What is Posterior Vitreous Detachment?

Posterior vitreous detachment (PVD), also called vitreous detachment, is a common experience for older adults. It is caused by a normal part of aging, and often starts after age 50, with most having a PVD by the time they’re 70-80 years old or older. It is rare for anyone under the age of 40 to have a PVD.

What is the vitreous?

The inside of the eye is filled with a gel-like fluid called vitreous. The vitreous helps give the eye its shape and is attached to the retina by a network of fibrous connections. The retina is at the back of the eye and has cells called photoreceptor cells (also known as rods and cones) that allow us to recognize images, see different colors, sense light, maintain sight when it’s dark, and contribute to other aspects of general vision. A PVD occurs when the vitreous starts to pull away or detach from the retina. A PVD can happen in one eye or both eyes. If it does happen in both eyes, it may not occur at the same time in each eye.

What causes PVD?

The eye itself and the retina maintain their same sizes as we age, however, the vitreous becomes more liquid-like and shrinks over time. As the vitreous shrinks, it will slowly pull away from the retina and tear the fibers that connect the retina to the vitreous. This separation is a PVD. Factors that increase your risk of a PVD include eye surgery (such as cataract surgery), being nearsighted (having difficulties seeing far away, otherwise known as myopia), diabetes, and trauma to the eye. However, although a PVD may sound intimidating, the shrinking of the vitreous and separation from the retina is normal as we age. It is not uncommon to have a second PVD in the other eye within a year after the first.

Symptoms

Some individuals with a PVD will experience no symptoms, while others may report floaters in their vision. Floaters are small black spots or specks that move across the field of vision. These may look similar to cobwebs, dust, or tiny insects, such as a gnats or fruit flies that remain in view or move around when turning your head or adjusting your eyes. These are not harmful, but may be annoying if they are in your central field of vision. Others may experience flashes of light in their peripheral vision, also called lightning streaks. These are especially noticeable in the dark.

Complications

Those who do experience symptoms from a PVD typically report that they improve over the course of a few months. In rare cases, the separation of the vitreous from the retina may get complicated and may be accompanied by vitreous hemorrhage (bleeding), holes in the macula (the structure within the retina that maintains central vision), or retinal detachment, among other complications. These are rare and may present with sudden changes in vision, a large increase in floaters or flashes, or other vision distortions. It’s important to seek medical attention as soon as possible if you notice any rapid vision changes. Normally, a PVD does not cause vision loss, however, a macular hole or detached retina can, which is why these issues need urgent medical attention.

Diagnosis and treatment

A PVD can be found during a dilated eye exam or with special imaging tests called optical coherence tomography (OCT) or ocular ultrasound. In most cases, a PVD requires no treatment, however, if one of the rare complications occurs (such as a macular hole or detached retina), surgery, lasers, or other treatment options may be required to protect the eye and vision.^1-3