The Case of the Shrinking Vitreous

I’ve been working with people who have macular degeneration since my long-time friend Sue became legally blind in February 2016 from advanced dry macular degeneration, which is also called geographic atrophy.

My dad had geographic atrophy

Before that, I knew what AMD was because my dad had geographic atrophy. I was, however, 700 miles away from him and really not involved in his day-to-day life. Also, I really didn’t know much about what can happen to eyes except for things like my own poor vision. I got glasses in sixth grade. That was pretty much the extent of my exposure to eye problems.

The story of the shrinking vitreous

This is the story of what happened to me before I had the ‘shrinking vitreous’ not knowing what was happening and what I learned after I started to do research into macular degeneration and other age-related problems.

Cataract surgery

I had my cataract surgery in 2014. It went very well. So well, as a matter of fact, that after having worn glasses since sixth grade, I was able to see without them! I needed reading glasses to see things near, but that wasn’t a big deal. I didn’t spend the money to get the ‘fancy’ new lenses. Mine had a prescription and a coating to filter some blue light.

Cobweb-like floaters

I don’t know exactly when it happened, but it was the same year when my first eye all of a sudden developed cobweb-like floaters that scared the heck out of me! I was freaked out because I had no idea what was happening. I called my optometrist who got me in to see him the same day.

Posterior vitreous detachment (PVD)

After a thorough dilated eye exam, he said that I’d had a PVD which means posterior vitreous detachment. The word ‘detachment’ concerned me because I’d heard of retinal detachments. He assured me it wasn’t that. He explained what was going on, but, to be honest, I didn’t understand it.

He asked if I wanted to see a retinal specialist. I said yes. My optometrist told me that this was ‘normal’ for someone my age after cataract surgery. Maybe it was my perception of the word ‘specialist’ as being someone ‘smarter’ than my optometrist. I did see a retinal specialist who assured me that everything was fine.

Floaters and flashes in the other eye

Not long after, the other eye developed the same cobweb-like floaters and flashes of light. I did see the optometrist again, but I didn’t go to the retinal specialist. Eventually, most of the floaters went away but some remained. I still have them, but most of the time they don’t bother me unless I'm looking at a blue sky or bare wall when they are most noticeable.

Understanding posterior vitreous detachment

It’s only been in the last two years that I’ve actually understood what had happened with the posterior vitreous detachment. At the time it happened, I knew that posterior meant the bottom or back of something. I knew that vitreous referred to the jelly-like fluid in our eyes that give the eyeball its shape. I didn't quite know where the detachment came in. What’s detached from what? I finally put it all together.

Signs of retinal detachment

Before I go on, if you ever have what looks like something blocking your vision like a curtain coming from any side or like a decal or sticker lifting, call your eye specialist ASAP. That can be a retinal detachment which is an emergency!

What is posterior detachment?

Posterior does mean the back or bottom of. In this context, it refers to the bottom of the eye where the vitreous fluid touches the retina. What happens as we age is that the vitreous fluid gets thinner and shrinks. When it shrinks, the posterior/back/base of the vitreous tugs/pulls at the fibers of the retina starting in one place. That tugging stimulates the retina which is where we get the flashes of light. Most often, the retina is stimulated by light, but this is what's called a 'mechanical' stimulation. I've heard some people say the vitreous thickens, but that just doesn't make sense to me. Thick means, well, bigger, right? If the fluid got thicker, how would it tug the retina?

What I think it should be called

Over time, the vitreous may continue to pull away from the retina, but in most cases, it stops. In my opinion, because of that, a posterior vitreous detachment should be called a posterior vitreous partial detachment (PVPD). If it doesn’t stop pulling away, that’s when a full retinal detachment occurs, and as I said above, that’s an emergency.

If you are 60 or over, you may have had one already and never noticed it. If it happens in one eye, it likely will happen in both.

Why does it happen after cataract surgery?

A PVD may happen after cataract surgery because the new lens (IOL meaning Intraocular Lens) surgically inserted is thinner than the natural lens taken out as a cataract. That shifts the vitreous which can tug at the retina. That's what happened to me. It may have happened to you.

Want to know more?

I really like illustrations that show how things work. If you are interested, there’s a good fact sheet from the American Society of Retina Specialists (ASRS). It’s one that you can download, save, and print. There’s also a large-print version.

If it happens to you

First, don’t panic!! Stay calm.

As long as you don’t have any obstructions in your visual field, it’s not an emergency. If you feel you’d like to have your eye specialist check it out, definitely make an appointment.

I firmly believe that knowledge is power. You now know what the symptoms of a PVD are and what would be an emergency. Who knows...maybe it's happened to you already and you missed all the 'fun!'

Editor's Note: As of August 2023, 2 drugs known as complement inhibitors — Syfovre® and Izervay™ — have been approved by the US Food and Drug Administration (FDA) to treat geographic atrophy (GA).