Vitreous Detachment: Symptoms, Diagnosis, and Treatment Options

Vitreous detachment

Hello Doctor, on the evening of September 5th, I noticed a small area of blurriness in the center of my right eye.
The details, like text, were unclear, but the surrounding area was clear.
It felt like there was a blurry obstruction in the center of my pupil.
The next day, I visited a clinic, and the doctor diagnosed me with macular degeneration and referred me to a larger hospital.
On September 7th, the doctor at the hospital examined me and said I had retinal inflammation with swelling, specifically a depression in the center of the macula, with some slight traction in the surrounding area.
Initially, the diagnosis was that I had a cat scratch infection affecting my vision due to toxoplasmosis, and I was advised to see an infectious disease specialist for blood tests and medication to suppress the infection.

On September 9th, the blood test results showed no reaction to toxoplasmosis, but there was a high index in the immune blood test, so I was advised to see a rheumatologist.
The fundus photography only indicated that I had retinal inflammation causing vision impairment.
On September 11th, I was referred to a clinic, and the night before, I noticed that the blurry spot had disappeared, and I could see text clearly.
The clinic diagnosed me with vitreous detachment and noted that there was edema in the macular area affecting my vision.
They advised me to monitor my vision, and if it continued to be problematic, surgery could be considered.
Recently, on September 16th, I experienced floaters in my vision, which were large and widespread.
Concerned, I returned to the clinic to see another doctor.
This doctor explained that floaters are a normal response to vitreous detachment.
Due to time constraints, they could not dilate my pupils, but they used a light to examine my eyes and mentioned that there seemed to be neovascularization and some edema present.
I was instructed to return in two days for another check-up and to apply for a fundus photography report from the larger hospital for comparison.
Depending on the examination results, they mentioned that injections might be considered.
Each doctor has given me different opinions: the first clinic doctor told me that vision loss from macular degeneration is irreversible, while the hospital suggested it was due to a toxoplasmosis infection and referred me to other specialists to find the cause.
I have been worried about my vision deteriorating while trying to find answers.
Finally, the last clinic diagnosed me with vitreous detachment, which gave me some relief as at least I found the cause, but now they are mentioning neovascularization.
I understand that if neovascularization spreads, it could affect my vision.
1.
I would like to ask the doctor if my condition truly requires injection treatment? If so, will I need to have regular injections?
2.
Since my vision has improved, will the vitreous gradually return to its original state?
3.
Will my current situation continue to affect my vision and lead to further damage?
4.
Is this condition serious?
5.
If surgery is performed, will it effectively treat the issue?
I appreciate your explanation, as I am very concerned.
Thank you, Doctor!

Qiao, 30~39 year old female. Ask Date: 2020/09/16

Dr. He Jianxian reply Ophthalmology

Dear Ms.
Qiao,
1.
Without a definitive diagnosis of the cause, it is better to avoid considering intraocular injections for the time being.
2.
The vitreous body will not return to its original state.
3.
We need to observe for a while before reaching further conclusions.
4.
Conditions that will resolve on their own typically have a lower severity.
5.
Since the cause has not been determined, I truly cannot say whether you need surgery.
This is for your reference.
Dr.
He Jianxian
Ophthalmology Department
Nantou Hospital

Reply Date: 2020/09/16

More Info

Vitreous detachment, also known as posterior vitreous detachment (PVD), is a common condition that occurs when the vitreous gel that fills the eye separates from the retina. This process can lead to various symptoms, including blurred vision, floaters (often described as "cobwebs" or "spots"), and in some cases, flashes of light. Understanding your situation involves addressing several key points regarding symptoms, diagnosis, and treatment options.

1. Symptoms and Diagnosis: Based on your description, it seems you initially experienced blurred vision in the center of your right eye, which later improved. The subsequent diagnosis of vitreous detachment aligns with your symptoms, particularly the appearance of floaters. The presence of swelling in the macula (the central part of the retina responsible for sharp vision) can also contribute to visual disturbances. Your experience of seeing floaters is a common occurrence with vitreous detachment, as the gel pulls away from the retina, causing debris to cast shadows on the retina.

2. Treatment Options: The management of vitreous detachment often depends on the severity of symptoms and the presence of any complications. In many cases, vitreous detachment is a benign condition that does not require treatment. However, if there is associated macular edema (swelling) or if there are signs of retinal tears or detachment, more aggressive treatment may be necessary. This could include injections of medications (such as corticosteroids) to reduce inflammation and swelling or, in more severe cases, surgical intervention.

3. Prognosis and Recovery: Regarding your concerns about whether your vision will return to normal, it is important to note that while some individuals experience a gradual improvement in symptoms, others may continue to have floaters or other visual disturbances. The vitreous gel does not typically "return" to its original state after detachment, but the brain often adapts to the new visual input over time. If the macular edema resolves, your vision may improve significantly.

4. Long-term Effects: The risk of permanent vision loss from vitreous detachment alone is low, especially if there are no associated complications like retinal tears. However, it is crucial to monitor your symptoms closely. If you notice any sudden changes in vision, such as an increase in floaters, flashes of light, or a shadow in your peripheral vision, you should seek immediate medical attention.

5. Surgical Options: If your condition progresses to a point where there are significant complications, such as a retinal tear or persistent macular edema that does not respond to injections, surgical options may be considered. Procedures like vitrectomy (removal of the vitreous gel) can be performed to address these issues. However, surgery carries its own risks and is typically reserved for more severe cases.

In conclusion, while your situation may seem concerning, it is essential to follow up with your eye care specialist for regular monitoring and to discuss the best course of action based on your specific condition. If injections are recommended, they may be administered periodically depending on your response to treatment. Always communicate any changes in your symptoms to your healthcare provider, as timely intervention can prevent complications and preserve your vision. Remember, many people with vitreous detachment lead normal lives with minimal impact on their vision.

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