The vitreous is the clear gel that fills the inside of the eyeball. The retina is the transparent light-sensitive membrane that lines the inside of the eye and allows us to see. In youth, the vitreous is a semi-solid gel similar to jello and is adherent to the retina throughout the entire back of the eye. As we age, the vitreous begins to liquefy. Eventually, it becomes so liquid that it collapses in on itself and peels away from the retina. This event is called a posterior vitreous detachment (PVD) or posterior vitreous separation. Individuals who have had a PVD often notice floaters in their vision due to small opacities in the vitreous which cast shadows on the retina. Despite peeling away cleanly from the back of the eye, the vitreous gel nearly always remains adherent to the more peripheral retina. Because of this, the vitreous may "tug" on the peripheral retina particularly when the eye is moved quickly in any direction. When this occurs, individuals may experience a split-second flashing light in the corner of their vision.

If the vitreous is firmly adherent to one point in the peripheral retina, it may tug hard enough on this area to cause a retinal tear. In fact, a posterior vitreous detachment is the most common cause of a retinal tear. For this reason, anyone with new flashes or floaters in his/her vision should be seen promptly to rule out the possibility of a retinal tear. Left untreated, retinal tears may allow liquid vitreous to pass into the space beneath the retina causing the retina to detach (see retinal detachment). If a retinal tear is caught early, it can almost always be walled off with laser treatment or freezing treatment to prevent a retinal detachment.

Fortunately, the majority of individuals who experience a PVD will not develop a retinal tear. The flashing lights usually spontaneously subside over the course of several weeks. Floaters may last much longer (months) but usually resolve spontaneously as well. A minority of individuals with floaters are bothered with them for the rest of their lives. The only treatment available to treat chronic floaters is vitrectomy surgery during which the vitreous gel is surgically removed and replaced with a saline solution. The risks of vitrectomy surgery, while reasonably small, usually outweigh the benefits in this situation and so vitrectomy surgery is very rarely recommended as a treatment for floaters.

Dr. Goldman has extensive experience in the diagnosis and treatment of posterior vitreous detachments and retinal tears. If you or someone you know has flashes, flaoters or other retinal problem, please call us to arrange a comprehensive evaluation at either of our convenient locations.