What happens to vitreous with age? A comprehensive guide

By age 80, a significant percentage of people will experience a complete posterior vitreous detachment. This process is part of the natural aging phenomenon that affects the gel-like substance in your eye, known as the vitreous. Understanding what happens to vitreous with age is crucial for maintaining good eye health and recognizing potential issues.

Quick Summary

As we age, the vitreous gel inside the eye undergoes a process of liquefaction and shrinkage. This can lead to the formation of clumps and strands that appear as floaters, and eventually, the vitreous may pull away from the retina in a posterior vitreous detachment (PVD), causing flashes of light.

Key Points

• Normal Aging Process: The vitreous gel in the eye naturally liquefies and shrinks over time, causing it to pull away from the retina in a process called Posterior Vitreous Detachment (PVD).

• Floaters are a Symptom: As the vitreous liquefies, collagen fibers clump together, casting shadows on the retina that are seen as floaters—the specks or cobwebs in your vision.

• Flashes Indicate Traction: Flashes of light occur when the shrinking vitreous gel tugs on the retina, stimulating the light-sensitive cells.

• Risk of Retinal Tear: In some cases, strong adhesions between the vitreous and retina can cause a retinal tear during PVD, which is a medical emergency.

• Emergency Signs: A sudden increase in floaters or flashes, or a curtain-like shadow over your vision, requires immediate evaluation by an ophthalmologist to rule out a retinal detachment.

• PVD is Unpreventable: PVD is a natural, age-related process that cannot be prevented, but early detection of complications can prevent permanent vision loss.

• Higher Risk Factors: Individuals who are nearsighted, have had eye surgery, or experienced eye trauma are at higher risk for PVD or related complications.

The structure and function of the vitreous

Initially, the vitreous is a firm, transparent gel that fills the space in the eye between the lens and the retina. It's mainly water, with collagen fibers and hyaluronic acid, providing shape and protecting the retina. Its outer layer, the cortex, connects firmly to the retina in specific areas.

The aging process: from gel to liquid

From our 20s onwards, the vitreous changes. This involves two stages:

• Liquefaction (Synchisis): The central vitreous breaks down as hyaluronic acid degrades, releasing water and forming liquid pockets. Liquefaction increases with age, from about 12.5% at 18 to over 60% by the 80s.

• Collagen aggregation (Syneresis): As the gel liquefies, collagen fibers clump, creating shadows on the retina seen as floaters.

Posterior vitreous detachment (PVD)

The liquefying and shrinking vitreous pulls away from the retina, a process called posterior vitreous detachment (PVD). This is common, affecting most people by age 70. While often benign, it can cause floaters and flashes. Floaters may increase suddenly, sometimes forming a Weiss ring. Flashes are brief lights caused by the vitreous pulling on the retina.

When PVD becomes a problem

Usually harmless, PVD can sometimes cause complications, particularly during the initial detachment.

• Retinal Tears: Strong pulling can tear the retina, potentially leading to retinal detachment if not treated.
• Retinal Detachment: A serious emergency where the retina separates from underlying tissue, risking permanent vision loss. Symptoms include a shadow in vision.
• Vitreous Hemorrhage: Tearing a small retinal blood vessel can cause bleeding into the vitreous, leading to sudden floaters or blurred vision.

Comparison of normal PVD vs. associated retinal complication symptoms

Feature	Normal PVD (Benign)	PVD with Retinal Tear/Detachment
Symptom Onset	Gradual or sudden onset of mild to moderate floaters and flashes.	Abrupt and significant increase in number and size of floaters. Flashes may be more frequent or intense.
Floaters	Small specks, strings, or webs that tend to settle and become less noticeable over time.	A new, large, single floater (Weiss ring) or a sudden "shower" of new floaters.
Flashes	Brief, quick flashes, often in the peripheral vision, that decrease as PVD progresses.	Persistent, more intense flashes, especially if a retinal tear is present.
Field of Vision	Clear vision; floaters and flashes are a nuisance but don't obstruct overall vision.	A dark shadow, curtain, or veil that blocks part of your peripheral or central vision. This is an emergency.
Pain	Painless.	Painless, but the sudden changes in vision are the warning signs.

Factors that increase risk

Certain factors increase the risk of earlier or complicated PVD:

• Myopia (Nearsightedness): Higher risk due to eye shape.
• Previous Eye Surgery: Increased risk after procedures like cataract surgery.
• Eye Trauma: Past injury is a risk factor.
• Diabetes: Can affect the vitreous.
• Inflammatory Conditions: May trigger premature PVD.

Management and monitoring

Uncomplicated PVD needs no treatment; symptoms usually subside. However, new symptoms require immediate eye specialist consultation to rule out retinal issues. A prompt dilated eye exam is crucial for diagnosis. Early-detected tears can be treated with laser to prevent detachment.

Protecting your aging eyes

While vitreous aging is inevitable, protect your eyes by:

1. Getting regular eye exams.
2. Reporting sudden symptom changes immediately.
3. Managing health conditions like diabetes.
4. Wearing protective eyewear.
5. Maintaining a healthy lifestyle.

Staying informed and vigilant about eye health is key as the vitreous changes with age. For more information, consult resources like the American Academy of Ophthalmology at www.aao.org.

Conclusion

What happens to vitreous with age is a natural process leading to PVD in most people, causing common symptoms like floaters and flashes. However, because these symptoms can indicate serious conditions like retinal tears or detachment, immediate medical evaluation is vital to differentiate between a benign process and an ocular emergency. Proactive eye care and prompt attention to symptoms are crucial for preserving vision as you age.

Frequently Asked Questions

Is posterior vitreous detachment (PVD) a serious eye condition?

PVD is a common, natural part of aging and is typically not a serious condition on its own. However, its symptoms can mimic a retinal tear or detachment, which is a medical emergency. For this reason, any sudden onset of new floaters or flashes should be evaluated by an eye care professional immediately.

What is the difference between floaters from aging and floaters from a retinal tear?

Floaters from normal aging typically appear gradually as small specks or strings. Floaters caused by a retinal tear or detachment often appear suddenly as a much larger number of spots or a 'shower' of dark specks, sometimes accompanied by flashes of light or a loss of peripheral vision.

Can I prevent vitreous detachment?

No, vitreous detachment is a natural, age-related process and cannot be prevented. However, protecting your eyes from trauma and managing risk factors like diabetes can help maintain overall eye health and reduce the risk of complications.

How soon should I see a doctor if I notice new floaters and flashes?

You should seek immediate medical attention within 24 hours of noticing a sudden onset of new floaters or flashes. An ophthalmologist needs to perform a dilated eye exam to determine the cause and rule out a retinal tear or detachment.

What is vitreous syneresis?

Vitreous syneresis is the technical term for the aging process of the vitreous. It refers to the degeneration and liquefaction of the gel-like vitreous, which leads to the formation of liquid pockets and the clumping of collagen fibers that cause floaters.

Do eye floaters and flashes eventually go away?

While the vitreous detachment itself is permanent, the symptoms of floaters and flashes typically become less noticeable over time. The brain adapts to ignore the floaters, and they often settle out of the central field of vision. The flashes usually subside once the vitreous fully separates from the retina.

Who is most at risk for developing complications from PVD?

Individuals who are highly nearsighted (myopic), have had previous eye surgery (especially cataract surgery), experienced eye trauma, or have diabetes are at higher risk for retinal tears or detachments during or after a PVD.

Can I use eye drops to treat PVD symptoms?

No, there are no eye drops that can treat the underlying cause or symptoms of PVD. The condition is an internal structural change in the eye. Treatment focuses on monitoring for complications and, in rare cases, addressing floaters that severely interfere with vision.