15 Dec Persistent Flashes After Posterior Vitreous Detachment (PVD)
Updated by Mike Rosco, MD 3/8/23 6:52PM PST
It is not uncommon for the symptoms of flashes to persist after a posterior vitreous detachment, or PVD. Flashes and floaters, common symptoms of a PVD, may also be warning signs of a possible retinal tear. Retinal tears oftencause a retinal detachment. Do persistent flashes mean increased risk for a tear or retinal detachment?
Ways to Stimulate the Retina
There are two ways to stimulate the retina. Light is the most common stimulus. Light enters the eye and falls onto the retina producing vision. The second way to stimulate this inner lining of the eye is by physical manipulation. Ever rub your eyes so hard you see patterns of light?
Another example of physical stimulation of the retina is a posterior vitreous detachment. As we age, the back (posterior) portion of the vitreous gel inside your eye separates from the retina. The anterior portion, however, remains adherent. Simply remember that the back part of the vitreous separates, but the front part never does (and that’s where the tears occur).
Flashes from a PVD
Part of the vitreous is now free floating in the eye and the other part is “tethered” to the anterior retina. (Think of a flag pole. Half the flag is flapping freely in the wind, while the other half is attached to the pole.) As the eye moves, part of the vitreous is free floating, while the other portion is attached to the retina. The part still attached gently tugs, causing the perception of flashes as the retina is stimulated. If the tugging is too hard, the vitreous that is still adherent can pull the retina with it and create a tear.
First 6 Weeks are the Scariest
The first six weeks following the initial symptoms of a PVD are the highest risk for developing a retinal tear. Statistically, this is the period when MOST retinal tears occur. There are exceptions.
It is during this period, as the vitreous separates from the retina, where the tugging forces change inside the eye. Usually if a tear is to occur, it happens within days to weeks. However, sometimes no tear is found yet the symptoms persist.
What Does This Mean? After the diagnosis of a posterior vitreous detachment is made, I recommend re-evaluation at 6 weeks after the initial symptoms began, or sooner if the symptoms worsen.
If the symptoms remain relatively the same, patients usually return at the 6-week mark. I look for any new tears at the follow-up exam. If none are found at the second exam and the symptoms have remained the same or decreased,I don’t ask for an additional exam.
Persistent flashes are worrisome. Are you at risk for a retinal tear? Studies vary, but generally speaking, if you experience these symptoms from a PVD, there is an 8-16% chance you will have a retinal tear.
Persistent flashes occur because the vitreous remains adherent to the retina. As we discussed, gentle tugging causes the flashes. If you had a retinal tear, the vitreous is still adherent to the tear, and it, too, is stimulated by the moving vitreous.
This vitreous pulling, or “vitreous traction,” is common and may last a long time, even if you do not have a retinal tear.
The recommendation of retinal specialists (and the AAO) is that you seek re-examination urgently if the flashes INCREASE as this may be a sign of a new tear.
Flashes that persist, but are not increased, are probably not an indication of a greater risk of tear. It is a sign that you’ve had a PVD.
Vitrectomy surgery can be performed to alleviate the symptoms, though generally speaking, these symptoms are temporary and will resolve in time.