Vitreous Degeneration

What Is It, Causes, Severity, Treatment, and More

Author: Ashley Mauldin, MSN, APRN, FNP-BC

Editors: Antonella Melani, MD, Lisa Miklush, PhD, RN, CNS

Illustrator: Aileen Lin


What is vitreous degeneration?

Vitreous degeneration refers to a change that occurs in the vitreous humor (or vitreous fluid) in the eye, as the vitreous humor changes from a thick vitreous gel to a thin liquid substance. Normally, the vitreous humor is a transparent gel that helps with clarity of vision and maintaining the shape of the eye. As we age, the vitreous gel may start to shrink and become more of a liquid consistency; it will no longer be able to fill the space of the eye, and the vitreous humor can detach from the retina, which is the light-sensing nerve layer at the back of the eye. The fibers connecting the vitreous humor to the retina will start to pull away as this happens. 

What causes vitreous degeneration?

Vitreous degeneration is a natural process that occurs with aging in most people. The degeneration of the vitreous gel starts early in life, with a small percentage of the vitreous gel liquifying and shrinking by age 18. But the majority of the vitreous gel will then maintain the gel-like consistency until around the age of 50, when the degeneration process resumes. 

Is vitreous degeneration serious?

Initially, with mild vitreous degeneration, the most common symptoms are vitreous floaters, which look like small cobwebs in the field of vision. 

With some individuals who experience significant degeneration, a posterior vitreous detachment (PVD) can happen. A posterior vitreous detachment is the complete detachment of the vitreous humor from the retina. Risk factors for PVD include aging, advanced myopia, recent eye surgery, and eye trauma. Although PVD rarely leads to vision loss, it can lead to flashes of light and an increase in floaters.

A vitreous hemorrhage (blood in the vitreous cavity) can happen when a blood vessel tears away with posterior vitreous detachment. A vitreous hemorrhage will give the individual flashes and floaters in the field of vision. Some vision loss may occur due to the presence of blood in the visual field.

Other complications that can occur with vitreous degeneration include retinal tears or a retinal detachment. A torn retina can occur as the fibers on the vitreous humor pull away from the retina. A sudden increase in the amount of flashes and floaters can be indicative of a retinal tear or detachment. If the torn retina is not treated promptly, a complete retinal detachment can occur.

How do you treat vitreous degeneration?

Currently, there are no specific treatments for vitreous degeneration. Symptoms typically become less bothersome. Most people become accustomed to the floaters and don’t consider them an issue after a few months. With PVD, the flashes and floaters tend to subside over time, and most individuals rarely require any type of treatment. 

For a vitreous hemorrhage caused by PVD, the recommendation is for the individual to maintain head elevation above the heart, to allow the blood to settle in the eye. The hemorrhage should start to clear from the eye within a few days. 

There are treatment options for those who experience significant vitreous floaters, retinal tears and a complete retinal detachment. Vitrectomy laser surgery can be performed to help alleviate any vitreous floaters. Vitrectomy is a surgical procedure in which the vitreous humor is removed and replaced with another fluid, and a laser is used to repair the retina. This treatment is reserved for those who have large floaters that have lasted longer than 6 months. Both a retinal tear and detachment require immediate intervention by a health care provider, and both can be treated with vitrectomy. 

Does vitreous degeneration go away?

Once posterior vitreous detachment develops, it is a permanent change to the structure of the eye. The vitreous fluid will maintain its new, thinner liquid state, and the vitreous humor will stay detached from the top of the retina and optic nerve. Usually, within three months, the symptoms will subside. 

What are the most important facts to know about vitreous degeneration?

Vitreous degeneration is a normal process that happens with age in most people. The vitreous gel will shrink and become more liquid. This presents as small, cobweb-like floaters that usually become less bothersome over time. A dilated eye exam by a health care provider is recommended to diagnose vitreous degeneration and monitor for any complications. Posterior vitreous detachment, vitreous hemorrhage, retinal tear, and a retinal detachment are potential complications that can occur with vitreous degeneration. There is no specific treatment for vitreous degeneration; a vitrectomy laser surgery can be performed to help alleviate any vitreous floaters.

Related links

Age-related macular degeneration
Anatomy and physiology of the eye
Clinical Reasoning: Pediatric ophthalmology
Glaucoma
Photoreception

Resources for research and reference

Ankamah, E., Sebag, J., Ng, E., & Nolan, J. M. (2019). Vitreous Antioxidants, Degeneration, and Vitreo-Retinopathy: Exploring the Links. Antioxidants (Basel, Switzerland), 9(1), 7. DOI: 10.3390/antiox9010007

Bakri, S., Berrocal, A., et al. (2016). Posterior Vitreous Detachment. American Society of Retina Specialists. Retrieved September 11, 2020, from https://www.asrs.org/patients/retinal-diseases/9/posterior-vitreous-detachment

Bakri, S., Berrocal, A., et al. (2016). Retinal Tears. American Society of Retina Specialists. Retrieved September 11, 2020, from https://www.asrs.org/patients/retinal-diseases/26/retinal-tears

Jena, S. & Tripathy, K. (2020). Vitreous Hemorrhage. StatPearls. StatPearls Publishing. Treasure Island (FL): StatPearls Publishing. Retrieved September 11, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK559131/

Katsanos, A., Tsaldari, N., Gorgoli, K., Lalos, F., Stefaniotou, M., & Asproudis, I. (2020). Safety and Efficacy of YAG Laser Vitreolysis for the Treatment of Vitreous Floaters: An Overview. Advances in Therapy, 37(4): 1319–1327. DOI: 10.1007/s12325-020-01261-w