What is vitreous degeneration?
Vitreous degeneration is a common age-related change that occurs in the vitreous humor, the clear gel that fills the inside of the eye. As we age, the vitreous humor starts to liquefy and its proteins and collagen fibers start to clump together. This causes the vitreous gel to collapse and pull away from the retina, resulting in clumps and strands that cast shadows on the retina. This is known as vitreous detachment. As the vitreous continues to liquefy over time, it becomes watery and shrinks in size. This is known as vitreous degeneration or synchysis senilis.
Some key facts about vitreous degeneration:
- Starts to occur after age 40, although usually mild until after age 60
- Caused by natural aging processes that affect the collagen and hyaluronic acid in the vitreous
- As the vitreous liquefies, it shrinks and detaches from the retina
- Can lead to symptoms like floaters, flashes of light, and cobwebs/cloudy areas in vision
- Usually part of normal aging, but can be associated with other eye conditions like posterior vitreous detachment, retinal tears, and retinal detachment
While bothersome, mild vitreous degeneration is usually not sight-threatening on its own. However, significant vitreous changes and detachments require monitoring by an ophthalmologist to check for any associated retinal issues.
What are the symptoms of vitreous degeneration?
There are several common symptoms associated with vitreous degeneration:
- Floaters – Small specks or cobweb-like shapes that drift across your field of vision as the vitreous gel collapses. These are especially noticeable when looking at bright backgrounds like white paper or blue skies.
- Flashes of light – Brief flashes of light caused by vitreous traction on the retina during eye movements. Sometimes described as lightning streaks in peripheral or side vision.
- Cloudy or hazy areas – Patches or cobwebs that partially block vision as the liquefied vitreous condenses and clumps.
- Blurry vision – If significant vitreous changes cause retinal wrinkling or edema, vision may be blurry or wavy.
These symptoms are usually most noticeable initially when you move your eyes quickly. Vitreous floaters and light flashes tend to gradually improve over weeks to months as the brain and retina adapt. However, new symptoms can develop as vitreous degeneration progresses with age. See an ophthalmologist promptly if you experience sudden onset of light flashes, increased floaters, or vision loss.
What causes vitreous degeneration and can it be prevented?
Vitreous degeneration is primarily caused by natural age-related weakening of collagen and changes in hyaluronic acid that forms the vitreous gel inside the eye. This causes the vitreous to liquefy and shrink. Specific factors that contribute to vitreous degeneration include:
- Aging – The main cause. Vitreous changes typically start around age 40.
- Genetics – Vitreous degeneration tends to occur earlier and be more severe in some families.
- Nearsightedness (myopia) – Associated with more pronounced vitreous liquefaction.
- Injury – Trauma to the eye may hasten vitreous changes.
- Inflammation – Prior eye inflammation can increase vitreous liquefaction.
- Prior eye surgery – Especially vitrectomy surgery removing vitreous.
Unfortunately, there are no proven ways to prevent vitreous degeneration since it’s primarily an inevitable age-related process. Eating well, exercising, maintaining a healthy weight, not smoking, and controlling other medical conditions may slow the degree of vitreous changes. But it cannot be stopped completely.
When should someone see a doctor about vitreous degeneration?
Most people develop at least some vitreous degeneration as they age without it causing significant vision problems. However, it’s important to see an ophthalmologist promptly if you experience:
- Sudden increase in floaters, flashes of light, or new cobwebs/dark areas affecting vision – This may indicate a posterior vitreous detachment or retinal tear.
- Episode of sudden flashers and floaters associated with cloudy vision – Can signal a vitreous hemorrhage.
- Increase in floaters along with loss of peripheral vision – May be retinal detachment.
- New floaters, flashes, or curtain/veil over vision with headache and eye pain – Could mean retinal detachment or tear.
- Significant nearsightedness and lithium use – Higher risk for retinal detachment.
- Unexplained vision loss – Needs immediate evaluation to identify the cause.
While new vitreous floaters and flashes associated with PVD are usually not an emergency, a dilated eye exam is still a good idea to ensure the retina is intact. Seek same day treatment if you notice sudden increase in symptoms, new vision loss, or possible retinal detachment signs.
How is vitreous degeneration evaluated by eye doctors?
An ophthalmologist can evaluate vitreous degeneration during a comprehensive eye exam using these tests:
- Visual acuity – Checks sharpness of vision using an eye chart.
- Refraction – Measures need for glasses by determining prescription strength.
- Pupil examination – Assesses pupil size and reactivity to light.
- Eye muscle movement test – Checks how well eyes track objects together.
- Peripheral vision check – Tests side vision using hand motions in periphery.
- Slit lamp exam – Uses a slit lamp microscope to inspect the vitreous and retina.
- Tonometry – Measures eye pressure to screen for glaucoma.
- Dilated fundus exam – Enlarges pupils with drops to carefully inspect the retina.
Reporting your specific symptoms like floaters helps guide what parts of the eye your doctor will focus most on examining. Diagnostic tests like optical coherence tomography (OCT) or ultrasound may be used to get better images of vitreous changes and retinal integrity if retinal tears or detachment are suspected.
What are the best ways to manage vitreous degeneration symptoms?
While vitreous degeneration itself cannot be reversed once it occurs, there are ways to manage annoying symptoms like eye floaters:
- Use dark glasses – Helps make floaters less noticeable in bright light.
- Try an eye lubricant – Can help minimize vitreous traction on retina.
- Limit caffeine – Caffeine may increase perceptibility of vitreous symptoms.
- Manage stress and fatigue – Can make visual noise from floaters seem worse.
- Ignore symptoms as much as possible – Your brain adapts over time.
- Track significant changes – Monitor vision daily and see an ophthalmologist promptly if sudden increase in floaters, flashes, or loss of vision occurs.
Vitrectomy surgery to remove the vitreous is sometimes performed for severe, persistent floaters and flashes. However, risks include retinal tears, cataract progression, glaucoma, and infection. LASER treatment is not effective for symptoms of vitreous degeneration itself. Ultimately, the vitreous symptoms tend to improve over time without treatment in most people as the brain learns to filter out visual noise. But regular eye exams are key to monitor for retinal complications.
What are the possible complications from vitreous degeneration?
For most people, vitreous degeneration is annoying but not sight-threatening. However, some potential complications to monitor include:
- Posterior vitreous detachment (PVD) – As the vitreous liquefies, it detaches from the retina which can cause prominent symptoms of flashes and floaters.
- Vitreous hemorrhage – In some cases, blood vessels may bleed into the vitreous cavity obscuring vision.
- Retinal tears – Shrinkage of vitreous can create traction on retina leading to tears.
- Retinal detachment – If retinal tears occur, liquid can get under retina causing it to detach which is vision threatening if not repaired promptly.
- Macular pucker – Scar tissue can develop on the macula distorting central vision.
- Macular hole – Rarely, a full thickness hole can occur in the macula leading to central vision loss.
That’s why it’s critical to see an ophthalmologist right away if you notice sudden increase in floaters, flashes, loss of peripheral vision, or curtain/veil over your vision. These symptoms need to be evaluated immediately to check for retinal complications requiring urgent treatment.
What is the outlook for someone with vitreous degeneration?
The overall outlook for vitreous degeneration is generally positive since symptoms tend to gradually improve over time without treatment in most cases. However, you should be aware of these key points:
- Vitreous floaters often steadily lessen and become less noticeable over 6-12 months as your brain adapts.
- Flashes of light from vitreous traction on the retina also tend to resolve.
- Small areas of vision obstruction by vitreous opacities usually do not progress significantly.
- peripheal vision is typically maintained though some visual noise from gel collapse may continue.
- Severe, disabling floaters that persist can be treated with vitrectomy surgery in rare cases.
- Follow-up exams are critical for early detection of retinal tears, retinal detachment, macular pucker, macular holes, or other complications.
Overall, vitreous degeneration from normal aging may be frustrating, but significant visual impairment is uncommon. By seeing an ophthalmologist regularly and being aware of symptoms like increase in floaters, most retinal complications can be treated early to prevent permanent vision loss. So the outlook is positive in the majority of cases with vitreous degeneration.
Conclusion
Vitreous degeneration is an age-related process leading to collapse of the vitreous gel that fills the inside of the eye. Annoying symptoms like eye floaters and flashes typically peak at the time of vitreous detachment from the retina, then gradually improve over months. While bothersome, vitreous degeneration is usually not sight threatening. But any sudden increase in floaters, flashes, or loss of vision requires prompt evaluation for possible retinal tears, detachment, hemorrhage, macular pucker, or macular hole which can lead to visual impairment if not treated early. By seeing an ophthalmologist for regular dilated eye exams and managing vitreous symptoms conservatively, most people with vitreous degeneration retain functional vision long-term.