Vitreous opacities

What are vitreous opacities?

Vitreous opacities are s clouding of the vitreous body of the eye, which is otherwise transparent. The hallmark symptom of vitreous opacity is known as “mouches volantes” or “floaters”. These so-called floaters appear as transparent to greyish spots visible in the field of vision and slowly follow eye movements.

The vitreous body is located between the lens and the retina in the main chamber of the eye. It is composed of 99% water, as it must allow light to pass through to the retina. Furthermore, it contains a supporting framework of collagen fibers and hyaluronic acid, which give the vitreous body and the eyeball its characteristic shape.

Vitreous opacities occur more frequently at an advanced age and therefore not considered a disease but rather a normal ageing process similar to wrinkles or grey hair. Nevertheless, floaters can be often bothersome, necessitating surgery.

What causes vitreous opacities?

The transparency of the vitreous body is only maintained by a very specific arrangement of collagen fibers, which is often altered or dissolved with age. A disorder of collagen fibers can lead to fibrous or patchy opacities.

Vitreous opacities also described as vitreous liquefaction, medically referred to as syneresis. This liquefaction is due to a progressive loss of the arrangement of collagen fibers and other structural changes of solid components. 

Not only structural changes occur with age, but the vitreous body also shrinks in size. This can lead to the detachment of the vitreous from the retina, a condition called posterior vitreous detachment. This condition may present with similar symptoms.

What are the risk factors for vitreous opacities?

Advanced age is the main risk factor for vitreous opacities. Additional risk factors can promote changes in the vitreous body.

Strong myopia (nearsightedness) can lead to an accelerated ageing process of the vitreous body. With this refractive error, affected individuals can no longer see distant objects clearly, requiring glasses for correction. The main cause of myopia is an excessively long eyeball, preventing distant objects from being properly focused on the retina. The elongated eyeball continuously stretches the vitreous body, promoting its degeneration.

Moreover. Previous interventions of the eye can promote changes to the vitreous body. Such interventions include cataract surgeries or injections into the eye. In rarer cases, inflammatory conditions of the eye such as uveitis or trauma can also be risk factors for vitreous opacities.

Symptoms of vitreous opacities 

Vitreous opacities usually present as floaters (mouches volantes). This phenomenon presents as streak- or dot-shaped shadows in the visual field.

These floaters are particularly noticeable against certain lighting conditions or when looking at a white wall. Even though many patients find them bothersome, it is not an eye disease and does not reduce visual acuity.

What are other causes of vitreous opacities?

Mouches Volantes, or floaters, are often used as a synonym for vitreous opacities, although they are strictly speaking a symptom that can have various causes. Vitreous opacities are simply the most common cause of floaters.

Another common cause of floaters is the detachment of the body from its underlying membrane of the retina. This also typically occurs as part of the natural ageing process and may progress gradually, with those affected not noticing any impairment. Moreover, posterior vitreous detachment may also cause floaters, which are more translucent.

If the vitreous body detaches too quickly, this can cause a retinal tear and lead to vitreous hemorrhage. This often manifests as dark, soot like spots moving across the visual field. Flashes of light are another characteristic symptom. As a tear carries the risk of retinal detachment, these warning signs must always be taken seriously and prompt immediate diagnostic evaluation.

Floaters diagnostics

Although in most cases floaters are a symptom of vitreous opacities, which have no pathological significance, patients should still undergo diagnostic evaluation. This way, causes requiring urgent treatment can be ruled out. 

First, the treating physician obtains a detailed medical history. Particularly important are the presence of possible risk factors and a detailed description of the symptoms. This is followed by a visual acuity test and a slit lamp examination. The latter is a specialized device that allows for precise examination of both the anterior and posterior segments of the eye. 

Depending on the examination findings, additional diagnostic tests may be required. Once the diagnostic evaluation is completed, the patient is informed about the various treatment options.

How are vitreous opacities treated?

A targeted treatment is usually not necessary as vitreous opacities have no pathological significance. However, it is important to take the patient’s complaint seriously and to provide thorough information about the examination findings. For most patients this is enough to relieve their concern about their symptoms.

There is only one single therapy that can cure vitreous opacities at present: vitreous removal (vitrectomy). However, this is a rather invasive procedure, which is associated with certain complications and risks. Therefore, indications for surgery should be made with great care and discussed in detail with the patient. Such indications include retinal involvement or a severe reduction in quality of life caused by floaters.

Laser vitreolysis is an alternative to surgery. This procedure can be performed on an outpatient basis and several sessions. A special laser is used during the attempts to destroy the fibers responsible for the patient’s floaters. However, this procedure is not suitable for all patients and treatment success is not guaranteed.

There is no medication capable of eliminating the opacities at present.  However, it is the subject of ongoing studies and research investigating whether vitamins and micronutrients may improve floaters. It remains to be seen whether patients will be offered another alternative to surgery in the future.

Can vitreous opacities disappear on their own?

The natural ageing process of the vitreous body cannot be stopped. However, it is possible to change the position of the fibers out of the way, so that they are no longer located in the visual field and do not cause floaters. This way, the degenerative processes of the vitreous continue but no longer cause symptoms so that those affected experience no reduction in quality of life.

Affected individuals are advised to ensure sufficient fluid intake as more fluid can enter the vitreous, allowing the opacities to sink more easily.

Improvement of vitreous opacities

As vitreous opacities are not, strictly speaking, a disease, one cannot speak of a cure. The opacities tend to reappear and increase with age, but they can also shift within the vitreous and disappear from the visual field.

Is early detection of vitreous opacities possible?

At present, there is no standardized examination for the early detection of vitreous opacities. As they are part of the natural ageing process, not every patient reports any symptoms, making early detection particularly difficult. Furthermore, it is widely debated whether it is even necessary, as the current treatment options are very limited.

Nevertheless, special emphasis should be placed on patient awareness. This involves patient education about the symptoms and helping them recognize possible warning signs of retinal involvement. If sudden and particularly dark opacities or flashes of light occur, it is advisable to consult an ophthalmologist as quickly as possible.

What physicians are specialists in vitreous opacities?

Contacts for specialists in ophthalmology for vitreous opacities. In cases of doubt, and especially in cases of sudden onset of floaters, shadows, or flashes of light, please contact an ophthalmologist immediately.

We help you find an expert for your condition. All listed physicians and clinics have been carefully selected for their outstanding expertise in vitreous opacities and are ready to receive your inquiry or treatment request.