Degenerative Vitreous Syndrome (DVS), describes:

“The spontaneous occurrence in the aging vitreous of opacities that substantially interfere with activities of daily living.”

Dr Robert Morris, President of The Helen Keller Foundation for Research and Education.

Prevalence

DVS is more prevalent in older populations; however it is also found amongst children, teenagers and young adults. It appears to affect women and men equally, but is more common in short-sighted people.

Eye floaters represent one of the most common presentations to hospital eye services. A 2002 survey of a proportion of the 9,349 practising UK optometrists suggested that an average of 14 people per month presented to an optometrist with symptoms of floaters. As there is no universal, objective measure of severity at the moment, it is unknown what proportion of these people have floaters that substantially interfere with activities of daily living.

Aetiology

Syneresis of vitreous is part of a normal aging process beginning to appear around the age of 50 years. However, vitreous imaging techniques suggest that as much as 20% of the vitreous will undergo liquefaction by the late teenage years.

There are certain factors that can accelerate this natural process in which it can occur at earlier age including myopia, in which the axial length of the eye is greater than normal, trauma, intraocular inflammation, degenerations and other pathological conditions. Hereditary vitreoretinopathies are potentially blinding inherited disorders characterized by an abnormal-appearing vitreous gel and associated retinal changes. Four of these disorders, Stickler’s syndrome, Wagner’s disease, erosive vitreoretinopathy, and Goldmann-Favre syndrome exhibit marked syneresis of the vitreous gel.

Vitreous syneresis is a common cause of posterior vitreous detachment (PVD) in which the degenerate vitreous gel separates from the retina. Posterior vitreous detachment is typically harmless but can cause more prominent floaters. PVD can occasionally lead to retinal tears and retinal detachment.

Effect on visual ability

In their 2011 paper, Wagle and associates presented information about the negative impact symptomatic degenerative vitreous floaters have on the quality of life of sufferers. In terms of an objective qualitative measure called Utility Value, people judged floaters as having a similar or higher impact than the eye diseases of AMD, retinopathy and glaucoma as well as the systemic diseases of mild angina, mild stroke, colon cancer, and asymptomatic HIV. Affected people were willing to take an 11% risk of death and a 7% risk of blindness for relief of symptoms related to floaters.

They also found that Utility values did not improve for patients who had had the condition for a long time.

Anxiety and depression

In addition to visual disability, DVS can adversely affect emotional wellbeing. Anecdotal evidence suggests that 20% of people presenting for surgical treatment of severe eye floaters are using anti-depressant medication. There is some suggestion that Cognitive Behavioural Therapy may help to alleviate the symptoms of anxiety and depression in eye floater patients, but as yet there is insufficient evidence to draw strong conclusions.

You can read patient accounts of their experiences with the condition and with the medical community.

Diagnosis

During a typical eye exam, the ophthalmologist will look for vitreous opacities using slit-lamp stereo fundus biomicrosopy. Identification of floaters may be aided by dynamic examination during eye movements. A B-scan ocular ultrasound examination can help diagnose vitreous syneresis and posterior vitreous detachment.

For the person with DVS it is useful to attempt to assess functional visual acuity over time and the continual visual disturbance that they experience. OCV is working with doctors to develop an objective measure of severity which we hope will aid in the assessment of risks and potential benefits of intervention. These measures may involve vitreous imaging or quality of life questionnaires.

Therapeutic intervention

Currently the only options for those seeking relief from persistently disabling vitreous floaters are disruption by Nd:YAG laser or surgical removal (vitrectomy). Laser treatment has been practised for over 20 years, but is offered by only a handful of doctors worldwide. Surgery is rarely recommended for DVS because of the associated risk of sight-threatening side effects. Many people with DVS report a hostile or dismissive response from parts of the ophthalmic community. Despite the difficulty, expense, risk and uncertain outcomes, a number of people do seek a surgical solution in preference to living with the problem.

Conservative management

Due to the risks associated with treatment, patients should, where possible and with appropriate support, be encouraged to manage their condition at least for a period of time. Some things that can help them to do this are listed below.

  • Enriching and darkening the visual environment is helpful in reducing the starkness of eye floaters For example, include large indoor plants, semi-opaque window blinds, large abstract pictures and change computer settings.
  • Glasses and lenses are helpful – straining to see causes increased visual gain and this increased sensitivity can make eye floaters more apparent. Correcting any associated sight loss reduces the perception of eye floaters. If in doubt, refer for an ophthalmological opinion. In our view, all people who describe eye floaters deserve a full visual assessment.
  • There is no direct role for drugs – although they can be used to treat associated symptoms such as eye strain, anxiety or depression. There is also no conventional or complementary medication that has been shown to have specific eye floater ameliorating qualities.
  • Support organisations and networks may help – please direct your patients to sight counsellors and to One Clear Vision.

References

  • Alwitry, A, H Chen, and S Wigfall. “Optometrists’ Examination and Referral Practices for Patients Presenting with Flashes and Floaters.” Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) 22 (2002): 183–8. Print.
  • Wagle, Ajeet M et al. “Utility Values Associated with Vitreous Floaters.” American journal of ophthalmology 152 (2011): 60–65.e1. Print.
  • Sebag, Jerry. “Floaters and the Quality of Life.” American journal of ophthalmology 152 (2011): 3–4.e1. Print.
  • Johnson, Mark W. “Posterior Vitreous Detachment: Evolution and Complications of Its Early Stages.” American journal of ophthalmology 149.3 (2010): 371–382.e1. Web. 2 Sept. 2012.
  • Kyung, Seong Eun, Moo Hwan Chang, and Jun Young Ji. “A Case of Erosive Vitreoretinopathy.” Korean journal of ophthalmology: KJO 16.1 (2002): 47–51. Print.
  • Balazs EA, Denlinger JL. Aging changes in the vitreous. In: Sekuler R, Kline D, Dismukes K, eds. Aging and Human Visual Function. New York: Liss; 1982:45–57.

This page has been reviewed by Mr James W B Bainbridge MA MB BChir PhD FRCOphth.