white wall, or a light surface.
Cobweb Effect
Sometimes, you may be able to spot the outer edge of your vitreous as it separates itself from the retina. As a result, you may feel like you are peeking through a cobweb. This cobweb effect is also incomplete and tends to go away once the process of detachment finishes.
What Complications Can Occur With Vitreous Detachment?
In some people, vitreous detachment is not too bothersome, but in others, it can lead to potential complications that may hurt the eye and even affect the eyesight. Some complications that may occur due to vitreous detachment are explained below.
Retinal Tear
Sometimes during the vitreous detachment, as the vitreous fibers are pulling away, they tend to produce a hole in the retina resembling a tear. This supposed retinal tear can be dangerous and if not treated urgently, it may cause the retina to detach as well. (6)
Retinal Detachment
Sometimes, as the vitreous body is pulling away, it pulls with itself the entire retina, causing its detachment. Retinal detachment secondary to vitreous detachment is considered a medical emergency and requires urgent care.
Macular Hole
In some cases, vitreous detachment drills a hole in the macula, an important part of the retina responsible for controlling the central vision. This may happen even before you start experiencing flashes or floaters in your vision. (7)
Macular Pucker
Sometimes, a thin layer of scar tissue grows on the macula as a result of the vitreous attachment. However, this normally takes years to occur.
Diagnosing Vitreous Detachment
Even though it is quite common to encounter vitreous detachment in the older ages, getting an appointment from an eye doctor is important, especially if you start developing any symptoms. This is because frequent floaters and flashes can indicate a potential retinal detachment secondary to vitreous detachment.
Detailed Eye Exam
To know about your condition in more detail, the doctor might need to perform a test. The test commonly includes a detailed examination of the eye and can confirm a retinal detachment, vitreous detachment, or other problems in the eye. Before conducting this test, your doctor will put some drops in both of your eyes to dilate the pupils. Once the pupils are dilated, it becomes easier for them to examine the back of the eyes completely and take a closer look at the macula, optic nerve, and retina.
The examination lasts about 30 minutes. It can take a few hours for the dilation to wear off. Bring a pair of sunglasses to put on after your appointment or line up an alternative driver, as sunlight and bright lights may be uncomfortable.
Additional Testing
While a detailed eye exam is sufficient to establish a diagnosis in most people, some cases require additional tests just to be sure. For instance, in some people, the vitreous gel is too clear to understand if a detachment has taken place. To confirm the diagnosis in such a scenario, the doctor may either suggest an eye ultrasound or an optical coherence tomography. (8)
Both types of tests are aimed at creating a three-dimensional model of your eye. The only difference is that an eye ultrasound utilizes high-frequency sound waves whereas an optical coherence tomography includes the use of light for this purpose.
Treating Vitreous Detachment
Most cases of vitreous detachment are not too serious and usually do not require any intervention. In most of these cases, it takes up to three months for the detachment process to complete, and by then, most symptoms that you have been experiencing since the initial days have been settled. However, if you experience any of the following conditions, additional treatment might be needed.
Persistent Floaters
If you continue experiencing lots of floaters even after three months of diagnosis and are unable to see things clearly, the doctor may recommend undergoing a vitrectomy. It is an outpatient process and involves the removal of all or a small part of the vitreous gel from the eye to relieve the symptoms.
Tears on the Retina
Sometimes, the fibers in the vitreous fluid pull too hard that it creates tears on one or multiple locations on the retina. This may cause the fluid to enter under the retina forcing it to detach. This condition is a medical emergency and if not treated timely, vision loss may occur. Surgery is normally needed to heal tears on the retina and address retinal attachment.
Holes in the Macula
In some cases, vitreous fluid is attached too firmly to the retina and when it pulls away, it drills holes in the macula. These holes may cause your vision to become blurry and distorted. Most macular holes can heal on their own and surgery can be performed to address those that don't.
Who Is At Risk of Vitreous Detachment?
Some of the most common factors putting you at risk of developing a vitreous detachment are:
- Old age
- Diabetes
- History of eye trauma
- Nearsightedness
- History of cataract surgery
If you have already developed vitreous detachment in one eye, chances are you will develop it in the other eye in a year or so. Older people, usually in their 60s, are more likely to get this condition but younger people with a history of eye trauma are also prone to developing it.
Wrapping Up
Vitreous detachment sounds like a scary condition but is likely harmless and hardly needs any intervention. However, if you develop any symptoms like floaters or flashes, it's always better to get yourself checked by an eye specialist just to be sure.
