Seniors at Risk for Vitreous Detachment & Floaters

exam eyes vitreous detachment floatersTwo-thirds of your eye comprises the vitreous, composed of about 98% water and 2% collagen, hyaluronic acid, other substances, and fibers that attach to the retina.  It takes up the space between the retina and the lens and has many important functions:

      • maintains the shape of the eye
      • serves as a shock absorber
      • cushions the eye against any blows or pressure applied to the eye
      • helps keep the retina in contact with the membrane at the back of the eye
      • enables transmission of light to the retina

Because the jelly-like vitreous has the consistency of gelatin, like gelatin, it tends to dry out and shrink with age. As it shrinks, it often detaches from the retina. This is a very common occurrence in elderly people.

Usually vitreous detachment (known as posterior vitreous detachment, or PVD) does not cause a serious problem. But it can. The vitreous is attached to the retina by a collection of fibers. As it shrinks and separates, the fibers do not always detach gently. In some cases, they remain attached to the retina and pull on it. This can cause tears, holes or an entire detachment of the retina. Retinal tears, retinal holes, and retinal detachments can cause serious vision problems, and, in some cases, even blindness.

Causes and Risk Factors

Causes and risk factors for a vitreous detachment include the following: age, nearsightedness greater than six diopters, a history of cataract surgery, inflammation in the eye, diabetes, bleeding inside the eye, blunt force trauma to the eye, and a previous vitreous detachment in the other eye within the preceding year. The condition is somewhat more common in women than in men. In addition, some drugs,1 chronic stress, and food allergies may cause floaters.

Symptoms

The most common symptoms of PVD are floaters and flashes.

Floaters are small particles in the vitreous that are ordinarily stationary. As the vitreous pulls away from the retina, the floaters begin to move through the liquefying vitreous and new floaters may be created. They appear in the visual field as small spots or dots, or cobwebs, or a “swarm of bees” that tend to drift out of your line of vision when you are not moving your eyes. Usually, a vitreous detachment will be accompanied by a swarm of floaters that will then dissipate if the retina has not been damaged.

Eye floaters are not dangerous, but for some can cause significant distress. There is a natural process in the body that attempts over time to break down the eye floaters, but it is a very slow process as there is no blood flow in this part of the eye. But one function of the immune system facilitates fluid movement through the vitreous to break down and remove debris.

Flashes resemble lightning or fireflies or disco lights. The retina has no nerve signals for pain, but if parts of the vitreous tug on the retina, these tugs are interpreted as light signals by the retina. Flashes will also usually be plentiful during a vitreous detachment and will also usually abate if the detachment is non-problematic.

Less commonly, people may also experience a ring of floaters or flashes at the edge of the visual field. Or the edge of the visual field may appear gray and cloudy. This grayness may slowly creep in to encompass central vision as well.

Incidence

Posterior vitreous detachment (PVD) affects 75% of people over the age of 65, though it may be helped with dietary and nutritional changes. It is found in about 10% of people aged 30-59, and 63% of people over 70.2 The prevalence is found to be as high as 87% among patients aged 80–89 years.3

In one study, 11% of the population ages 64-69, experience a vitreous detachment.4

After occurring in one eye, PVD usually occurs in the other eye within 6 months to 2 years.5 In patients with symptoms of PVD, there is an incidence of retinal tears of 14.5% and hemorrhages of 22.7%.6 7

One study shows floaters in 42%, flashes in 18%, and both floaters and flashes in 20% of patients with PVD and secondary retinal pathology.6 Only about 10% of patients with PVD develop a retinal tear; around 40% of patients with an acute retinal tear, if left untreated, will develop a retinal detachment.8

Complications

Ordinarily, vitreous detachments are uncomplicated and require no treatment. But in 7% to 15% of cases, there will also be a retinal tear, a retinal hole, or a retinal detachment. Such conditions are serious. If the vitreous exerts enough force on the retina to create only small tears, the retina will proliferate glial cells to attempt to heal the tears. In this case, the extra layer of cells can diminish vision. The risk of retinal detachment is greatest in the first six weeks following a vitreous detachment, but one can occur even several months after the event.

Diagnosis

If you experience a sudden increase of flashes or floaters it is very important to see an ophthalmologist immediately. If an uncomplicated vitreous detachment is underway, it can only be diagnosed through a close examination of the back of the eye done with dilation of the pupil. If it is uncomplicated, the ophthalmologist will most likely suggest you return for another exam in four to six weeks to ensure a retinal tear or detachment has not also occurred.

Treatment

A vitreous detachment is not sight-threatening and requires no medical treatment. In some cases, with a partial vitreous tear, the remaining fibers can continue to pull on the retina, resulting in a macula hole, or potentially, a tear in the retina or retinal blood vessel. Again, this needs to be monitored by your eye doctor.

The potential retinal problems associated with vitreous detachment are why an eye exam is urgent if you notice an increase in flashes or floaters. Retinal problems have a much better prognosis with early treatment, and left untreated, they can create serious and permanent vision problems.

Maintaining Eye Health

While vitreous detachment is a frequent occurrence in later life, it may be prevented or its effects may be mitigated by maintaining proper eye health.

      • Eat a healthy diet
      • Exercise regularly
      • Manage chronic stress – medication, walks in the woods, yoga, qigong, etc. When you find yourself in stressful situations, remember to stop and take long, slow deep breaths.
      • Targeted supplementation (see recommendations below)

These nutrients may be particularly helpful for vitreous health.

  • Vitamin C is useful for eliminating waste and neutralizing oxidization. Citric acid improves lymph and blood circulation. Take no more than 1,500 mg per day if you have floaters. Too much vitamin C can reduce absorption of other nutrients and actually increase floaters.
  • The body produces hyaluronic acid daily to lubricate joints and help heal tissues. The vitreous contains significant amounts of hyaluronic acid. Seniors produce less and less hyaluronan as they age.
  • Traditional Chinese Medicine: A liver tonic containing milk thistle and dandelion is the classic remedy. The ReVision formula contains these herbs plus Rambling Powder, ginger, eyebright, bilberry, ginkgo, and more. These wild-crafted herbal drops are taken by mouth. They support circulation, encourage the movement of energy, and mitigate stress effects. ReVision formula is part of the Vitreous Support Package.
  • Resveratrol is also found in the vitreous, and has been detected in the vitreous of patients given oral resveratrol following surgery for retinal detachment.9

Other nutrients which are important for vision health.

Lutein (which is also found in the vitreous),10 zeaxanthin, and bilberry.

Vitreous Support Package 1 – 1-2 month supply

Vitreous Support Package 2 – 3-6 month supply

Resveratrol (Trans) w/Quercetin 60 vegcaps

Any of the products in the packages can be ordered individually as well.

Next: Nutritional support, diet, & lifestyle tips to support the vitreous.

Footnotes

  1.  Medications that can cause floaters include Benadryl (for allergies), Cardizem (heart disease), Elavil (depression) and Xanax (anxiety). ↩
  2. Eliott D. (2004). Evaluation and Management of PVD. Review of Ophthalmology. Retrieved May 2, 2022 from https://www.reviewofophthalmology.com/article/evaluation-and-management-of-pvd. ↩
  3. Albert, D.M., Jakobiec, F.A., editors. (2000). Principles and Practice of Ophthalmology. 2nd ed. Philadelphia, PA: WB Saunders Co. ↩
  4. Stolyszewski, I., Niemcunowicz-Janica, A., Pepinski, W., Spolnicka, M. Zbiec, R., et al. (2007). Vitreous humour as a potential DNA source for postmortem human identification, Fola Histochem Cytobiol, 45(2):135-6. ↩
  5. Jabs, D.A., Akpek, E.K. (2005). Immunosuppression for posterior uveitis. Retina, Jan; 25(1):1-18. ↩
  6. Ibid. Albert. (2000). ↩
  7. Michelle Stephenson. (2011). Systemic Drugs with Ocular Side Effects. Retrieved Dec 04 2017 from https://www.reviewofophthalmology.com/article/systemic-drugs-with-ocular-side-effects. ↩
  8. Ray, P.D., Huang, B.W., Tsuji, Y. (2012). Reactive oxygen species (ROS) homeostasis and redox regulation in cellular signaling. Cell Signal, May;24(5):981-990. ↩
  9. Wang S, Wang Z, Yang S, Yin T, Zhang Y, et al. (2017). Tissue Distribution of trans-Resveratrol and Its Metabolites after Oral Administration in Human Eyes. J Ophthalmol. 2017:4052094. ↩
  10. Panova IG, Yakovleva MA, Tatikolov AS, Kononikhin AS, Feldman TB, et al. (2017). Lutein and its oxidized forms in eye structures throughout prenatal human development. Exp Eye Res. Jul;160:31-37. ↩