Symptoms of Acute Posterior Vitreous Detachment in Myopia

Q: Symptoms of Acute Posterior Vitreous Detachment in Myopia

Hello, Hsun-Hsun： 1. After two weeks, the likelihood of developing a retinal tear should decrease. 2. Blinking should not be an issue. 3. There is no way to slow down the detachment; one can only try to avoid head movement when detachment occurs. <

The appearance of clusters of black spots in the field of vision, along with flashes of light when blinking?

Hello, doctor.
I am a patient with high myopia, with my left eye at -7.50 and my right eye at -9.50.
Three years ago, three holes were found in my right eye and one in my left eye.
Two weeks ago, I suddenly started seeing about seven black spots (also known as floaters) in my right eye, along with a wavy distortion in bright areas.
I went to the hospital for a check-up and was diagnosed with suspected acute posterior vitreous detachment.
No new retinal tears were found.
However, ten days later, the seven black spots in my right eye clustered together, increasing in number to nearly twenty.
Additionally, I see flashes of light when I blink in bright areas, while in dark areas, I rarely see any light or flashes.
I then visited a well-known clinic, where no new retinal tears were detected.
Today, 3-4 days later, the number of clustered black spots has increased to nearly thirty, and I continue to see flashes of light when I blink in bright areas.
When I blink while sleeping, I momentarily see a lot of visual noise that quickly disappears.
1.
I read from a source that "approximately 20% of patients with acute posterior vitreous detachment and acute symptoms have retinal tears at the initial examination," and "patients with acute posterior vitreous detachment who do not have retinal tears at the time of examination have about a 2% to 5% chance of developing retinal tears within the following week." However, since it has already been two weeks, does this mean the likelihood of developing retinal tears has decreased further? What is the probability of retinal tears occurring within three months? Will these symptoms gradually subside over time, as the pulling force on the retina decreases?
2.
If I keep blinking, could this cause the vitreous to pull on the retina? I see flashes of light when I blink in bright areas, and I have been blinking continuously for 2-3 days.
Is it possible that a tear has already formed during this time?
3.
Given that the number of clustered black spots has increased to thirty and I frequently see flashes of light when blinking in bright areas, should I seek immediate medical attention? Are there any methods to alleviate the symptoms of acute posterior vitreous detachment and prevent the retina from being torn?

Xun Xun, 20~29 year old female. Ask Date: 2020/10/28

Dr. Gao Pilin reply Ophthalmology

Hello, Hsun-Hsun:
1.
After two weeks, the likelihood of developing a retinal tear should decrease.

2.
Blinking should not be an issue.

3.
There is no way to slow down the detachment; one can only try to avoid head movement when detachment occurs.
If you are concerned, it is best to get checked.

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Gao Pi-Lin

Reply Date: 2020/10/28

More Info

Acute posterior vitreous detachment (PVD) is a condition that can occur, particularly in individuals with high myopia, where the vitreous gel that fills the eye separates from the retina. This condition can lead to various symptoms, including the perception of floaters (black dots or spots), flashes of light, and in some cases, vision changes. Given your history of high myopia and previous retinal holes, your symptoms warrant careful consideration.

1. Understanding the Risk of Retinal Tears: You mentioned that approximately 20% of patients with acute PVD symptoms may have retinal tears at the initial examination, and that 2% to 5% of those without tears may develop them within a week. While it is true that the risk of developing a retinal tear decreases over time, it does not eliminate the risk entirely. The first few weeks following a PVD are critical, and the risk of retinal tears is highest during this period. After two weeks, while the risk may decrease, it is still significant, especially in the context of your high myopia. Studies suggest that the risk of retinal tears can persist for several months after the onset of PVD, particularly in myopic patients.

2. Symptoms and Their Implications: The increase in the number of floaters you are experiencing, along with the flashes of light, is concerning. Flashes can indicate that the vitreous is tugging on the retina, which can lead to tears. The fact that you are seeing more floaters and experiencing flashes, especially when blinking in bright light, suggests that there may still be significant vitreous traction on the retina. Continuous blinking does not typically cause new tears, but if there is existing traction, it could exacerbate the situation. It is essential to monitor these symptoms closely.

3. When to Seek Immediate Care: Given that your symptoms have worsened, with an increase in the number of floaters and persistent flashes of light, it is advisable to seek immediate ophthalmologic evaluation. An eye care professional can perform a thorough examination, including a dilated fundus exam, to assess for any new retinal tears or other complications. Early detection and intervention are crucial in preventing potential vision loss.

4. Management of Acute PVD: Unfortunately, there is no specific treatment to reverse a vitreous detachment once it has occurred. However, managing your symptoms and monitoring for complications is vital. Your ophthalmologist may recommend regular follow-up appointments to monitor your condition. In some cases, if a retinal tear is detected, treatment options such as laser photocoagulation or cryotherapy may be employed to prevent retinal detachment.

5. Long-term Outlook: Many individuals with PVD experience a gradual decrease in symptoms over time as the brain adapts to the presence of floaters. However, the risk of retinal complications remains, particularly in high myopia. It is essential to maintain regular eye exams and report any new symptoms immediately.

In summary, your symptoms of increased floaters and flashes of light, especially in the context of high myopia and previous retinal holes, necessitate prompt evaluation by an eye care professional. Monitoring and timely intervention are key to preserving your vision and managing the risks associated with acute posterior vitreous detachment.

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