Retina and Vitreous

The vitreous is a clear liquid that fills our eyes and gives them shape. When we are young, the vitreous has a thick, gelatinous consistency and is firmly attached to the retina. As we age, the vitreous thins and separates from the retina. Although this usually results in nothing more than a few harmless floaters, tension from the detached vitreous can sometimes tear the retina.

If liquid seeps through the tear and collects behind the retina or between its nerve layers, the retinal tear can become a retinal detachment. Retinal detachment can cause significant, permanent vision loss and requires immediate medical treatment.

There are three kinds of retinal detachment. The most common form, described above, occurs when fluid leaks into the retina; people who are nearsighted or who have had an injury or eye surgery are most susceptible. Less frequently, friction between the retina and vitreous or scar tissue pulls the retina loose, something that occurs most often in patients with diabetes. Third, disease-related swelling or bleeding under the retina can push it away from the eye wall.

Signs of retinal tear or detachment include flashes of light, a group or web of floaters, wavy or watery vision, a sense that there is a veil or curtain obstructing peripheral vision, or a sudden drop in vision quality. If you experience any of these symptoms, call your doctor immediately. Early treatment is essential to preserve your vision and is usually done through laser and cryoprobe procedures. 

Diabetic retinopathy is a complication of diabetes that weakens the blood vessels that supply nourishment to the retina (the light-sensitive lining in the back of the eye where vision is focused). These weak vessels can leak, swell, bleed or develop thin branches, causing a loss of vision. Changes to your vision may not be noticeable at first. But in its advanced stages, the disease can cause blurred or cloudy vision, floaters and blind spots – and, eventually, blindness. This damage is irreversible. Diabetic retinopathy is the most common diabetic eye complication and a leading cause of blindness in American adults. Macular edema, which is leaking fluid that causes blurred vision, often occurs with diabetic retinopathy.

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Although most flashes and floaters occur in people with healthy or merely nearsighted eyes, they can be symptoms of serious problems including injury and retinal and posterior vitreous detachments. Flashes in vision are caused by traction on the retina, the bundle of nerves in the back of the eye where images are detected and transmitted to the brain. Patients complain of flashing lights or lightning streaks. 

Floaters are often seen when fibers move within the vitreous humor, the gelatinous substance made of water and protein fibers that fills the eye. Patients complain of small specks or dots that can be seen against clear backgrounds. Serious vision loss can occur if the retina detaches from the eye wall. Patients experiencing flashes and floaters should contact their doctor immediately so an examination can be performed. 

A vitreous hemorrhage involves a rupturing and leaking of the retinal blood vessels into the vitreous humor. This is most often caused by weakened blood vessels in the retina, and may be associated with diabetic retinopathy. Patients with a vitreous hemorrhage may experience dark spots in their vision or completely obstructed vision as the amount of light that can pass through the vitreous is reduced. These symptoms may be present for several months before the body reabsorbs the blood.

Treatment for a vitreous hemorrhage may be limited to “watchful waiting” to see if the hemorrhage will clear on its own, or may include vitrectomy, a surgical procedure to remove the vitreous humor and replace it with a balanced salt solution. Your doctor will decide which option is best for you based on your individual condition.

The macula is the part of the retina in the back of the eye that ensures that our central vision is clear and sharp.  As you age, the tissue in the eye responsible for central vision slowly begins to deteriorate, significantly affecting a patient’s quality of life and causing a condition known as macular degeneration. Also known as age-related macular degeneration (AMD), this condition is common among older adults and is the leading cause of vision loss and blindness in people over the age of 65.

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A retinal vein occlusion occurs when an artery supplying blood to the eye hardens or swells and presses on a nearby vein and blocks it, making it difficult for blood to leave the eye. The restricted circulation leads to high pressure in the eye, which can in turn cause swelling, bleeding, growth of abnormal blood vessels, and partial or total vision loss.

Vascular occlusions do not cause a change in physical appearance, and they can occur with no pain or noticeable loss of vision. For these reasons, it is important to have routine eye exams and also to check one’s own vision by closing one eye at a time.

There is no cure, so emphasis is placed on risk management, treatment of symptoms and prevention of further vision loss. It is critical to control high blood pressure, high cholesterol, diabetes and other health conditions that increase the risk of vascular hardening, narrowing and blood clotting.