Posterior Vitreous Detachment: An Overview

U Hin Lai

Introduction

Posterior Vitreous Detachment (PVD) is a common condition where the vitreous, a clear jelly-like substance, separates from the internal limiting membrane of the retina at the back of the eye (1, 2). The prevalence of PVD is associated with the increase of age. PVD typically affects most people by the eighth decade of life (3). Of note, prevalence and incidence of PVD is not documented well; most data collected are not large-scale studies done at an international or national level. However, the most common cause of PVD is old age (2). Other important Risk Factors for development PVD include female gender, myopia (especially if >-6D; high myopia), myopia, underlying ocular diseases, menopause (potentially due to lack of oestrogen), Vitamin B6 (Pyridoxine) deficiency, long-standing inflammation, ocular trauma, and ocular surgery (2, 4).

Symptoms and Signs

Symptoms of PVD include:

  • Floaters & Flashes
  • Blurred Vision
  • Reduced Visual Acuity
  • Painless

It is difficult to elicit signs of PVD outside of Ophthalmology and Optometry clinics. In a General Practice (GP) setting, direct fundoscopy may reveal a Weiss ring, if separation of the vitreous and optic nerve head occurs (5). A Weiss ring presents as a grey-brownish ring.

As PVD symptoms are initially similar to retinal detachment and vitreous hemorrhage; therefore, it is important for referral to Ophthalmology to ensure a thorough assessment.

Investigations

After referral to Ophthalmology, investigations can include (2):

  • Slit Lamp and/or Indirect Ophthalmoscopy: Used to examine the front and the back of the eye. This can be used to look for any gross abnormalities.
  • B-Scan Ultrasonography: Ultrasound machine used to visualize any abnormalities/foreign bodies in the anatomical structure of the eye. PVD may show an undulating (smoothly rising and falling outline) appearance (6).
  • Optical Coherence Tomography: Use of light waves to allow for visualization of layers of the retina. This can be used to rule out retinal detachment or other pathologies.

Treatment

PVD is a benign condition that requires no treatment. Symptoms that patients experience, such as floaters and flashes, usually are less noticeable after 3 months (7). If patient do remain symptomatic and floaters are affecting quality of life, treatment may be provided. A potential treatment option is pars plana Vitrectomy (8). This is a surgical technique that allows for access to the posterior segment of the eye.

Complications & Important Safety Netting Advice

Although PVD is benign, it is associated with increased risk of developing retinal tears, retinal detachment, and vitreous haemorrhage (9). Therefore, it is important to provide appropriate safety netting advice for patients. This advice includes seeking medical attention if vision worsens, if there are increased number of floaters and flashes and to arrange follow-up with appropriate clinicians (10).

Conclusion

PVD is a common condition that all clinicians may encounter throughout their career. It is important to know the relevant symptoms so that we can counsel patients and to appropriately refer to rule out sinister causes.

References

  1. Sebag J. Posterior Vitreous Detachment. Ophthalmology. 2018;125(9):1384–5.
  2. Ahmed F, Tripathy K. Posterior Vitreous Detachment. 2023 Feb 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 33085420.
  3. Tabernero SS, Lim JI, Bhagat N, Manzanas L, Fernandez MAM, Kim N, et al. Posterior Vitreous Detachment [Internet]. EyeWiki. 2023 [cited 2023May4]. Available from: https://eyewiki.aao.org/Posterior_Vitreous_Detachment
  4. Akiba J. Prevalence of posterior vitreous detachment in high myopia. Ophthalmology. 1993;100(9):1384–8.
  5. Columbia University. Weiss Ring [Internet]. Vagelos College of Physicians and Surgeons. 2022 [cited 2023May4]. Available from: https://www.vagelos.columbia.edu/departments-centers/ophthalmology/education/digital-reference-ophthalmology/vitreous-and-retina/tumor-others/weiss-ring#:~:text=Peripapillary%20glial%20tissue%20that%20remains,of%20fibrous%20astrocytes%20and%20collagen
  6. De La Hoz Polo M, Torramilans Lluís A, Pozuelo Segura O, Anguera Bosque A, Esmerado Appiani C, Caminal Mitjana JM. Ocular ultrasonography focused on the posterior eye segment: What radiologists should know. Insights into Imaging. 2016;7(3):351–64.
  7. The American Society of Retina Specialists. Posterior Vitreous Detachment [Internet]. Posterior Vitreous Detachment – Patients – The American Society of Retina Specialists. [cited 2023May4]. Available from: https://www.asrs.org/patients/retinal-diseases/9/posterior-vitreous-detachment
  8. de Nie KF, Crama N, Tilanus MA, Klevering BJ, Boon CJ. Pars plana vitrectomy for disturbing primary vitreous floaters: Clinical outcome and patient satisfaction. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2012;251(5):1373–82.
  9. Gishti O, Nieuwenhof R, Verhoekx J, Overdam K. Symptoms related to posterior vitreous detachment and the risk of developing retinal tears: A systematic review. Acta Ophthalmologica. 2019;97(4):347–52.
  10. Tidy DC. Posterior vitreous detachment (PVD) [Internet]. Patient.info. 2022 [cited 2023May4]. Available from: https://patient.info/doctor/posterior-vitreous-detachment#nav-6
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