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The vitreous is the clear gel that occupies about 80% of the inside of the eyeball. As we age, this jello-like substance liquefies, shrinks, and eventually separates from the optic nerve and the retina in the back of the eye. This is called posterior vitreous detachment (PVD) and occurs in most adults between 40 and 70 years of age without untoward consequences. A PVD may occur in younger individuals who have undergone cataract surgery or are very nearsighted.When a PVD occurs, floaters are usually noticed. Floaters are small specks that move in and out of your field of vision. They may be more noticeable when looking at a plain background, such as a white page, wall, or clear sky. Some people mistake floaters for flying bugs. Flashes of light in the periphery of the visual field, particularly in low ambient light, are also a common symptom of a PVD. These flashes are a result of the retina being tugged on by the separating vitreous.PVD is a common occurrence, which usually has no untoward consequences. However, if the retina is weak or the vitreous gel is abnormal, a retinal tear can occur, which in about 50 percent of cases eventually leads to a retinal detachment.

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Central Serous Chorioretinopathy affects the macula, the part of the retina responsible for central vision. This disorder is characterized by fluid leakage from the choroidal circulation underneath the retina. The leakage occurs due to a defect in the retinal pigment epithelium (RPE), a single layer of tissue normally separating the retina and the choroid, allowing fluid from the choroid to accumulate under the retina.Central serous chorioretinopathy can lead to a “serous detachment” or blister beneath the retina, which causes distorted or blurry vision, a blind or gray spot in central vision, and unexplained flashes of light. The exact cause of central serous chorioretinopathy is not known, but it is known to be associated with stress and steroid medications.It is currently believed that the choroidal circulation develops a pool of extracellular fluid or edema. This edema or leakage puts pressure on the RPE, causing it o blister up into focal or multifocal elevations known as serous detachments of the pigment epithelium. The blister develops an opening allowing fluid to leak under the retina. This leak is called “avascular” since it is not usually associated with the development of abnormal blood vessels (neovascularization), but this can occur as a secondary complication of central serous chorioretinopathy.One of the challenges of detecting central serous chorioretinopathy is differentiating between the two kinds of leakage. This is especially true in middle-aged and older people who are at greater risk of developing both central serous chorioretinopathy and age-related macular degeneration. The distinction is important, since the treatment differs for the two types.

Many people with macular degeneration experience minimal vision loss during the early stages of the disease. For most people, macular degeneration does not become vision impairing. During this stage, the transport of wastes and nutrients by the RPE has slowed down. As a result, waste builds up under the retina and forms yellowish deposits known as drusen.An ophthalmologist examining a patient at this stage may see drusen, although no symptoms may be present or develop later. If the doctor sees drusen, the patient will be monitored. In most cases, the disease will not progress to vision loss, although some patients do experience vision loss with drusen. Many patients over 60 have some drusen.

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The macula is the very small area in the back of the retina that is responsible for providing sharpness and clarity in our vision. This detailed vision is necessary for daily tasks such as reading, driving, and watching television. A jelly-like substance called the vitreous fills the central portion of the eye.It is composed of 99% water, some chemicals to create the gel, and long protein fibers. As we age the vitreous begins to shrink. The jelly starts to break down and the protein fibers start to aggregate. In most people the vitreous eventually separates from the retina in a process called posterior vitreous detachment.In some people the vitreous may remain adherent to the central portion of the macula and pulling by the vitreous can cause bad things to happen to the macula. Chronic pulling, or traction, on the macula can cause the macula to become distorted or stretched. In some people the force of the traction exceeds the mechanical strength of the macula and a hole can form.Macular holes are typically very small – smaller in diameter than a pin. However the macula is very important for sharp vision and even a very small hole can cause important visual problems. The vision is generally decreased and distorted.The curious aspect of macular holes is that they don’t heal themselves. If someone had their ears pierced, but didn’t wear an earring the hole would close. Only the smallest macular holes can close without surgery and even then the chance is low. The retina is really a type of brain tissue, and brain tissue doesn’t heal well. The steps naturally taken by the body to heal a macular hole can make it get larger over time.

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