Posterior Vitreous Detachment: Current Concepts and Management

Alan Ang, FRCO; Arabella V. Poulson, FRCO; David R.J. Snead, FRCP; Martin P. Snead, Md, FRCO

In This Article

Epidemiology of Posterior Vitreous Detachment

Several studies have looked at the epidemiology of PVD. Foos found that PVD was present in 23.2% of autopsy cases.[15] In a more elderly population of patients (average age was 83.4 years), Snead et al found a higher prevalence of PVD at 57%.[6]

Two factors have been found to be important in determining the onset of PVD in a healthy subject: age and refractive error. Studies have demonstrated a clear increasing prevalence of PVD with age.[16,17,18] Posterior vitreous detachment was rare in emmetropic subjects under the age of 40 years, and the prevalence steadily increased through the decades. The reported prevalence in the 9th decade ranged from 57% to 86%.[16,17] Therefore, in a significant proportion of elderly subjects, the vitreous remains attached, indicating that PVD is not inevitable with aging and syneresis.

Subjects with high myopia (> 6 D) are more likely to develop PVD at an earlier age, and the prevalence of PVD in each age decade was found to be higher than in emmetropic counterparts.[16] The relationship between myopia and age of onset of PVD appears to be related—i.e., the higher the degree of myopia, the earlier the age of onset.[19]

The occurrence of PVD can also be influenced by ocular surgery and pathology. Previous cataract surgery has been found to increase the prevalence of PVD, although Nd:YAG capsulotomy does not increase its prevalence.[18,20] In patients with diabetic retinopathy, regardless of the severity of retinopathy, PVD appears to occur following panretinal photocoagulation.[21] Uveitis, retinal vascular disorders, and ocular trauma may all induce PVD, while anterior ischemic optic neuropathy (AION) is associated with reduced frequency of PVD.[18,22,23]

Other factors that may potentially affect the prevalence of PVD in the general population include sex, race, and even climatic changes.[18,24,25,26]