A posterior vitreous detachment is a common condition that can cause flashes and floaters.
Flashes and floaters can also indicate a retinal tear or retinal detachment, so evaluation by a retina specialist is important.
Posterior Vitreous Detachment
As we grow older, the clear, firm jelly inside out our eyes, referred to as the vitreous, becomes softer, and has a tendency to pull away from the retina– this is commonly referred to as a vitreous detachment, or posterior vitreous detachment (PVD). Most people will actually develop a posterior vitreous detachment at some point in their lives, and while some may notice flashes or floaters, others may not notice anything at all. The important thing to know, however, is that a vitreous detachment can cause a retinal tear and/or retinal detachment.
Retinal Tear
If the posterior vitreous detachment occurs with sufficient strength, a piece of the retina can be torn, called a retinal tear; sometimes if the force is great enough, and a blood vessel is also torn, bleeding (vitreous hemorrhage) can occur. In either case, a careful examination by a retina specialist is necessary; sometimes a retinal tear can only be detected by certain examination techniques and skills, and a vitreous hemorrhage may also require the use of an ultrasound.
Treatment of Retinal Tears
If your retina specialist determines that the posterior vitreous detachment has caused a retinal tear, same-day treatment is usually considered. In most cases, retinal tears can be treated in the office with either laser (laser retinopexy) or cryo (cryopexy).
Both techniques use topical anesthetic, and deliver either heat (laser retinopexy) or very cool (cryopexy) energy to the area around the tear, which over the course of about two weeks, creates a firm adhesion around the tear, to reduce the risk of developing a retinal detachment.
Following the treatment of a retinal tear, patients leave the office without any patch or need for medications, and are usually rechecked in about a week.
Retinal Detachment
If a retinal tear goes undetected, or fails treatment, it can lead to a retinal detachment. Retinal detachments arise because there is enough force pulling on the tear to allow for fluid to creep underneath, and elevate the retina.
Retinal detachments are commonly seen by retinal specialists, and there are numerous ways to fix them.
Treatment of Retinal Detachments
Depending on your retina specialist, and the nature of the detachment, many retinal detachments can be treated simply in the office, by a procedure called a pneumatic retinopexy; this involves injected some gas in the eye, and again applying laser or cryo to the retina– either the same day, or a few days later. Under the right circumstances, pneumatic retinopexy can be a very effective, simple method of treating a retinal detachment in the office.
In other cases, a retinal detachment may require treatment in the operating room. Two methods are widely used in these cases, either alone or in combination. One method is called a scleral buckle, where a thin band of silicone is sutured to the outside wall of the eye, and again, gas is injected, and usually cryopexy is also applied; this method is usually done in the outpatient setting, with regional anesthesia. Most patients go home the same day with a patch over their eye, and if successful, vision can be restored in a couple of weeks.
Another method, which can be used alone, or sometimes in combination with a scleral buckle, is a vitrectomy (also called pars plana vitrectomy), where again, in the operating room, tiny instruments are inserted into the eye, the vitreous is removed, and gas and usually laser are again applied to reattach the retina. As with a scleral buckle, a vitrectomy is typically performed in the outpatient setting, with regional anesthesia.
Many hospitals have outpatient surgery centers; for example, I regularly perform detachment surgeries at Orlando Regional Medical Center and Winter Haven Hospital, which have well-equipped, dedicated operating rooms for outpatient retina surgery. I also operate at Central Florida Surgery Center in Lakeland, which has outstanding facilities and staff for the the treatment of all types of retina problems.
An experienced retina specialist can differentiate between a retinal tear, vitreous detachment, and retinal detachment. Based on a thorough conversation, you and your retina specialist can decide which plan works best for you.
Nader Moinfar, M.D., M.P.H., F.A.C.S.
Retina Specialist
Lakeland | Winter Haven
Zephyrhills | Lake Mary