Posterior Vitreous Detachment (PVD)

The most common cause of flashes and floaters — a common, age-related phenomenon where the vitreous gel (attached to the retina from birth) separates from the retina with age.

• Typical onset age 40–60; myopia, trauma and recent ocular surgery can bring it on earlier
• ~75% of Australians develop a PVD before age 65
• If PVD occurs in one eye, the fellow eye often follows within the same year or 1–2 years later

Mechanism

As the vitreous separates from the retina it mechanically stimulates it — producing flashes. Vision remains normal and there is no relative afferent pupillary defect.

Risk of retinal tear/detachment

Most PVD is benign and self-limiting, but it carries a risk of causing a retinal tear or detachment:

• ~10–15% risk in uncomplicated PVD
• Up to 70% risk if there is associated vitreous haemorrhage (“haemorrhagic PVD”) — this specific combination substantially raises the probability of an underlying tear

Any new PVD symptoms therefore warrant ophthalmic assessment, particularly with high-risk features or in high-risk groups — see retinal-detachment.md for the full risk-factor table and the “4 Fs” (flashes, floaters, field defect, failing vision) red-flag framework.

Management

• No treatment is required for PVD itself
• Review at 6 weeks — 3.4% will be found to have a new retinal tear at that review
• A new shower of flashes or floaters with normal vision requires a prompt dilated fundus exam within 24–48 hours, not the routine 6-week review — same-day ophthalmic assessment is reserved for flashes or floaters accompanied by a field defect or sudden vision loss

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Source: https://www.racgp.org.au/afp/2014/april/flashes-and-floaters/