Vitreous Detachment - An Age-Related Eye Disease

Introduction

The eye is divided into three fluid chambers - anterior, posterior, and vitreous. The space between the cornea and the iris is called the anterior chamber. The space between the iris and the lens is called the posterior chamber. The space between the lens and the retina is called the vitreous chamber. Aqueous humor fills the anterior chamber. The vitreous chamber is filled with a more viscous gel-like fluid. The vitreous humor is transparent and allows the passage of light to the retina. It also helps maintain the shape of the eye.

What Is Called Vitreous Humor?

Also called vitreous fluid, it is a transparent, colorless gel-like substance in the eye that occupies the space between the lens and the retina. It is present in the posterior segment, or the back of the eye, that fills the vitreous chamber. It has a thick gel-like consistency and occupies 80 % of the eye. It consists of water, a mixture of collagen, and protein.

What Is the Function of Vitreous Humor?

The round shape of the eyes is maintained by vitreous humor, and the pressure within it helps keep the retina in place. The transparent fluid also helps in the passage of light through the eyes to reach the retina.

What Is Vitreous Detachment?

The gel-like substance is full of tiny fibers attached to the retina. Changes due to age, the fibers of the retina get pulled away from the retina, causing vitreous detachment. Usually, vitreous detachment is seen after 50 years of age. The vitreous gel changes its composition, is liquefied, and shrinks, making the collagen and protein present in the gel stringy. These stringy structures are called floaters.

These are the two most important symptoms of vitreous detachment.

• Floaters - The appearance of floaters when the light passes through the irregularities of the vitreous gel. This leaves a shadow on the retina at the back of the eye. Floaters appear as small dark spots or small curved lines passing across the vision. The appearance of floaters is not an alarming sign. However, a sudden increase in the number of floaters may require medical advice. The process of a vitreous detachment is gradual, and many people will leave it unnoticed; however, the sudden appearance of noticeable floaters with other symptoms in the eye needs immediate attention.

• Flashes of Light - The appearance of streaks of light usually at the side of vision. It is more likely to appear in darker environments.

What Are the Risk Factors for Developing Vitreous Detachment?

• Old Age - Vitreous detachment is a common age-related eye disease that usually occurs in the late 50s and after 60 years. It is rarely seen in young individuals.

• Female Gender - The progression of the disease is faster in women when compared to men.

• Eye Surgery - Various ocular surgeries like cataract surgery, Lasik, intraocular lens placement, and others can cause vitreous modification.

• Eye Injuries - Deep penetrating injury to the eye can cause vitreous detachment.

• Nearsightedness or Myopia - Patients with myopia who have an axial length of an eyeball greater than 30 mm show an increased chance of developing vitreous detachment.

• Menopause - Post-menopausal female patients are more prone to develop vitreous detachment.

• Vitamin B6 - Increased take of Vitamin B6 can increase the chances of vitreous detachment in females.

• Inflammation - Long-standing ocular inflammations can cause proliferation and fibrosis. Fibrosis over the retina can cause vitreous detachment.

• Presence of Diseases - Underlying diseases like retinitis pigmentosa and sticklers syndrome may result in vitreous detachment.

What Are the Complications of Vitreous Detachment?

• Retinal tear.

• Retinal detachment.

• Vitreous hemorrhage.

• Cystoid macular edema.

• Macular hole.

How Is Vitreous Detachment Diagnosed?

A complete eye examination followed by a few special tests confirms vitreous detachment.

• Dilated Eye Examination - Simple and painless routine eye examination to check for vision problems that are otherwise difficult to see. Eye drops are applied to dilate the pupil to check for eye problems. Dilated eye examinations have to be done every one to two years if one is over 60 years of age and has a familial history of glaucoma. A dilated pupil will let more light rays enter the eyes and make eye examination easier. For a few hours after the dilated eye examination, the vision may appear blurry and light-sensitive.

• Ocular Ultrasound - An imaging technique where high-frequency sound waves are used instead of light rays to create an image of the retina and the surrounding structures. It helps in improved visualization of eye structures. The most important uses of ophthalmic ultrasound are to find the globe length, lens dislocation, tumor visualization, and detection of retinal detachment. Ocular ultrasound is a safe procedure and does not expose the patient to radiation.

How Is Vitreous Detachment Treated?

Vitrectomy Surgery - Vitreous Detachment is an age-related change and does not cause a serious eye condition. Treatments are given to avoid the complications of vitreous detachment. In vitrectomy surgery, very small openings are made in the eyeball and most of the vitreous gel from the eye is removed with a section tool. The doctor uses a laser or freeze treatment to repair the retina. Injection of air, gas, or silicon oil into the eye is done to hold the retina in place. This procedure is preferred in patients with an increased number of floaters, causing serious vision problems.

How Is Vitreous Detachment Managed?

Elderly people with vitreous detachment can carry out all day-to-day activities without any restrictions. This condition does not change, but the floaters and flashes can become less noticeable over time. After the diagnosis of vitreous detachment in one eye, it is quite common to develop vitreous detachment in the other eye as well. Proper symptomatic treatment is done to avoid the complications of vitreous detachment

• Gentle eye movements in circles may shift a floater out of the direct line of sight.

• Reducing the brightness of television, smartphones, and computers.

• Use of eyeglasses if required.

• The use of sunglasses in bright light makes the floaters less noticeable.

Conclusion

Vitreous detachment occurs when the gel-like substance gets separated from the retina. It is considered a normal age-related disease of the eye. The symptoms become less noticeable as time passes. The condition is not painful and does not cause vision loss. But one must make sure to visit an ophthalmologist and get a routine eye examination to prevent the complications of vitreous detachment.