Pathophysiology
- A PVD is largely due to the aging process of the eye.
- With age, the vitreous loses its strength and elasticity and becomes a little more soft/watery. As a result, the vitreous can lose its shape and come away from the retina.
- More common in severely myopic patients
Presentation
- Floaters are the predominant feature- as the vitreous comes away, it casts a shadow on the retina
- Flashes may occur- this is caused by mechanical traction on the retina causing a photopsia (flash)
- This is a warning sign that the retina is at risk and could tear/detach. NB retinal detachment is still a rare complication of PVD despite this.
- A halo of floaters/hairs on the temporal side of vision may be seen. This occurs as the vitreous detaches from the optic disc area. This is technically a blind spot, resulting in the shadow causing a halo around it.
- There is no pain
- It may be difficult to visualise the retina on fundoscopy
Management/Prognosis
- Refer urgently to ophthalmology in case of retinal detachment.
- In most cases, watchful waiting for any signs of retinal tearing is the main management.
- Most patients’ vitreous gels will continue to degenerate, but symptoms will either become less noticeable or will resolve.
- If any of the signs (4 F’s) of retinal detachment appear (or worsen after seeing the doctor), refer urgently for repair.
- Floaters
- Flashes
- Fall in acuity
- peripheral Field loss.
Notes on Medicine/Surgery 