Vitreous Degeneration · What Is It, Causes, Severity, Treatment, and More

Vitreous degeneration is an age-related process that occurs in the vitreous humor of the eye. The vitreous humor, or vitreous fluid, is the clear, gel-like substance that fills the space between the lens and the retina in the back 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.  

Vitreous degeneration is not a serious condition in itself; however, it can predispose to certain retinal pathologies. Initially, with mild vitreous degeneration, the most common symptoms are vitreous floaters, which look like small cobwebs, specks, or strings in the field of vision.  

Individuals who experience significant degeneration can develop a posterior vitreous detachment (PVD) which is when the liquefied humor causes traction on the retina and becomes detached from it. Although PVD rarely leads to vision loss, it can lead to flashes of light and an increase in floaters.  

If the vitreous pulls too hard on retina, it can cause a retinal tear, allowing the liquefied humor to seep through the tear and under the retina, causing it to detach from its underlying layer of support tissue. Common symptoms of retinal detachment include light flashes or an increase in floaters, followed by sudden visual field loss in the affected eye. Vision loss typically begins in the periphery and progresses toward the central visual axis over hours to weeks like a “curtain drawn down”. 

Finally, a vitreous hemorrhage (i.e., 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.  

Treatment of vitreous degeneration is usually not necessary unless complications arise. Symptoms typically become less bothersome over time and 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.  

Individuals who experience significant vitreous floaters, retinal tears or a complete retinal detachment require evaluation by an ophthalmologist to assess treatment. Vitrectomy laser surgery can be performed to help alleviate any vitreous floaters. In this procedure, 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, bothersome floaters for more than 6 months. Both a retinal tear and detachment require immediate intervention by a health care provider, and both can be treated with vitrectomy.