Initial stages of posterior vitreous detachment in healthy eyes of older persons evaluated by optical coherence tomography

Arch Ophthalmol. 2001 Oct;119(10):1475-9. doi: 10.1001/archopht.119.10.1475.


Objective: To promote understanding of the development of posterior vitreous detachment (PVD) in healthy eyes using optical coherence tomography (OCT).

Methods: We studied 209 eyes of 209 healthy volunteers (165 men and 44 women; mean age, 52.3 years [range, 31-74 years]). In addition to biomicroscopy and ophthalmoscopy, OCT was performed to obtain high-resolution cross-sectional images of the vitreoretinal interface in the posterior fundus.

Results: The condition of the posterior vitreoretinal interface was classified as 1 of 5 stages, according to biomicroscopic findings and OCT images relative to discrete linear signals indicating a detached posterior vitreous face: stage 0, no PVD (61 eyes [29.2%]); stage 1, incomplete perifoveal PVD in up to 3 quadrants (100 eyes [47.8%]); stage 2, incomplete perifoveal PVD in all quadrants, with residual attachment to the fovea and optic disc (26 eyes [12.4%]); stage 3, incomplete PVD over the posterior pole, with residual attachment to the optic disc (4 eyes [1.9%]); or stage 4, complete PVD identified with biomicroscopy, but not with OCT because of instrument limitations (18 eyes [8.6%]). Stage 1, 2, and 3 incomplete PVD without subjective symptoms was not recognizable on contact lens biomicroscopy. There was a significant age-related progression in the condition of the vitreoretinal interface from stage 0 to stage 4. The superior quadrant was usually the initial site of incomplete PVD.

Conclusions: Optical coherence tomography demonstrates that healthy human eyes have incomplete or partial PVD beginning as early as the fourth decade of life. Age-related PVD occurs initially as a focal detachment in the perifovea of 1 quadrant, with persistent attachment to the fovea and optic nerve head, with a predilection for the superior quadrant. It extends its range slowly for years and eventually results in complete PVD, associated with release of vitreopapillary adhesion.

MeSH terms

  • Adult
  • Aged
  • Diagnostic Techniques, Ophthalmological*
  • Female
  • Humans
  • Interferometry
  • Light
  • Male
  • Middle Aged
  • Ophthalmoscopy
  • Prospective Studies
  • Tomography / methods
  • Vitreous Body / pathology*
  • Vitreous Detachment / classification
  • Vitreous Detachment / diagnosis*