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Vitreous degeneration

If you are someone who enjoys sports and has experienced vision issues such as nearsightedness due to sports activities, or if you frequently sleep in well-lit environments until you fall asleep, or if you are entering your forties, fifties, or sixties, you may be prone to a degenerative eye condition known as vitreous degeneration. In Thailand, statistics reveal that up to 14 million people are affected by this condition. But what exactly is vitreous degeneration? Let's begin our journey of understanding it.

If we take a cross-sectional view of the eye, we will see the cornea and the lens, which focus light onto the retina, like a camera lens and film. The inside of the eye is filled with a gel-like substance, which is often referred to as "jelly" in Thai. When we are born and young, this jelly is clear and smooth. However, as we age or due to certain risks, some parts of the jelly may become more liquid and shift around. Other parts may clump together and form spots, sediment, lines, and rings that can be seen. When vitreous degeneration first occurs, it may be noticed when looking at the sky or bright white materials, which may appear as black spots or lines floating along the field of vision. Patients may also see lights that resemble lightning flashes or camera flashes. These symptoms can be very bothersome, and it is important to seek treatment before the vitreous completely detaches from the retina, which can cause a tear and lead to retinal detachment.

The cause of vitreous deterioration has been studied, and it has been found that the majority of cases are related to aging. Approximately 50-60% of individuals aged 60-70 years experience macular degeneration. However, even younger individuals have the potential to develop this condition, especially those who have myopia (nearsightedness). In these cases, vitreous degeneration tends to progress more rapidly compared to others. Additionally, eye accidents where something gets into the eye can accelerate the deterioration process. The third factor is eye surgery, such as cataract surgery, which may also contribute to a faster deterioration of the vitreous. Lastly, individuals who frequently rub their eyes due to allergies are also at a higher risk of experiencing vitreous degeneration.

Individuals who are short-sighted have an increased risk of vitreous deterioration. This is because the curvature of the cornea and the length of the eyeball do not match during the development of the eyeball. In other words, the eyeball may appear longer than normal. As a result, the retina in short-sighted individuals tends to be slightly thinner compared to those with normal eyesight. This makes the vitreous more susceptible to deterioration and increases the chances of the retina tearing or peeling off more easily. It is recommended that individuals with short-sightedness of 400 or higher periodically have their retina checked and their iris dilated every 2-3 years, even if they do not experience any symptoms. This proactive approach can help identify any potential problems early on and take necessary preventive measures. In terms of general eye usage, activities such as watching TV, sleeping, or reading a book in the wrong lighting conditions (too close, too far, too long, too bright, or too dark) do not directly cause issues with the vitreous or retina. However, if these activities are not done properly, they can strain the eyes, leading to eye fatigue, difficulties in focusing, and dry eyes. It's important to note that macular degeneration is not primarily caused by these behaviors, but accidents or certain activities can increase the risk of eye injuries, especially sports involving small objects, sprinting, badminton, tennis, and squash.

Initially, people with vitreous degeneration will experience floaters, which are spots floating in the vision field. As the vitreous erodes the separation between itself and the wall of the retina, there will be a separation between the vitreous and the retina. At this moment, they may be separated after being together all along, but sometimes they won't be separated and will be pulled back instead. This is especially true at the optic nerve terminal, blood vessels, or the edge of the retina. When the retina is pulled, it does not cause pain, but the patient may see flashes of light, like lightning, which is not painful and will be more evident when the eyes are closed or in a dark room. It indicates that the retina has been pulled back. However, this won't happen all the time and will occur rhythmically, especially when it pulls back on some people who don't want to separate from each other. If the pull is too strong, it can tear the retina, which is dangerous because water from the retina will go into the tear, leading to retinal detachment that requires major surgery. Otherwise, vision will deteriorate. But if we detect the tear marks early and laser around them, the water will not be able to go through, and it will prevent retinal detachment. Many people do not notice themselves until they reach the stage of retinal detachment, which is more difficult to treat and may require surgery. If there are black spots floating around and flashes of light like lightning, it is advisable to come and get checked because it will be easier to maintain.

The treatment process for vitreous degeneration begins with an eye examination, during which the doctor will administer eye drops to dilate the iris. This is necessary because our pupils are naturally small and need to be dilated for a comprehensive examination. After the eye drops are instilled, vision may become blurry and unclear. It is recommended to have someone accompany you as driving may be inconvenient for the first 2-3 hours. Approximately 30 minutes after the administration of the dilating eye drops, the pupil will dilate sufficiently, allowing the doctor to thoroughly examine the retina for any tear problems. In most cases, no tears will be found, but around 5% of individuals with vitreous degeneration and new floaters may have a retinal tear.

If a retinal tear is identified, the recommended treatment is laser therapy. This procedure aims to prevent the retina from detaching and is successful in preventing detachment in 95% of cases. Medication is not typically prescribed for this condition. The key is to monitor the retina for any issues. If the retina is unaffected, the patient may continue to experience annoyance from floaters, but over time, they tend to become accustomed to them. While there are experimental drugs being developed to dissolve vitreous opacities, they are still in the early stages of research. In some countries, vitreous surgery is performed to remove the bothersome floaters, but when weighing the benefits against the risks, it is generally not recommended unless the retina is at risk of detachment. Therefore, if only floaters are observed, surgery is not typically recommended.

To prevent macular degeneration, it is advisable to wear protective glasses while performing activities that pose a risk to the eyes. A good lens option is polycarbonate, which is slightly adhesive. For activities such as hammering nails, deteriorating steel, or playing sports, athletes often wear protective glasses to prevent eye accidents. Additionally, when going outside, it is recommended to wear sunglasses as UV light can cause deterioration to occur more quickly on the surface of the cornea, pterygium, glaucoma, cataracts, and even the back of the eye. If someone notices a black spot floating around when looking at the sky or flashing light like lightning in a dark room, it is important to see an ophthalmologist for appropriate examination. Early detection and intervention can help prevent further escalation of the issue.

By Dr. Teeravee Hongyok, Ophthalmologist

Cataract Corneal and Vision Correction Surgery