Is vitreous detachment a normal part of aging?

Posterior Vitreous Detachment as a Normal Part of Aging

Yes, posterior vitreous detachment (PVD) is a normal part of the aging process, typically occurring between the ages of 45 and 65 in the general population. 1

Understanding Posterior Vitreous Detachment

• PVD is defined as a separation of the posterior vitreous cortex from the internal limiting membrane of the retina, occurring as an acute event after substantial age-related liquefaction in the vitreous gel 1
• The separation usually extends rapidly to the posterior margin of the vitreous base in all quadrants 1
• The vitreous is most firmly attached at the vitreous base, the optic nerve head, and the macula, with PVD evolving and progressing over years 1
• Population studies show that PVD occurs earlier in men than women, with earlier onset also possible in cases of trauma and myopia 1, 2

Prevalence and Age Correlation

• While exact prevalence is difficult to determine due to lack of definite clinical signs, PVD incidence increases significantly with age 1, 3
• In the 65-69 age group, approximately 11% exhibit complete PVD, while 71% still have completely attached vitreous 4
• By ages 80-89, the percentage with completely attached vitreous decreases to 43%, with 46% showing complete PVD and 11% showing partial PVD 4
• PVD occurs in approximately 65% of individuals between 65 and 85 years 5

Stages and Progression

• PVD begins in the perifoveal macula and evolves over a prolonged period before complete vitreopapillary separation 6
• Initially, the posterior vitreous partially detaches yet remains attached within the macular region 1
• Complete detachment occurs when the vitreous detaches from the macula and finally from the optic nerve head 1
• Longitudinal studies demonstrate that early PVD stages persist chronically and progress slowly over months to years 6

Symptoms and Clinical Signs

• When the vitreous detaches from the nerve head, patients may experience acute onset of floaters or flashes (photopsias) 1, 7
• The presence of a glial annulus in the vitreous cavity (Weiss ring) is strong evidence of PVD 1
• Floaters may be due to blood from torn vessels, condensations of vitreous collagen, or epipapillary glial tissue (Weiss ring) 1, 2
• Symptoms typically diminish over time, sometimes requiring several months to resolve 7

Potential Complications

• Between 8% and 22% of patients with acute PVD symptoms have a retinal tear at initial examination 1, 2
• Patients with acute PVD but no retinal breaks have approximately 2% chance of developing breaks in the following weeks 1, 7
• PVD can lead to vitreous traction at sites of significant vitreoretinal adhesion, potentially causing retinal breaks that may lead to retinal detachment 1
• Early stages of PVD may be complicated by various macular pathologies, determined in part by the size and strength of residual vitreoretinal adhesion 6

Clinical Implications

• Patients with new symptoms of flashes and floaters should undergo thorough examination to rule out complications such as retinal tears or detachment 7, 8
• Selected patients, particularly those with vitreous pigment, vitreous/retinal hemorrhage, or visible vitreoretinal traction, should have follow-up examination within 6 weeks 1, 2
• Patients should be educated about symptoms of PVD, retinal breaks, and retinal detachments, as well as the need for periodic follow-up 1
• While most cases of PVD are asymptomatic and require no intervention, complications may require treatment such as laser photocoagulation, cryotherapy, or in some cases, vitrectomy 7